Medicina intensiva最新文献

英文中文

The role of point-of-care ultrasonography in central venous catheter insertion: A randomized controlled trial of safety and cost-effectiveness 即时超声检查在中心静脉置管中的作用：一项安全性和成本效益的随机对照试验。

Medicina intensiva

Pub Date : 2025-11-01 Epub Date: 2025-05-14 DOI: 10.1016/j.medine.2025.502221

Ahmed Beniamen , Ahmed Mosallem , Hossam Tharwat Ali , Hanaa A. Nofal , Essamedin M. Negm

Objective

The objective of the study was to compare landmark-based and ultrasound-guided techniques of central venous catheter insertion (CVC).

Design

Randomized controlled trial (2021–2023).

Setting

Zagazig University Hospitals (ZUH), a tertiary care center.

Patients

Adult patients in whom CVC insertion is indicated.

Main variables of interest

Demographic and clinical peri-procedural data, the safety of the technique, time of performance, and cost-effectiveness were compared.

Results

Patient ages ranged from 17 to 80 years with 56% being males. Urgent indications were found in around 22% without significant differences between groups. Regarding the time of performance, the ultrasound-guided method had slightly but significantly less time of performance (25.7 ± 4.3; range: 18−33) compared to the blind technique (26.9 ± 7.4; range: 15−45) (P-value < 0.001) with a higher but non-significant number of patients without complications (64% vs 52%; P-value = 0.2). Failure to insert the CVC into the IJV occurred in 12 patients (12%) with the blind technique and in eight patients (8%) with the ultrasound-guided technique (P-value = 0.04). Carotid artery puncture with neck hematoma occurred in only 8 (8%) patients with the blind technique (P-value = 0.04). Excess cost was consumed in only 36 patients (36%) in the blind technique group (P-value = 0.001).

Conclusion

Point-of-care ultrasonography bundle for CVC insertion is considered superior to, safer, and more cost-effective than the blind technique.

目的：本研究的目的是比较基于地标和超声引导的中心静脉置管技术（CVC）。设计：随机对照试验（2021-2023）。环境：扎加齐格大学医院（ZUH），三级护理中心。患者：指征CVC插入的成年患者。主要感兴趣的变量：人口统计学和临床围手术期数据，技术的安全性，执行时间和成本效益进行比较。结果：患者年龄从17岁到80岁不等，56%为男性。紧急适应症发生率约为22%，组间无显著差异。在表现时间方面，超声引导法的表现时间略短但显著(25.7 ± 4.3；范围：18-33)与盲法相比(26.9 ± 7.4；范围：15-45)(p值< 0.001)，无并发症的患者数量较高但不显著(64% vs 52%；假定值 = 0.2)。盲法和超声引导法分别有12例（12%）和8例（8%）CVC插入失败（p值 = 0.04）。采用盲法穿刺颈动脉导致颈部血肿的患者仅8例（8%）（p值 = 0.04）。在盲法组中，只有36例（36%）患者消耗了额外的费用（p值 = 0.001）。结论：超声束在CVC插入中的应用优于盲法，安全性好，性价比高。

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引用次数: 0

Quality of life in post-COVID-19 patients after discharge from a weaning and rehabilitation center: a retrospective cohort study covid -19后患者从断奶和康复中心出院后的生活质量：一项回顾性队列研究

Medicina intensiva

Pub Date : 2025-11-01 Epub Date: 2025-08-11 DOI: 10.1016/j.medine.2025.502257

Emilio Sebastián Rositi , Emiliano Navarro , Mirian Lorena Delvalle , Agustín García , Miguel Antonio Escobar , Javier Cromberg , Gastón Germán Morel Vulliez , Melina Calvo Delfino , Eduardo Luis De Vito

引用次数: 0

Electrical impedance tomography implementation in pleuropulmonary pathology in adult patients 电阻抗断层扫描在成人胸膜肺病理中的应用。

Medicina intensiva

Pub Date : 2025-11-01 Epub Date: 2025-09-19 DOI: 10.1016/j.medine.2025.502262

Gabriel Appendino, Celeste Gomez, Carlos Lovesio

引用次数: 0

Septic shock secondary to Capnocytophaga canimorsus bite acquired without celulitis 无蜂窝组织炎的狼噬细胞虫咬伤继发感染性休克。

Medicina intensiva

Pub Date : 2025-11-01 Epub Date: 2025-08-25 DOI: 10.1016/j.medine.2025.502233

Hugo Arrando Barbera , Ángel Orera Pérez , Juan Díaz Nohales

引用次数: 0

Thomas R. Martin, M.D. (1947–2025) 托马斯·马丁，医学博士（1947-2025）

Medicina intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medine.2025.502317

Raquel Herrero , Antonio Artigas , Gustavo Matute-Bello

引用次数: 0

Early mobilization during intensive care admission and perceived quality of life in the course of the COVID-19 pandemic - A prospective cohort study and propensity score matching. COVID-19大流行期间重症监护入院期间的早期动员和感知生活质量——一项前瞻性队列研究和倾向评分匹配

Medicina intensiva

Pub Date : 2025-10-27 DOI: 10.1016/j.medine.2025.502341

Beatriz Lobo Valbuena, Lourdes Manglano-Cerrato, Ana Rodríguez Alcaraz, Raúl Castañeda-Vozmediano, Rosario Molina Lobo, Alejandro Alcina, Pedro Benavides, Jesús Juárez, Federico Gordo

Objective: To analyze the effect of early physiotherapy (ePHYS) on patients' functional quality of life one year after discharge.

Design: Prospective observational study.

Settings: Adult polyvalent ICU.

Patients or participants: Patients with SARS-CoV2 pneumonia requiring invasive mechanical ventilation between March 2020 and July 2022.

Intervention: Early physiotherapy.

Main variables of interest: Quality of life measured by CFS, Barthel and SF36 on ICU admission, at hospital discharge and one year after hospital discharge.

Results: Ninety-nine patients included. In the raw data analysis we observed statistically significant differences in SAPS-3 (Mdn_No-ePHYS = 59 [53.5-64.5]; Mdn_Yes-ePHYS = 53 [47-58]; P = .001). After propensity score, we did not observe statistically significant differences except for two SF-36 items: social activities (Mdn_No-ePHYS = 56.2 [37.5-71.9]; Mdn_Yes-ePHYS = 75 [62.5-97.5]; P = .004; Wilcoxon r effect size = 0.5) and one-year health transition (Mdn_No-ePHYS = 50 [50-75]; Mdn_Yes-ePHYS = 75 [50-100]; P = .031; Wilcoxon r effect size = 0.29), where patients who belonged to NO-ePHYS had lower scores than those who did receive ePHYS.

Conclusions: Despite not having found statistically significant differences in most of the items assessed, we should highlight that patients who received ePHYS reported a clear positive influence on their lives.

目的：分析早期物理治疗（ePHYS）对患者出院后1年功能生活质量的影响。设计：前瞻性观察研究。设置：成人多价ICU。患者或参与者：2020年3月至2022年7月期间需要有创机械通气的SARS-CoV2肺炎患者。干预：早期物理治疗。主要感兴趣的变量：ICU入院时、出院时和出院后1年，通过CFS、Barthel和SF36测量生活质量。结果：纳入99例患者。在原始数据分析中，我们观察到sap -3差异有统计学意义（MdnNo-ePHYS = 59 [53.5-64.5];mdnys - ephys = 53 [47-58];P = .001）。倾向得分后,我们没有观察到显著差异除了两个SF-36项目:社会活动(MdnNo-ePHYS = 56.2 (37.5 - -71.9);MdnYes-ePHYS = 75 [62.5 - -97.5];P = 04;Wilcoxon r效应大小 = 0.5)和一年健康过渡(MdnNo-ePHYS = 五十(50 - 75);MdnYes-ePHYS = 75 (50 - 100);P = .031;Wilcoxon r效应大小 = 0.29),在患者属于NO-ePHYS比那些接受ePHYS分数也很低。结论：尽管在大多数评估项目中没有发现统计学上的显著差异，但我们应该强调，接受ePHYS的患者报告了对他们生活的明显积极影响。

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引用次数: 0

Operative mortality predictors in patients with acute type A aortic dissection. 急性A型主动脉夹层患者手术死亡率的预测因素。

Medicina intensiva

Pub Date : 2025-10-24 DOI: 10.1016/j.medine.2025.502342

Bárbara Segura-Méndez, Rocío Bernal, Irene Velasco, Yolanda Carrascal

Objective: To develop a model capable of predicting risk factors for operative in-hospital mortality in patients diagnosed with acute type A aortic dissection, that includes inflammatory biomarkers and imaging variables of the ascending aorta in the acute phase.

Design: Unicentric retrospective analysis.

Setting: Cardiac surgery unit.

Patients: Adult patients undergoing cardiac surgery after acute type A aortic dissection, during a 11-year period.

Main variables of interest: Pre- and intraoperative risk factors for mortality, inflammatory markers and ascending aortic diameter, at the time of diagnosis.

Results: 120 patients were analysed. The presence of preoperative visceral ischemia (OR) 7.48, 95% confidence interval (CI) (1.98-28.18); (p: 0.003); redo cardiac surgery (OR: 10.07, 95% CI (1.62-62.27); (p: 0.013); preoperative dual antiplatelet therapy (OR: 7.21, 95% CI (1.45-35.69); (p: 0.015) and the neutrophil/lymphocyte ratio (OR: 1.11; 95% CI (1.03-1.20); (p: 0.006) were independent predictors for operative mortality in the analysed sample. These risk factors were included in a model to predict operative mortality, which also included ascending aortic diameter, with an area under the ROC curve of 0,793 ± 0,052; IC 95% (0,691-0,895); (P < 0,0001).

Conclusions: The inclusion of variables that quantify inflammatory activity, as well as imaging variables at the time of diagnosis of acute type A aortic dissection, may contribute to a more accurate estimate of surgical risk.

目的：建立一个能够预测急性a型主动脉夹层患者手术住院死亡危险因素的模型，包括急性期升主动脉的炎症生物标志物和影像学变量。设计：单中心回顾性分析。单位：心脏外科病房。患者：11年内急性A型主动脉夹层后接受心脏手术的成年患者。主要感兴趣的变量：在诊断时，术前和术中死亡率的危险因素，炎症标志物和升主动脉直径。结果：对120例患者进行了分析。术前存在内脏缺血（OR） 7.48, 95%可信区间（CI）（1.98-28.18）；(p: 0.003);重做心脏手术(OR: 10.07, 95% CI (1.62-62.27)；(p: 0.013);术前双重抗血小板治疗(OR: 7.21, 95% CI (1.45-35.69)；（p: 0.015）和中性粒细胞/淋巴细胞比值(OR: 1.11; 95% CI (1.03-1.20)；（p: 0.006）是分析样本中手术死亡率的独立预测因子。这些危险因素被纳入预测手术死亡率的模型，其中还包括升主动脉直径，ROC曲线下面积为0.793±0.052；IC 95% (0,691-0,895)；结论：纳入量化炎症活动的变量，以及诊断急性A型主动脉夹层时的影像学变量，可能有助于更准确地估计手术风险。

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引用次数: 0

Hypernatremia and renal dysfunction after sevoflurane sedation in the intensive care unit: Three case reports 重症监护病房七氟醚镇静后的高钠血症和肾功能障碍：3例报告。

Medicina intensiva

Pub Date : 2025-10-01 Epub Date: 2025-05-16 DOI: 10.1016/j.medine.2025.502215

Marta Bauça Socias , Dolly Andrea Caicedo , Eva Benveniste-Pérez , Georgina de la Rosa Loppacher , Eva Montané

引用次数: 0

Update of the taxonomy of mechanical ventilation modes 机械通气方式分类的更新。

Medicina intensiva

Pub Date : 2025-10-01 Epub Date: 2025-06-06 DOI: 10.1016/j.medine.2025.502211

Aurio Fajardo-Campoverdi , Eduardo Mireles-Cabodevila , Alberto Medina , Miguel Ibarra-Estrada , José Baltazar-Torres , Robert Chatburn

The rapid technological development of mechanical ventilation has resulted in increasingly complex modes, advanced monitoring capabilities and the incorporation of artificial intelligence. However, manufacturers have created a multitude of trade names, which has generated a great deal of confusion in their understanding, handling and application. This problem is exacerbated in Spanish-speaking countries due to inconsistencies in translations and variability in nomenclature between regions. This manuscript aims to provide an updated review of the taxonomic classification of ventilatory modes in order to promote standardization of terminology, especially in the Spanish-speaking clinical context, and includes changes in the taxonomy and manner of labeling modes of mechanical ventilation. This review focuses on invasive mechanical ventilation of the adult critically ill patient, although the taxonomy is also applicable to all ventilation modalities, including noninvasive, high-frequency, pediatric, and even home ventilation.

机械通气技术的快速发展使其模式日益复杂，监测能力日益先进，人工智能技术的应用也越来越广泛。然而，制造商创造了大量的商品名称，这在他们的理解、处理和应用中产生了很大的混乱。这一问题在西班牙语国家由于翻译的不一致和地区之间命名的变化而加剧。该手稿旨在提供通气模式分类分类的最新综述，以促进术语的标准化，特别是在西班牙语临床环境中，并包括机械通气的分类和标签模式的变化。尽管该分类也适用于所有的通气方式，包括无创、高频、儿科甚至家庭通气，但本文的综述主要集中在成人危重患者的有创机械通气上。

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引用次数: 0

Utility of airway occlusion pressure in traumatic diaphragmatic rupture 气道闭塞压在外伤性膈破裂中的应用。

Medicina intensiva

Pub Date : 2025-10-01 Epub Date: 2025-05-07 DOI: 10.1016/j.medine.2025.502214

Noemi Merino Pizarro , Manuel Valdivia Marchal , Carmen Bermudez Ruiz , Juan Francisco Martinez Carmona , Ashlen Rodriguez Carmona , Jose Manuel Serrano Simon

引用次数: 0

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