Medicina intensiva最新文献

英文中文

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 Epub Date: 2025-11-03 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

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 Epub Date: 2025-07-23 DOI: 10.1016/j.medine.2025.502261

Dipesh Raniga, Bradley Hefford, Maria Gabriela Matta

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 Epub Date: 2025-10-13 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 Epub Date: 2025-05-16 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 Epub Date: 2025-11-10 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 Epub Date: 2025-09-22 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 Epub Date: 2025-05-14 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 Epub Date: 2025-03-01 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 Epub Date: 2025-09-26 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

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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