Medicina Intensiva最新文献

{"title":"Contrast media extravasation mimicking subarachnoid hemorrhage due to hypertensive encephalopathy","authors":"Gökhan Tonkaz, Merve Nur Taşdemir, Mehmet Tonkaz","doi":"10.1016/j.medin.2025.502208","DOIUrl":"10.1016/j.medin.2025.502208","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502208"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of norepinephrine versus vasopressin in the stabilization phase of septic shock: RENOVA clinical trial","authors":"Cássio Mallmann ,&nbsp;Thizá Maria Bianchi Galiotto ,&nbsp;Michele Salibe de Oliveira ,&nbsp;Rafael Barberena Moraes","doi":"10.1016/j.medin.2025.502147","DOIUrl":"10.1016/j.medin.2025.502147","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the incidence of hypotension during the weaning phase of vasopressors.</div></div><div><h3>Design</h3><div>A single-center, open-label randomized clinical trial between May and December 2022.</div></div><div><h3>Setting</h3><div>a tertiary care academic medical center.</div></div><div><h3>Patients</h3><div>91 adult patients over 18 years of age with septic shock (according to Sepsis-3).</div></div><div><h3>Intervention</h3><div>Patients were divided into two groups: initial reduction of norepinephrine or initial reduction of vasopressin.</div></div><div><h3>Main variables of interest</h3><div>The primary outcome was the incidence of hypotension within the first 24 h after reducing vasopressors. Additionally, the clinical impact of this hypotension was assessed through mortality, length of hospital stay, duration of vasopressor use, incidence of arrhythmias, and prevalence of hemodialysis.</div></div><div><h3>Results</h3><div>Out of a total of 91 patients, 78 were included in the analysis: 39 in the norepinephrine group and 39 in the vasopressin group. Despite a numerically significant difference in the incidence of hypotension between the groups (norepinephrine 43.6%, vasopressin 25.6%), there was no statistical difference (<em>p</em> =  0.153, relative risk = 1.7, 95% confidence interval: 0.9–3.2). In this sample, vasopressin withdrawal was predominantly titrated. There were no differences between the groups in terms of the evaluated clinical outcomes.</div></div><div><h3>Conclusion</h3><div>No differences were detected in the incidence of hypotension when weaning was initiated with norepinephrine or vasopressin, although it was non significantly higher in norepinephrine group. In our sample, vasopressin withdrawal was titrated, which differs from North American practice. Brazilian Clinical Trials Registry (REBEC: RBR-10smbw65). ClinicalTrials.gov platform (NCT 05506319).</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502147"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacto de la COVID-19 en las activaciones del equipo de parada cardiorrespiratoria intrahospitalaria: estudio retrospectivo","authors":"Ghali Ballout ,&nbsp;Marta Magaldi Mendaña ,&nbsp;Bartomeu Ramis Bou ,&nbsp;Cristian Torres Quevedo ,&nbsp;Adriana Capdevila Freixas ,&nbsp;Silvia Moreno-Jurico ,&nbsp;Enrique Jesús Carrero Cardenal ,&nbsp;Jaime Fontanals Dotras ,&nbsp;Comisión a la Atención a la Parada Cardiorrespiratoria del Hospital Clínic de Barcelona","doi":"10.1016/j.medin.2024.502137","DOIUrl":"10.1016/j.medin.2024.502137","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze whether the characteristics of the patients treated by the in-hospital cardiorespiratory arrest team, IHCA and cardiopulmonary resuscitation (CPR) were different in the period before the COVID-19 compared to the pandemic period; also analyzing the differences between COVID+ and COVID− patients.</div></div><div><h3>Design</h3><div>Observational and retrospective study from January 1st, 2018, to December 31st, 2021.</div></div><div><h3>Setting</h3><div>Tertiary hospital.</div></div><div><h3>Patients</h3><div>All adult patients over 18<!--> <!-->years old requiring attention from the IHCA response team.</div></div><div><h3>Interventions</h3><div>CPR maneuvers according to the advanced life support guidelines of the European Resuscitation Council published in 2015, as well as the modifications made in the COVID era (2020).</div></div><div><h3>Main variables</h3><div>Demographic and epidemiological data, activations of the IHCA response team, CA data, hospital and intensive care unit (ICU) length of stay, survival and neurological outcome at hospital discharge.</div></div><div><h3>Results</h3><div>A total of 368 patients were analyzed: 173 in the pre-pandemic group and 195 in the pandemic group. The neurological outcome was better in the pre-pandemic group, and COVID+ patients had a longer ICU length of stay. However, no differences in the response time of the CPR team or in CPR duration were found, nor in immediate survival or at hospital discharge, between both groups or between COVID+ and COVID− patients.</div></div><div><h3>Conclusions</h3><div>Changes in CPR care protocols due to the COVID-19 pandemia did not seem to affect response times from IHCA team neither immediate nor discharge survival.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502137"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between lactate-to-albumin ratio and all-cause mortality in cirrhosis patients: Analysis of the MIMIC-IV database","authors":"Yusong Ye ,&nbsp;Shu Huang ,&nbsp;Xiaohong Wang ,&nbsp;Wensen Ren ,&nbsp;Xiaomin Shi ,&nbsp;Sha Liu ,&nbsp;Wei Zhang ,&nbsp;Lei Shi ,&nbsp;Muhan Lü ,&nbsp;Xiaowei Tang","doi":"10.1016/j.medin.2025.502145","DOIUrl":"10.1016/j.medin.2025.502145","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates the predictive value of the lactate/albumin ratio (LAR) for all-cause mortality in cirrhosis patients.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Intensive care unit (ICU).</div></div><div><h3>Patients or participants</h3><div>626 first-time ICU-admitted cirrhosis patients in the USA (MIMIC-IV v2.2).</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>LAR index, 28-day, and 90-day all-cause mortality.</div></div><div><h3>Results</h3><div>Of 626 patients (60.86% male), 27.80% and 39.14% died within 28 and 90 days, respectively. Multivariate Cox analysis showed a significant association between higher LAR and mortality. Adjusted for confounders, elevated LAR increased the 28-day mortality risk [HR: 1.31 (1.21–1.42), P &lt; 0.001]. A restricted cubic spline analysis revealed non-linear relationships between LAR and mortality. For 28-day mortality, the inflection point was 1.583: below this, HR was 2.29 (95% CI: 1.61–3.27, P &lt; 0.001); above, HR was 1.16 (95% CI: 1.02–1.31, P = 0.021; P = 0.002). For 90-day mortality, the inflection point was 1.423: below, HR was 1.60 (95% CI: 1.04–2.47, P = 0.033); above, HR was 0.94 (95% CI: 0.75–1.16, P = 0.542; P = 0.012).</div></div><div><h3>Conclusions</h3><div>LAR predicts 28-day and 90-day mortality with a segmented effect. An LAR ≥1.583 signals high 28-day mortality risk, necessitating intensified monitoring and potential ICU admission. For 90-day mortality, LAR near 1.423 serves as an early warning for high-risk patients and guides interventions. Continuous LAR monitoring aids management, but prospective studies are needed to confirm clinical utility.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502145"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Definiciones y recomendaciones de consenso sobre la medicina crítica en la altitud del Comité de Expertos de Medicina Crítica en la altitud de la Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva","authors":"Amilcar Tinoco-Solórzano ,&nbsp;Adrian Avila-Hilari ,&nbsp;Manuel Luis Avellanas-Chavala ,&nbsp;Felipe de Jesús Montelongo ,&nbsp;Jorge Vélez-Páez ,&nbsp;Víctor Nieto Estrada ,&nbsp;Antonio Viruez Soto ,&nbsp;Daniel Molano Franco ,&nbsp;Eduardo Castelo Tamayo ,&nbsp;Ignacio Granda Luna ,&nbsp;Alfonso Salazar Mendoza ,&nbsp;Luis Mamani Cruz ,&nbsp;Jonathan Galindo Ayala ,&nbsp;Pablo Vásquez-Hoyos ,&nbsp;Fausto Maldonado Coronel ,&nbsp;Roger Huanca Payehuanca ,&nbsp;Jorge Rosendo Sánchez Medina","doi":"10.1016/j.medin.2025.502256","DOIUrl":"10.1016/j.medin.2025.502256","url":null,"abstract":"<div><div>The Expert Committee on Critical Care Medicine at altitude of the Pan American and Iberian Federation of Critical Care Medicine and Intensive Care detected a lack of terms defining this critical care medicine, as well as a lack of standardization in the approach to these patients. These shortcomings can lead to errors in management, for example, in critically ill patients at risk of death who require oxygen therapy, whether invasive or non-invasively.</div><div>The objective of the expert committee was to develop an international consensus that would standardize terminology and establish key definitions and recommendations for the care of critically ill patients at altitude. This document includes five important definitions, four recommendations related to the management of acute respiratory failure at altitude, and a series of considerations for future research. It also establishes specific criteria that differentiate it from the traditional approach used at sea level.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502256"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypernatremia and renal dysfunction after sevoflurane sedation in the intensive care unit: Three case reports","authors":"Marta Bauça Socias ,&nbsp;Dolly Andrea Caicedo ,&nbsp;Eva Benveniste-Pérez ,&nbsp;Georgina de la Rosa Loppacher ,&nbsp;Eva Montané","doi":"10.1016/j.medin.2025.502215","DOIUrl":"10.1016/j.medin.2025.502215","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502215"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilación con liberación de presión en la vía aérea y membrana de oxigenación extracorpórea (ECMO) con configuración veno-venosa","authors":"Ruben Martín-Latorre,&nbsp;Laura de Rivas-Alcover,&nbsp;Àngela Poquet-Poquet","doi":"10.1016/j.medin.2025.502177","DOIUrl":"10.1016/j.medin.2025.502177","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502177"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of non-invasive ventilation on bilevel pressure mode and CPAP in the treatment of COVID-19 related acute respiratory failure. A propensity score–matched analysis","authors":"Andrés Carrillo-Alcaraz ,&nbsp;Miguel Guia ,&nbsp;Laura Lopez-Gomez ,&nbsp;Pablo Bayoumy ,&nbsp;Aurea Higon-Cañigral ,&nbsp;Elena Carrasco González ,&nbsp;Pilar Tornero Yepez ,&nbsp;Juan Miguel Sánchez-Nieto","doi":"10.1016/j.medin.2025.502146","DOIUrl":"10.1016/j.medin.2025.502146","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to analyze the differences in the effectiveness and complications of CPAP versus non-invasive ventilation on bilevel positive airway pressure (BiPAP) in the treatment of COVID-19 associated acute respiratory failure (ARF).</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>ICU.</div></div><div><h3>Patients</h3><div>All COVID-19 patients, admitted to an ICU between March 2020 and February 2023, who required CPAP or BiPAP were analyzed.</div></div><div><h3>Interventions</h3><div>Use of CPAP or BiPAP in COVID-19 associated ARF.</div></div><div><h3>Main variables of interest</h3><div>Initial clinical variables, CPAP and BiPAP failure rate, complications, in-hospital mortality.</div></div><div><h3>Results</h3><div>429 patients were analyzed, of whom 328 (76.5%) initially received CPAP and 101 (23.5%) BiPAP. Initial respiratory rate was 30 ± 8 in the CPAP group and 34 ± 9 in BiPAP (p &lt; 0.001), while PaO₂/FiO₂ was 120 ± 26 and 111 ± 24 mmHg (p = 0.001), respectively. The most frequent complication related to the device was claustrophobia/discomfort, 23.2% in CPAP and 25.7% in BiPAP (p = 0.596), while the most frequent complications not related to the device were severe ARDS, 58.6% and 70.1% (p = 0.044), and hyperglycemia, 44.5% and 37.6%, respectively (p = 0.221). After adjusting by propensity score matched analysis, neither failure of the device (OR 1.37, CI 95% 0.72–2.62) nor in-hospital mortality (OR 1.57, CI 95% 0.73–3.42) differed between both groups.</div></div><div><h3>Conclusions</h3><div>Either non-invasive ventilatory device failure or mortality rate differed in patients initially treated with CPAP versus BiPAP.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502146"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"¿Es la inestabilidad hemodinámica una contraindicación absoluta para la posición prono?","authors":"Marina Busico,&nbsp;Fernando Villarejo","doi":"10.1016/j.medin.2025.502201","DOIUrl":"10.1016/j.medin.2025.502201","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502201"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of airway occlusion pressure in traumatic diaphragmatic rupture","authors":"Noemi Merino Pizarro ,&nbsp;Manuel Valdivia Marchal ,&nbsp;Carmen Bermudez Ruiz ,&nbsp;Juan Francisco Martinez Carmona ,&nbsp;Ashlen Rodriguez Carmona ,&nbsp;Jose Manuel Serrano Simon","doi":"10.1016/j.medin.2025.502214","DOIUrl":"10.1016/j.medin.2025.502214","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502214"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}