Medicina intensiva最新文献

英文中文

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

Physiotherapy in the ICU: Past, present, and future ICU的物理治疗：过去，现在和未来。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502205

Gonzalo Ballesteros-Reviriego , Joan-Daniel Martí

引用次数: 0

Videolaryngoscopy vs. direct laryngoscopy in orotracheal intubation in obese critical patients: Systematic review and meta-analysis 视频喉镜与直接喉镜在肥胖危重患者经气管插管中的应用：系统回顾和荟萃分析。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502168

Samuel David Gil-Bazán , Gustavo Adolfo Vásquez-Tirado , Edward Chávez-Cruzado , Edinson Dante Meregildo-Rodríguez , Claudia Vanessa Quispe-Castañeda , Wilson Marcial Guzmán-Aguilar , Leslie Jacqueline Liñán-Díaz

Objective

To determine whether the use of videolaryngoscopy (VL) is more effective than direct laryngoscopy (DL) for orotracheal intubation in obese patients.

Design

This is a systematic review and meta-analysis.

Setting

A comprehensive search was conducted in five databases for studies published up to December 26, 2023, using a PICO strategy. Fifteen studies were identified for quantitative analysis and included in our meta-analysis.

Participants

The participants of the included primary studies (obese patients).

Interventions

Orotracheal intubation with videolaryngoscopy or direct laryngoscopy.

Main variables of interest

Videolaryngoscopy, direct laryngoscopy, intubation time, first--pass success rate, minor complications.

Results

No significant differences were found in intubation time between VL and DL in obese patients (MD: −4.84; 95% CI: −13.49 to 3.80; I²: 90%). In the subgroup analysis, the Airtaq technique showed a significant difference in intubation time compared to the Macintosh technique (MD: −25.29; 95% CI: −49.17 to −1.38; I²: 95%). However, no significant differences were observed in the first--pass success rate (OR: 1.58; 95% CI: 0.77–3.23; I²: 33%) or in complications such as pain (OR: 1.15; 95% CI: 0.75–1.75; I²: 0%) and voice changes (OR: 0.76; 95% CI: 0.46–1.26; I²: 0%) between the two methods.

Conclusion

There are no significant differences in intubation time, first--pass success rate, or complications between VL and DL in obese critical patients.

目的：探讨视频喉镜（VL）是否比直接喉镜（DL）更有效地应用于肥胖患者的气管插管。设计：这是一项系统回顾和荟萃分析。设置：使用PICO策略，在5个数据库中对截至2023年12月26日发表的研究进行了全面检索。15项研究被确定用于定量分析，并纳入我们的荟萃分析。参与者：纳入的主要研究的参与者（肥胖患者）。干预措施：经气管插管配合视频喉镜或直接喉镜检查。主要感兴趣的变量：视频喉镜、直接喉镜、插管时间、一次通过率、轻微并发症。结果：肥胖患者VL与DL插管时间无显著差异(MD: -4.84；95% CI: -13.49 ~ 3.80；I2: 90%)。在亚组分析中，与Macintosh技术相比，Airtaq技术在插管时间上有显著差异(MD: -25.29；95% CI: -49.17 ~ -1.38；I2: 95%)。然而，在第一次通过成功率(OR: 1.58；95% ci: 0.77-3.23；I2: 33%)或并发症，如疼痛(or: 1.15；95% ci: 0.75-1.75；I2: 0%)和声音变化(OR: 0.76；95% ci: 0.46-1.26；I2: 0%)。结论：肥胖危重患者VL与DL在插管时间、一次通过成功率、并发症等方面无显著差异。

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引用次数: 0

Linezolid continuous infusion protects from subtherapeutic linezolid concentrations in critically ill patients 利奈唑胺持续输注对危重病人的亚治疗性利奈唑胺浓度有保护作用。

Medicina intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medine.2025.502268

Leonardo Lorente , Jonathan González García , Sergio Pérez Reyes , Cristo Yared Pérez Martín , Mario Rodín , Santiago Viera , Alejandro Jiménez

Objective

Different studies have determined blood linezolid concentrations. However, the largest studies reporting data on factors associated with subtherapeutic linezolid concentrations in critically ill patients account for less than 60 patients. Thus, the objective of our study was to determine what factors were associated with subtherapeutic linezolid concentrations in critically ill patients in a larger series of patients.

Design

Historical cohort study.

Setting

One Spanish Intensive Care Unit.

Patients

Critically ill adult patients who received linezolid due to suspected or confirmed infection by multidrug-drug-resistant Gram-positive bacteria during 2022 and 2023.

Interventions

Blood samples were collected to determine linezolid concentrations (C_min) immediately before dosing after at least 48 h from starting linezolid therapy.

Main variable of interest

Subtherapeutic linezolid concentrations.

Results

We included a total of 168 patients. We found 79 (47.0%) patients with and 89 (53.0%) patients without subtherapeutic linezolid concentrations. Multiple logistic regression showed that linezolid continuous infusion (OR = 0.192; 95% CI = 0.053–0.694; P = .01) and older age (OR = 0.952; 95% CI = 0.926–0.980; P = .001) were associated with lower risk of subtherapeutic linezolid concentrations.

Conclusions

As far as we know, this is the largest study reporting data on factors associated with subtherapeutic linezolid concentrations in critically ill patients. To our knowledge, our study is the first to report that linezolid continuous infusion was independently associated with lower risk of subtherapeutic linezolid concentrations in critically ill patients.

目的：不同的研究测定了血液中利奈唑胺的浓度。然而，报道重症患者亚治疗利奈唑胺浓度相关因素数据的最大研究只涉及不到60例患者。因此，我们研究的目的是在更大的患者系列中确定哪些因素与危重患者的亚治疗利奈唑胺浓度相关。设计：历史队列研究。环境：一间西班牙重症监护病房。患者：在2022年和2023年期间，因怀疑或确认感染多重耐药革兰氏阳性菌而接受利奈唑胺治疗的危重成人患者。干预措施：在开始利奈唑胺治疗至少48 小时后，在给药前立即采集血液样本以测定利奈唑胺浓度（Cmin）。主要感兴趣的变量：亚治疗利奈唑胺浓度。结果：我们共纳入168例患者。我们发现79例（47.0%）患者有亚治疗性利奈唑胺浓度，89例（53.0%）患者没有。多元logistic回归显示，利奈唑胺持续输注组（OR = 0.192;95% CI = 0.053-0.694;P = ）。01)和老年(或 = 0.952;95%可信区间 = 0.926 - -0.980;P = 。001)与亚治疗性利奈唑胺浓度降低的风险相关。结论：据我们所知，这是报道重症患者亚治疗利奈唑胺浓度相关因素数据的最大研究。据我们所知，我们的研究是第一个报道利奈唑胺持续输注与危重患者亚治疗利奈唑胺浓度降低风险独立相关的研究。

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引用次数: 0

ICU efficiency during the COVID-19 pandemic: A retrospective analysis across three periods. COVID-19大流行期间ICU效率：三个时期的回顾性分析

Medicina intensiva

Pub Date : 2025-11-29 DOI: 10.1016/j.medine.2025.502304

Pablo Álvarez-Maldonado, Juan D Fernández-Patiño, Ulises Cerón-Díaz

引用次数: 0

PICU simulation: critical care training. PICU模拟：重症监护训练。

Medicina intensiva

Pub Date : 2025-11-28 DOI: 10.1016/j.medine.2025.502316

Alicia Ogando Martínez, Amelia Martínez de Azagra, Vianor Pablo Silvero Enríquez, Santiago Mencía Bartolomé

David Gaba was one of the first to use simulation in medicine. He defined it as a learning method used to replace or amplify real experiences by guided experiences that evoke or reproduce aspects of the real world in a completely interactive way. In the past, learning process and professional improvement in the healthcare were carried out progressively with the patient himself, so the management of infrequent situations was conditioned to a prolonged training period. Tools such as simulation allow us to carry out this training prior to patient care, providing an experience that was not available before. In the last decade, this methodology has experienced exponential growth, gaining more and more prominence in the field of paediatric intensive care. It has not only been consolidated as a pedagogical method, but also as an essential tool for the acquisition and improvement of technical and non-technical skills in healthcare practice. Nowadays, it's considered a fundamental part of patient safety improvement strategies, allowing to examine care environments and processes, train multidisciplinary teams and practice work algorithms. In this review, we will focus on the usefulness of clinical simulation for the training of PICU staff, especially in non-technical skills such as effective communication and teamwork in critical situations.

David Gaba是最早在医学上使用模拟的人之一。他将其定义为一种学习方法，通过引导体验以一种完全互动的方式唤起或再现现实世界的各个方面，从而取代或放大真实体验。在过去，医疗保健的学习过程和专业改进是与患者自己逐步进行的，因此对不常见情况的管理需要长时间的培训。模拟等工具使我们能够在患者护理之前进行这种培训，提供以前无法获得的经验。在过去的十年中，这种方法经历了指数增长，在儿科重症监护领域获得越来越多的突出。它不仅被巩固为一种教学方法，而且还作为获得和改进医疗保健实践中的技术和非技术技能的基本工具。如今，它被认为是改善患者安全策略的基本组成部分，允许检查护理环境和流程，培训多学科团队和实践工作算法。在这篇综述中，我们将重点关注临床模拟对PICU工作人员培训的有用性，特别是在非技术技能方面，如在危急情况下的有效沟通和团队合作。

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引用次数: 0

Risk prediction model for unplanned weaning during continuous renal replacement therapy: A cross-sectional study. 持续肾替代治疗期间计划外断奶的风险预测模型：一项横断面研究。

Medicina intensiva

Pub Date : 2025-11-28 DOI: 10.1016/j.medine.2025.502361

Xiaomin Liu, Minling Li, Rui Wu, Jiajia Ma, Cunyi Shen, Xiaohong Yang, Meng Wei, Limin Wei, Lei Chen, Qiaoning Wei, Hao He, Julin Gao

Objective: To construct a risk prediction model and systematically analyze factors contributing to unplanned weaning during continuous renal replacement therapy (CRRT) in critically ill adult patients.

Design: Cross-sectional, single center study.

Setting: Dialysis Center of Third-level hospital in China.

Patients: Eight hundred and thirteen critically ill adults receiving CRRT after exclusions during May 2023 to Dec 2024.

Interventions: Prospective collection of variables during hospital admission and follow-up.

Main variables of interest: Demographics, clinical conditions, nursing parameters, vascular access, consumables, laboratory profiles, treatment prescriptions, and hemodynamic data.

Results: Independent predictors of unplanned weaning included anticoagulant type (nemastat mesylate, OR = 10.20, 95%CI 3.15-33.02), scheduled treatment time > 24 h (OR = 6.66, 95%CI 3.22-13.79), agitation status (OR = 2.76, 95%CI 1.27-6.02), peak venous pressure > 114 mmHg (OR = 3.58, 95%CI 1.84-6.93), peak transmembrane pressure > 172 mmHg (OR = 2.19, 95%CI 1.11-4.33), weight > 70 kg (OR = 2.13, 95%CI 1.13-4.01). The model demonstrated AUCs of 0.874 (training) and 0.730 (validation).

Conclusions: This nomogram-based model integrates multidimensional risk factors and provides actionable insights for preventing unplanned CRRT weaning. Key clinical strategies include optimizing anticoagulation protocols and monitoring hemodynamic parameters. Further multicenter validation is warranted to improve generalizability.

目的：建立成人危重患者持续肾替代治疗（CRRT）过程中意外脱机的风险预测模型，系统分析其影响因素。设计：横断面、单中心研究。地点：中国三级医院透析中心。患者：813名危重成人在2023年5月至2024年12月排除后接受CRRT。干预措施：住院和随访期间的前瞻性变量收集。感兴趣的主要变量：人口统计、临床条件、护理参数、血管通路、耗材、实验室概况、治疗处方和血流动力学数据。结果：非计划性脱机的独立预测因子包括抗凝剂类型（甲磺酸nemastat， OR = 10.20, 95%CI 3.15-33.02）、预定治疗时间> 24 h （OR = 6.66, 95%CI 3.22-13.79）、激动状态（OR = 2.76, 95%CI 1.27-6.02）、静脉峰值压> 114 mmHg （OR = 3.58, 95%CI 1.84-6.93）、跨膜峰值压> 172 mmHg （OR = 2.19, 95%CI 1.11-4.33）、体重> 70 kg （OR = 2.13, 95%CI 1.13-4.01）。模型的auc分别为0.874（训练）和0.730（验证）。结论：该模型整合了多维风险因素，为预防非计划的CRRT断奶提供了可行的见解。关键的临床策略包括优化抗凝治疗方案和监测血流动力学参数。进一步的多中心验证是必要的，以提高普遍性。

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引用次数: 0

Impact of empiric anti-MRSA therapy on survival outcome in severe acute pancreatitis: a MIMIC-IV cohort study. 经验性抗mrsa治疗对严重急性胰腺炎患者生存结局的影响：一项MIMIC-IV队列研究。

Medicina intensiva

Pub Date : 2025-11-28 DOI: 10.1016/j.medine.2025.502363

Yinghui Hong, Mingliang Ye, Junshi Wang, Yuhang Chen, Bin Huang, Xi Li, Lei Huang

Objective: To evaluate the impact of early empirical anti-Methicillin-resistant Staphylococcus aureus (MRSA) therapy on the survival outcomes of patients with severe acute pancreatitis (SAP) in the intensive care units (ICUs).

Design: Secondary Analysis of the the Medical Information Mart for Intensive Care-IV (MIMIC-IV v3.1) on MRSA therapy in Intensive Care Units (ICUs).

Setting: 94,458 ICU hospitalization records from 65,366 unique patients between 2008 and 2019.

Patients: 494 patients diagnosed with acute pancreatitis first admitted to the ICU.

Interventions: Anti-MRSA (vancomycin or linezolid) agents.

Main variables of interest: 28-day and 90-day mortality rates, incidence of renal impairment, and total hospitalization costs.

Results: A total of 494 patients were included, 302 (61.1%) patients received anti-MRSA therapy. After PSM, no significant differences were observed in ICU mortality (adjusted relative risk [aRR], 0.39; 95% CI, 0.11-1.38, p = 0.14) or hospital mortality (aRR, 0.53; 95% CI, 0.21-1.33, p = 0.18) between the two groups. Similarly, 28-day mortality and 90-day mortality did not significantly differ (p > 0.05). Empirical anti-MRSA therapy was associated with significantly longer ICU and hospital LOS (p < 0.001). Subgroup analysis revealed that anti-MRSA therapy significantly increased acute kidney injury incidence (p = 0.002), particularly in patients without pre-existing kidney disease (p < 0.001).

Conclusions: Empirical anti-MRSA therapy was not associated with improved short- or long-term survival in SAP patients, and may lead to prolonged ICU and hospital stays. These findings highlight the importance of integrating local MRSA epidemiology into antimicrobial stewardship decisions.

目的：探讨重症监护病房（icu）早期经年性抗甲氧西林耐药金黄色葡萄球菌（MRSA）治疗对重症急性胰腺炎（SAP）患者生存结局的影响。设计：重症监护医学信息市场- iv （MIMIC-IV v3.1）对重症监护病房（icu） MRSA治疗的二次分析。背景：2008年至2019年期间，65,366名独特患者的94,458例ICU住院记录。患者：494例确诊为急性胰腺炎的患者首次入住ICU。干预措施：抗mrsa（万古霉素或利奈唑胺）药物。感兴趣的主要变量：28天和90天死亡率、肾脏损害发生率和总住院费用。结果：共纳入494例患者，302例（61.1%）患者接受了抗mrsa治疗。经PSM治疗后，两组ICU死亡率（校正相对危险度[aRR]， 0.39; 95% CI, 0.11-1.38, p = 0.14）和住院死亡率（aRR, 0.53; 95% CI, 0.21-1.33, p = 0.18）无显著差异。同样，28天死亡率和90天死亡率无显著差异（p > 0.05）。结论：经验性抗mrsa治疗与SAP患者的短期或长期生存改善无关，并可能导致ICU和住院时间延长。这些发现强调了将当地MRSA流行病学纳入抗菌药物管理决策的重要性。

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引用次数: 0

Macroscopic findings in Tracheobronchial Aspergillosis during Bronchoscopy. 支气管镜下气管支气管曲菌病的宏观表现。

Medicina intensiva

Pub Date : 2025-11-27 DOI: 10.1016/j.medine.2025.502364

Leandro Tapia Barredo, Santiago Menjura Gómez, Carmen Angela Centeno Clemente

引用次数: 0

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