Medicina Intensiva最新文献

英文中文

¿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

Intravenous beta-blockers versus amiodarone on in-hospital mortality and safety profile in adult septic patients 静脉注射受体阻滞剂与胺碘酮对成人脓毒症患者住院死亡率和安全性的影响

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502143

Guoge Huang , Haizhong Li , Feier Song , Chunmei Zhang , Mengling Jian , Chunyang Huang , Yingqin Zhang , Bei Hu , Wenqiang Jiang

Objective

In the present study, we aimed to compare in-hospital mortality and safety of intravenous beta-blockers and amiodarone in septic patients with new-onset atrial fibrillation (NOAF). The null hypothesis is that there is no significant difference in in-hospital mortality and safety of Beta-blocker (BBs) and amiodarone in treating NOAF in patients with sepsis.

Design

We conducted a retrospective analysis based on the MIMIC-IV database. Septic patients with NOAF were screened.

Setting

Patients admitted to adult mixed ICU for septic patients with NOAF.

Patients

A total of 34,789 patients were screened of whom 1394 patients were included for the analysis: 286 in the amiodarone group and 1108 in the BBs group.

Interventions

None.

Main variables of interest

Cox proportional hazard model was used to examine the in-hospital mortality, ventilator-free days and duration of atrial fibrillation in patients receiving either amiodarone or intravenous BBs. Propensity score matching was applied to determine any association.

Results

After Propensity Score (PS) matching, a total of 244 patients were included in both the BB and amiodarone groups. In this cohort, BBs was significantly associated with lower in-hospital mortality [adjusted hazard ratio (HR) of 0.70 (95% CI 0,54–0,91; P = 0.008)]. On the other hand, patients who received amiodarone had a shorter duration of atrial fibrillation (54.17 h vs 72.81 h; P = 0.003). There was no significant difference in ventilator-free days between the BB group and the amiodarone group.

Conclusion

In septic patients with NOAF, patients receiving BBs had lower in-hospital mortality than those who received amiodarone. On the other hand, amiodarone group had a shorter duration of atrial fibrillation. There was no significant difference in ventilator-free days between the BB group and the amiodarone group.

目的比较乙型受体阻滞剂和胺碘酮在脓毒症合并新发心房颤动（NOAF）患者中的住院死亡率和安全性。原假设：β受体阻滞剂（BBs）与胺碘酮治疗脓毒症患者NOAF的住院死亡率和安全性无显著差异。我们基于MIMIC-IV数据库进行回顾性分析。对脓毒性NOAF患者进行筛查。背景：脓毒症合并NOAF患者入住成人混合ICU。患者共筛选34,789例患者，其中1394例纳入分析：胺碘酮组286例，BBs组1108例。干预措施：主要感兴趣的变量采用cox比例风险模型检查接受胺碘酮或静脉注射BBs的患者的住院死亡率、无呼吸机天数和房颤持续时间。使用倾向评分匹配来确定任何关联。结果倾向评分（PS）匹配后，BB组和胺碘酮组共纳入244例患者。在这个队列中，BBs与较低的住院死亡率显著相关[校正危险比（HR）为0.70](95% CI 0,54 - 0,91； = 0.008页)]。另一方面，接受胺碘酮治疗的患者房颤持续时间较短(54.17 h vs 72.81 h； = 0.003页)。BB组与胺碘酮组无呼吸机天数差异无统计学意义。结论在脓毒症NOAF患者中，服用BBs的患者住院死亡率低于服用胺碘酮的患者。胺碘酮组房颤持续时间较短。BB组与胺碘酮组无呼吸机天数差异无统计学意义。

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引用次数: 0

What should intensivists know about immune checkpoint inhibitors and their side effects? 关于免疫检查点抑制剂及其副作用，强化医师应该知道些什么？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2024.502135

Viktor Yordanov Zlatkov Aleksandrov, Fernando Martínez Sagasti, Juncal Pérez-Somarriba Moreno, Helena Huertas Mondéjar

The pharmacological group of immune checkpoint-inhibitors (ICI) has revolutionized the field of oncology in the last ten years. The improvements in the survival of certain cancers thanks to these treatments comes at the cost of an increased morbidity and mortality due to certain immune related adverse events (irAE). This review will concentrate on the irAE that more frequently require intensive care unit (ICU) admission. The infectious burden of patients treated with ICI is also explored, shining light not only on the infections caused by the immunosuppression needed to manage the different irAE, but also on the specific infections arising from a unique immune dysregulation only seen in ICI treated patients.

在过去的十年中，免疫检查点抑制剂（ICI）的药理学组已经彻底改变了肿瘤学领域。由于这些治疗，某些癌症的生存率有所提高，但代价是某些免疫相关不良事件（irAE）导致的发病率和死亡率增加。本综述将集中在更频繁需要重症监护病房（ICU）入院的irAE。研究还探讨了ICI治疗患者的感染负担，不仅揭示了由控制不同irAE所需的免疫抑制引起的感染，还揭示了仅在ICI治疗患者中可见的独特免疫失调引起的特定感染。

引用次数: 0

Seguridad y eficacia de betabloqueantes y amiodarona en el manejo de la fibrilación auricular de nueva aparición en el paciente crítico con sepsis β受体阻滞剂和amiodarone在治疗严重败血症患者耳部新发纤颤方面的安全性和有效性

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502159

Alfonso Canabal Berlanga

引用次数: 0

Niveles óptimos de hemoglobina en el paciente neurocrítico: ¿hemos llegado ya? 神经危急患者的最佳血红蛋白水平：我们已经达到了吗？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502162

Manuel Quintana-Diaz , Daniel Agustin Godoy

引用次数: 0

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