Medicina intensiva最新文献

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Solid consequences of enteral nutrition: Facing the therapeutic challenge of esophageal bezoars - A case report. 肠内营养的坚实后果：面对食道牛黄的治疗挑战-一个病例报告。

Medicina intensiva

Pub Date : 2025-12-19 DOI: 10.1016/j.medine.2025.502311

Marta de Antonio-Cuscó, Lucía Picazo, Agustí Albalat-Torres, Mónica Marín-Casino, Francisco José Parrilla-Gómez, Javier Mateu-de Antonio

引用次数: 0

Respiratory rate remains the forgotten vital sign 呼吸频率仍然是被遗忘的生命体征。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502225

Enrique Chicote-Álvarez, Adolfo Calvo-Martínez, María Macías-Pascual

引用次数: 0

Cardiac hydatid disease 心脏包虫病。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502218

Emilio Curiel Balsera, Javier Muñoz Bono, Hugo Molina Diaz

引用次数: 0

Primary central nervous system vasculitis. A rare disease with high mortality 原发性中枢神经系统血管炎。一种死亡率高的罕见疾病。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502298

María Teresa Belmonte Alcaraz , Diego Martínez García , Carola Giménez-Esparza Vich

引用次数: 0

Massive left atrial appendage thrombus in a patient with paroxysmal atrial fibrillation 阵发性心房颤动患者的大块左心房附件血栓。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502261

Dipesh Raniga, Bradley Hefford, Maria Gabriela Matta

引用次数: 0

Early identification of hypofibrinogenemia in major trauma: The usefulness of the FiT-6 (Fibrinogen in Trauma-6) score 严重创伤中低纤维蛋白原血症的早期识别：fit6（创伤纤维蛋白原-6）评分的实用性。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502296

Ángela Ruiz-Bocos , Gonzalo Sirgo , Marc Cartanyà , Sandra Canelles , Silvia Urgelés , Xavi Daniel , Natalia Murillo , Julen Berrueta , Reyes Aguinaco , María Bodí , Alejandro Rodríguez , Gerard Moreno

Objective

To develop a clinical predictive score for hypofibrinogenemia in severely injured trauma patients.

Design

Retrospective cohort study.

Setting

Intensive Care Unit (ICU) at Hospital Joan XXIII.

Patients

Consecutive patients admitted to the ICU for severe trauma with significant bleeding between 2015 and 2021 were included. Patients with an Injury Severity Score (ISS) < 16 were excluded.

Interventions

Data were analyzed from the ICUTRAUMA registry, designed to establish the epidemiological profile of critically ill trauma patients in the province of Tarragona. The association between admission fibrinogen levels and ICU mortality was assessed using Cox regression with restricted cubic splines. A logistic regression model was then constructed to predict hypofibrinogenemia (≤203 mg/dl), from which a clinical score was developed and internally validated, and subsequently named FiT-6.

Main variables of interest

Association between initial fibrinogen levels and ICU mortality.

Results

A non-linear relationship was observed between fibrinogen levels and ICU mortality. Fibrinogen levels ≤ 203 mg/dl were significantly associated with increased mortality (HR: 1.66; 95%CI: 1.01–2.72). Six independent predictors of hypofibrinogenemia were identified: ionic calcium < 1 mmol/l, hemoglobin < 10 g/dl, platelets < 100 × 10⁹/l, base excess < –6, Shock Index > –0.9, and lactate > 2 mmol/l. The model demonstrated good diagnostic performance (AUC-ROC 0.90) after cross-validation.

Conclusions

The FiT-6 score shows high predictive ability for identifying hypofibrinogenemia, which is associated with increased ICU mortality.

目的：建立严重创伤患者低纤维蛋白原血症的临床预测评分。设计：回顾性队列研究。环境：Joan XXIII医院重症监护病房（ICU）。患者：纳入2015 - 2021年间连续入住ICU的严重创伤大出血患者。损伤严重程度评分（ISS） 患者干预措施：分析来自ICUTRAUMA登记处的数据，旨在建立塔拉戈纳省重症创伤患者的流行病学概况。采用限制性三次样条Cox回归评估入院纤维蛋白原水平与ICU死亡率之间的关系。然后构建逻辑回归模型来预测低纤维蛋白原血症（≤203 mg/dl），并以此为基础开发临床评分并进行内部验证，随后命名为FiT-6。主要研究变量：初始纤维蛋白原水平与ICU死亡率之间的关系。结果：纤维蛋白原水平与ICU死亡率呈非线性关系。纤维蛋白原水平 ≤ 203 mg/dl与死亡率增加显著相关（HR: 1.66; 95%CI: 1.01-2.72）。确定了6个独立的低纤维蛋白原血症预测因子：离子钙 9/l、碱过量  -0.9和乳酸 > 2 mmol/l。经交叉验证，该模型具有良好的诊断性能（AUC-ROC为0.90）。结论：FiT-6评分对识别低纤维蛋白原血症具有较高的预测能力，而低纤维蛋白原血症与ICU死亡率增加有关。

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引用次数: 0

Prehospital extracorporeal cardiopulmonary resuscitation in mass gatherings: Towards a new paradigm in cardiac arrest 院前体外心肺复苏在大规模集会：迈向心脏骤停的新范式。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502266

Eduard Argudo , Maria Vidal-Burdeus , Jorge Morales-Álvarez , Jordi Riera

引用次数: 0

Bridging the nutritional gap between the intensive care unit and the ward: A plea for action to ensure continuity of care 弥合重症监护室和病房之间的营养差距：呼吁采取行动确保护理的连续性。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502222

David Pérez-Torres, Isabel Canas-Pérez, Cristina Díaz-Rodríguez, Ana Isabel Martín-Luengo

引用次数: 0

Analysis of clinical experience with angiotensin II: A meta-analysis and 4 AI 血管紧张素II的临床经验分析：一项荟萃分析和4个AI。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502269

Íñigo Isern-de-Val , Saray Antón Juarros , Marta Malingre Gajino , Héctor Mercado Castillo , Irene Orduna Casla , Raquel Lorenzo Álvarez , Lidia Serrano Martínez , Juan José Araiz Burdio

Objective

Angiotensin II (ATII) was approved for distributive shock in Spain (2023). The objective is to assess the experience with ATII by comparing a meta-analysis (MTA) and 4 Artificial Intelligence (AI) tools.

Design

A search was conducted in Pubmed®, Central®, Embase®, and Scopus®. Randomized clinical trials, non-randomized trials, and observational studies were included. The primary outcome was all-cause mortality. Odds ratios (OR) with 95% confidence intervals (CI) were pooled. Four AI tools were used: Consensus, Perplexity, Elicit, and Scite.

Setting

Intensive care medicine.

Patients or participants

One thousand six hundred and thirty-six studies were identified, with 10 studies included in the MTA.

Interventions

No interventions.

Main variables of interest

Mortality, efficacy, and safety.

Results

ATII shows a trend towards mortality reduction when compared with controls, OR 0.86 (95% CI: 0.60–1.23); this reduction reaches significance in patient subgroups: High Renin Levels, OR 0.45 (95% CI: 0.22−0.93); shock with renal replacement therapy, OR 0.38 (95% CI: 0.17−0.84). ATII is very effective in increasing mean arterial pressure, OR 3.25 (95% CI: 2.24–4.73), without increasing events, OR 0.77 (95% CI: 0.51–1.14). The AI reached the same conclusions, but only 25%–30% of the studies were included in the MTA.

Conclusions

ATII effectively increases blood pressure without side effects and without altering mortality. AI can assist in evaluating clinical evidence.

目的：血管紧张素II （ATII）在西班牙被批准用于治疗缺血性休克（2023年）。目的是通过比较荟萃分析（MTA）和4种人工智能（AI）工具来评估ATII的经验。设计：在Pubmed®、Central®、Embase®和Scopus®中进行检索。包括随机临床试验、非随机试验和观察性研究。主要结局为全因死亡率。合并优势比（OR）和95%置信区间（CI）。使用了四种人工智能工具：Consensus， Perplexity， Elicit和Scite。单位：重症监护医学。患者或参与者：确定了1636项研究，其中10项研究被纳入MTA。干预：无干预。主要研究变量：死亡率、疗效和安全性。结果：与对照组相比，ATII显示死亡率降低的趋势，OR为0.86 (95% CI: 0.60-1.23)；这种降低在患者亚组中达到显著性：高肾素水平，OR 0.45 (95% CI: 0.22-0.93)；休克合并肾脏替代治疗，OR 0.38 （95% CI: 0.17-0.84）。ATII在增加平均动脉压方面非常有效，OR为3.25 (95% CI: 2.24-4.73)，而不增加事件，OR为0.77 （95% CI: 0.51-1.14）。人工智能也得出了同样的结论，但只有25%-30%的研究被纳入了MTA。结论：ATII可有效提高血压，无副作用，且不改变死亡率。人工智能可以协助评估临床证据。

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引用次数: 0

Noninvasive bedside neuromonitoring in acute brain injury. A narrative review 急性脑损伤的无创床边神经监测。叙述性评论

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502305

Daniel Agustín Godoy , Jon Pérez-Bárcena , Francisco de Paula Delgado-Moya , Jesús Abelardo Barea-Mendoza , Juan Antonio Llompart-Pou

Clinical neurological examination remains the gold standard to detect, diagnose, and follow-up responses to treatment in acute neurological conditions in the critical care setting. However, in patients with severe neurological deficits at baseline or those requiring sedatives, detecting neurological deterioration can be challenging. In this scenario, noninvasive bedside neuromonitoring as a part of multimodal strategies can be useful in the avoidance of secondary brain injury and in the selection of which patient with acute brain injury would benefit from invasive neuromonitorization.

临床神经学检查仍然是在重症监护环境中检测、诊断和随访急性神经系统疾病治疗反应的金标准。然而，在基线时有严重神经功能缺陷或需要镇静剂的患者中，检测神经功能恶化可能具有挑战性。在这种情况下，非侵入性床边神经监测作为多模式策略的一部分，在避免继发性脑损伤和选择哪些急性脑损伤患者将受益于侵入性神经监测方面是有用的。

引用次数: 0

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