Medicina Intensiva最新文献

英文中文

Exploring volatile anesthetics in critical care: Facts and uncertainties 探索挥发性麻醉药在重症监护：事实和不确定性

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502174

José Manuel Añón , María Paz Escuela , Javier Oliva-Navarro , Arís Pérez-Lucendo , Fernando Suarez-Sipmann

引用次数: 0

Afectación multisistémica por infección comunitaria grave por Streptococcus pyogenes 严重社区化脓性链球菌感染引起的多系统疾病

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502206

Ángel Orera Pérez, Mónica Gordón Sauquillo, Paula Ramírez Galleymore

引用次数: 0

Experience with ECMO therapy for acute respiratory distress syndrome treatment throughout the COVID-19 pandemic 在COVID-19大流行期间ECMO治疗急性呼吸窘迫综合征的经验

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502207

José María Arribas-Leal , José Miguel Rivera-Caravaca , Claudia Vicente-Andreu , Alicia Verdú-Verdú , Ángel Sornichero , Daniel Pérez-Martínez , Juan Blanco-Morillo , Francisco Gutiérrez , Marina Simón-Páez , Rubén Jara , Sergio J. Canovas-Lopez , Carlos Albacete-Moreno

Objective

To analyze our experience with extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS) treatment during the COVID-19 pandemic.

Design

Retrospective, observational, single center study.

Setting

Third-level hospital in Spain.

Patients

Adult patients with COVID-19 ARDS treated with an ECMO system in our center between March 2020 and March 2023.

Interventions

Retrospective collection of variables during hospital admission and follow-up.

Main Variables of Interest

Demographic variables, clinical history, variables related to ECMO therapy, COVID-19 wave number, in-hospital mortality, adverse events, ICU and hospital length of stay, and functional status at follow-up were collected.

Results

Eighty-one patients were included. Of these, 61 patients (75%) died during hospitalization. Patients who died were older and had more comorbidities. During the second, third, and sixth waves, mortality was higher. In the multivariate analysis, the only independent predictor of mortality was age (OR 1.24 95% CI (1.027–1.5, P = 0.025). After discharge, 40% of patients had difficulties returning to normal life due to respiratory failure requiring oxygen and arthropathies.

Conclusion

In-hospital mortality increased during the pandemic. Older age was the only independent predictor of mortality. After discharge, no deaths were recorded during the first 18 months of follow-up, although 40% of surviving patients had respiratory and motor sequelae making it difficult for them to return to a normal life.

目的分析2019冠状病毒病疫情期间体外膜氧合（ECMO）治疗急性呼吸窘迫综合征（ARDS）的经验。设计回顾性、观察性、单中心研究。西班牙三级医院。2020年3月至2023年3月期间，我们中心接受ECMO系统治疗的成年COVID-19 ARDS患者。干预措施：回顾性收集住院和随访期间的变量。收集人口学变量、临床病史、ECMO治疗相关变量、COVID-19波数、住院死亡率、不良事件、ICU和住院时间、随访时功能状态。结果共纳入81例患者。其中，61例（75%）患者在住院期间死亡。死亡的患者年龄较大，有更多的合并症。在第二次、第三次和第六次浪潮中，死亡率更高。在多变量分析中，死亡率的唯一独立预测因子是年龄(OR 1.24, 95% CI （1.027-1.5, P = 0.025）。出院后，40%的患者由于呼吸衰竭需要氧气和关节病变而难以恢复正常生活。结论流感大流行期间住院死亡率上升。年龄较大是死亡率的唯一独立预测因子。出院后，在前18个月的随访中没有死亡记录，尽管40%的存活患者有呼吸和运动后遗症，使他们难以恢复正常生活。

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引用次数: 0

Desarrollo y validación de modelos predictivos de mortalidad en pacientes oncológicos críticos en la UCI: una necesidad urgente 开发和验证重症监护患者癌症死亡率预测模型：迫切需要

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502163

Elena Cuenca Fito , Inés Gómez-Acebo , Alejandro González Castro

引用次数: 0

¿Cambiaron durante la pandemia los procedimientos de intubación de pacientes críticos sin infección por SARS-CoV-2? Análisis secundario del estudio multicéntrico INTUPROS 在大流行期间，未感染SARS-CoV-2的危重病人的插管程序是否发生了变化？INTUPROS多中心研究的二次分析

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2024.502122

José Luis García-Garmendia , Josep Trenado-Álvarez , Federico Gordo-Vidal , Elena Gordillo-Escobar , Esther Martínez-Barrios , Fernando Onieva-Calero , Víctor Sagredo-Meneses , Emilio Rodríguez-Ruiz , Rafael Ángel Bohollo-de-Austria , José Moreno-Quintana , María Isabel Ruiz-García , José Garnacho-Montero

Objective

To determine the changes in intubation procedures of critically ill patients without SARS-CoV-2 infection induced during the COVID-19 pandemic.

Design

Secondary analysis of the INTUPROS prospective multicenter observational study on intubation in intensive care units (ICUs).

Setting

A numbre of 43 Spanish ICUs between April 2019 and October 2020.

Patients

A total of 1,515 non-COVID-19 patients intubated before and during the pandemic.

Interventions

None. Main variables of interest: Intubation procedures and medication, first-pass success rate, complications, and mortality.

Results

A total of 1,199 patients intubated before the pandemic and 316 during the pandemic were analyzed. During the pandemic, there were fewer days until intubation (OR 0.95; 95% CI: 0.92-0.98), reduced resuscitation bag (OR 0.43; 95% CI: 0.29-0.63) and non-invasive ventilation oxygenation (OR 0.51; 95% CI: 0.34-0.76), reduced use of capnography (OR 0.55; 95% CI: 0.33-0.92) and fentanyl (OR 0.47; 95% CI: 0.34-0.63). On the other hand, there was an increase in oxygenation with non-HFNC devices (OR 2.21; 95% CI: 1.23-3.96), in use of videolaryngoscopy on the first-pass (OR 2.74; 95% CI: 1.76-4.24), and greater use of midazolam (OR 1.95; 95% CI: 1.39-2.72), etomidate (OR 1.78; 95% CI: 1.28-2.47) and succinylcholine (OR 2.55; 95% CI: 1.82-3.58). The first-pass success was higher (68.5% vs. 74.7%; P = 0.033). There were no pre-post differences in major complications (34.7% vs. 34.8%; P = 0.970) and in-hospital mortality (42.7% vs. 38.6%; P = 0.137).

Conclusions

The COVID-19 pandemic modified intubation procedures in non-COVID-19 patients, changing the oxygenation strategy, the medication and the use of videolaryngoscopy, with no impact on complications or mortality.

目的了解新冠肺炎大流行期间非SARS-CoV-2感染危重患者插管程序的变化。设计：对INTUPROS关于重症监护病房（icu）插管的前瞻性多中心观察性研究进行二次分析。在2019年4月至2020年10月期间，西班牙将设立43个icu。患者在大流行之前和期间，共有1515名非covid -19患者插管。感兴趣的主要变量：插管程序和药物，首次通过成功率，并发症和死亡率。结果分析大流行前插管患者1199例，大流行期间插管患者316例。在大流行期间，距插管的天数更少(OR 0.95；95% CI: 0.92-0.98)，复位复苏袋(OR 0.43；95% CI: 0.29-0.63)和无创通气氧合(OR 0.51；95% CI: 0.34-0.76)，减少使用血管造影(OR 0.55；95% CI: 0.33-0.92)和芬太尼(OR 0.47；95% ci: 0.34-0.63)。另一方面，非hfnc设备的氧合增加(OR 2.21；95% CI: 1.23-3.96)，第一次使用视频喉镜检查(OR 2.74；95% CI: 1.76-4.24)，更多地使用咪达唑仑(OR 1.95；95% CI: 1.39-2.72)，依托咪酯(OR 1.78；95% CI: 1.28-2.47)和琥珀胆碱(OR 2.55；95% ci: 1.82-3.58)。第一次通过率更高(68.5% vs. 74.7%；p = 0.033)。术后主要并发症发生率无差异(34.7% vs 34.8%；P = 0.970)和住院死亡率(42.7% vs. 38.6%；p = 0.137)。结论COVID-19大流行改变了非COVID-19患者的插管程序，改变了氧合策略、药物和视频喉镜检查的使用，对并发症和死亡率没有影响。

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引用次数: 0

Pneumomediastinum radiologic signs: Naclerio's V and continuous diaphragm sign 纵膈气征：Naclerio's V和连续膈征

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502171

Christopher Barrera-Hoffmann , Yadira Mariaca-Ortíz , Enrique Monares-Zepeda

引用次数: 0

Complicación del shock cardiogénico y uso de la ecografía 心源性休克并发症和使用超声波

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502150

Julia Macías Clemente , Nora Palomo López , Gerardo Ferrigno Bonilla

引用次数: 0

Effect of respiratory physiotherapy in a patient with complete atelectasis of the left lung 呼吸物理疗法治疗左肺完全不张1例疗效观察

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502204

Ramón Pérez-Gil , Gonzalo Ballesteros-Reviriego

引用次数: 0

¿Mejora el surfactante precoz la evolución en el recién nacido pretérmino tardío? Estudio retrospectivo en una unidad de cuidados intensivos neonatal 早期表面活性剂能改善早产儿的发育吗？新生儿重症监护病房的回顾性研究

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502161

Jorge Bartual Bardisa, Carolina Vizcaíno Díaz, María Jesús Ferrández Berenguer

Objective

To compare the early administration of surfactant, before 12 hours of life, versus late, in late preterm neonates (born between 34 + 0 and 36 + 6 weeks of gestation), with moderate-severe respiratory distress.

Design

Retrospective, observational, analytical, case-control study, with late preterm infants admitted between 2012-2021. It is divided into 2 groups: surfactant administered ≤ 12 hours of life and >12 h and evolution is compared using univariate analysis.

Setting

Neonatal Intensive Care Unit (NICU) level III of a Universitary Hospital.

Patients or participants

57 patients, 30 in the early group and 27 in the late group. Inclusion criteria: neonates from 34 + 0 to 36 + 6 weeks of gestation, with respiratory distress syndrome, in need of non-invasive ventilation and surfactant.

Interventions

None.

Main variables of interest

Sociodemographic, clinical and evolutionary: redosing, duration of respiratory support, oxygen and time to stop requiring it after surfactant. Also, complications and length of hospitalization.

Results

In the early group there was less need for redosing (3.3% vs 48.1%, P<.001) and a decrease in duration, in days, of stay in the NICU (7 vs 10.5, P .002), invasive mechanical ventilation (2.4 vs 3.9, p0.034), total respiratory support (4.6 vs 6.6, P0.005) and oxygen therapy (0.4 vs 2.8, P<.001). Also, lower incidence of pneumothorax (0% vs 33.3%, P .001). Furthermore, 12 hours after administration, 83.4% maintained FiO₂ 0.21, compared to 44.4% in the late administration.

Conclusions

In our study, early administration in late preterm infants provides benefits in terms of respiratory assistance and complications. We suggest expanding studies to establish recommendations in this group of patients.

目的比较中重度呼吸窘迫晚期早产儿（妊娠34 + 0 ~ 36 + 6周）12小时前早期给药与晚期给药的效果。设计回顾性、观察性、分析性、病例对照研究，纳入2012-2021年间入院的晚期早产儿。将其分为两组：给予表面活性剂≤12 h和≤12 h，并采用单变量分析比较其演变。某大学医院新生儿重症监护病房（NICU）三级。患者或参与者：57例患者，早期组30例，晚期组27例。纳入标准：妊娠34 + 0 ~ 36 + 6周，伴有呼吸窘迫综合征，需要无创通气和表面活性剂的新生儿。干预措施1 .主要感兴趣的变量：社会人口学、临床和进化：再给药、呼吸支持持续时间、氧气和表面活性剂后停止需要的时间。还有并发症和住院时间。结果早期组患儿需要重新给药的次数较少（3.3% vs 48.1%, P < 0.001），在NICU的住院天数（7 vs 10.5, P < 0.001）、有创机械通气（2.4 vs 3.9, P < 0.034）、全呼吸支持（4.6 vs 6.6, P < 0.005）和氧治疗（0.4 vs 2.8, P < 0.001）均有所减少。此外，气胸发生率较低（0% vs 33.3%, P .001）。给药12 h后，83.4%的患者FiO2维持在0.21，而给药后期为44.4%。结论在我们的研究中，早期给药对晚期早产儿的呼吸辅助和并发症有好处。我们建议扩大研究，在这组患者中建立推荐。

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引用次数: 0

The endothelium or mitochondrial level therapy: new frontiers in sepsis? 内皮或线粒体水平治疗：败血症的新领域？

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2024.502130

Rashmi Datta , Shalendra Singh

The host and microbes play complex roles in balancing the pro- and anti-inflammatory pathways that cause sepsis. It is now increasingly recognized as a disorder of the mitochondrial system intrinsically or as a consequence of microcirculatory abnormalities leading to hypoperfusion/hypoxia ("microcirculatory and mitochondrial distress syndrome”). It is expected that improvements in endothelium or mitochondrial level therapy will lower sepsis-related morbidity and mortality. This article aimed to clarify the mitochondrial and microcirculation abnormalities in patients with sepsis and the futuristic research agenda for the management of sepsis.

宿主和微生物在平衡导致败血症的促炎和抗炎途径方面发挥着复杂的作用。现在越来越多的人认为它是线粒体系统的一种疾病，或者是微循环异常导致低灌注/缺氧的结果（“微循环和线粒体窘迫综合征”）。预计内皮或线粒体水平治疗的改善将降低败血症相关的发病率和死亡率。本文旨在阐明脓毒症患者的线粒体和微循环异常以及脓毒症治疗的未来研究议程。

引用次数: 0

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