Medicina Intensiva最新文献

{"title":"Canalización accidental del cayado aórtico con un catéter venoso central","authors":"Antonio Padilla-Serrano , José Miguel Pérez Villares , Antonio Cárdenas Cruz","doi":"10.1016/j.medin.2025.502352","DOIUrl":"10.1016/j.medin.2025.502352","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 5","pages":"Article 502352"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147756797","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":"Left ventricular systolic function and mechanical ventilation weaning failure: An updated systematic review and meta-analysis with trial sequential analysis","authors":"Cristina Santonocito ,&nbsp;Simone Messina ,&nbsp;Mateusz Zawadka ,&nbsp;Andrzej Pruszczyk ,&nbsp;Elena Bignami ,&nbsp;Andrea Morelli ,&nbsp;Sabino Scolletta ,&nbsp;Alberto Noto ,&nbsp;Filippo Sanfilippo","doi":"10.1016/j.medin.2025.502231","DOIUrl":"10.1016/j.medin.2025.502231","url":null,"abstract":"<div><h3>Objective</h3><div>The impact of left ventricular (LV) systolic dysfunction on weaning failure is unclear.</div></div><div><h3>Design</h3><div>Updated meta-analysis assessing the association between LV ejection fraction (LVEF) and weaning failure.</div></div><div><h3>Setting</h3><div>A systematic search of MEDLINE and EMBASE for prospective studies reporting weaning according to echocardiographic data measured before starting a spontaneous breathing trial (SBT).</div></div><div><h3>Patients or participants</h3><div>Studies included in the meta-analysis that reported on weaning and echocardiographic data.</div></div><div><h3>Main variables of interest</h3><div>LVEF, E/e’ ratio, E velocity, deceleration time of the E wave, and e’ velocity.</div></div><div><h3>Results</h3><div>Three studies were added in this update (<em>n</em> = 14, sample 20–30% larger). Lower LVEF (<em>n</em> = 12) was associated with weaning failure: MD: −4.71 95%CI [−9.18, −0.23]; <em>p</em> = 0.04, I² = 90%, low certainty of evidence), without subgroups difference according to SBT type or LVEF mean values. Trial sequential analysis showed that results were not robust (information size <em>n</em> = 745/1378). E/e’ ratio (MD: 1.90, 95%CI [0.48,3.32]; <em>p</em> = 0.009, I² = 84%), E velocity (MD: 8.32, 95%CI [2.59,14.05]; <em>p</em> = 0.004, I² = 54%) and shorter deceleration time of the E wave (MD: −12.01, 95%CI [−21.13, −2.89]; <em>p</em> = 0.01, I² = 0%) were associated with weaning failure, whilst e’ velocity was not (MD: -0.59, 95%CI [−1.51,0.32]; <em>p</em> = 0.20, I² = 64%).</div></div><div><h3>Conclusions</h3><div>An association of weaning failure with poorer LV systolic function (LVEF), not detected by the previous meta-analysis, was found. However, such association is highly fragile and with a mean difference below 5%, which seems not clinically relevant. Higher E/e’ ratio and other diastolic parameters confirmed their association with weaning failure, whilst e’ did not.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 5","pages":"Article 502231"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147756986","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":"Triglyceride-Glucose Index as a predictor of severity in acute pancreatitis: Systematic Review and Meta-Analysis","authors":"Gustavo Adolfo Vásquez-Tirado ,&nbsp;Odett Yamile Aguirre-Varas ,&nbsp;Edinson Dante Meregildo-Rodríguez ,&nbsp;Claudia Vanessa Quispe-Castañeda ,&nbsp;Wilson Marcial Guzmán-Aguilar ,&nbsp;Leslie Jacqueline Liñán-Díaz ,&nbsp;Luis Ángel Rodríguez-Chávez","doi":"10.1016/j.medin.2025.502210","DOIUrl":"10.1016/j.medin.2025.502210","url":null,"abstract":"<div><h3>Objective</h3><div>The triglyceride-glucose (TyG) index has been proposed as a novel predictive variable of severe acute pancreatitis (SAP)</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>A comprehensive search was conducted across five databases of studies published up to March 17, 2024, using the PECO strategy. Seven studies were identified and included in our meta-analysis.</div></div><div><h3>Participants</h3><div>The participants of the included primary studies (non-severe acute pancreatitis).</div></div><div><h3>Interventions</h3><div>High triglyceride-glucose (TyG) index</div></div><div><h3>Main variables of interest</h3><div>Severe acute pancreatitis,</div></div><div><h3>Results</h3><div>Our analysis evaluated the risk of progression to severity in patients with elevated TyG index in acute pancreatitis through four non-randomized studies. The TyG index was found to be a predictor of severity in acute pancreatitis, with an overall severity risk (OR: 2.38; 95% CI: 1.50–4.08; I²: 80%). Additionally, the analysis of the standardized mean difference (SMD) across all seven studies between patients with SAP and non-SAP yielded an overall mean (OR: 0.90; 95% CI: 0.70–1.11; I²: 28%).</div></div><div><h3>Conclusion</h3><div>In patients with acute pancreatitis, a TyG index is a predictor of severity.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 5","pages":"Article 502210"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147756985","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":"Prediction of COVID-19 mortality using machine learning strategies and a large-scale panel of plasma inflammatory proteins: A cohort study","authors":"Luiz Filipe Bastos Mendes ,&nbsp;Henrique Ritter Dal-Pizzol ,&nbsp;Gabriele Prestes ,&nbsp;Carolina Saibro Girardi ,&nbsp;Lucas Santos ,&nbsp;Daniel Pens Gelain ,&nbsp;Glauco A. Westphal ,&nbsp;Roger Walz ,&nbsp;Cristiane Ritter ,&nbsp;Felipe Dal-Pizzol ,&nbsp;Jose Claudio Fonseca Moreira","doi":"10.1016/j.medin.2025.502200","DOIUrl":"10.1016/j.medin.2025.502200","url":null,"abstract":"<div><h3>Objective</h3><div>To apply machine learning algorithms to generate models capable of predicting mortality in COVID-19 patients, using a large platform of plasma inflammatory mediators.</div></div><div><h3>Desing</h3><div>Prospective, descriptive, cohort study.</div></div><div><h3>Setting</h3><div>6 intensive care units in 2 hospitals in Southern Brazil.</div></div><div><h3>Patients</h3><div>Patients aged &gt; 18 years who were diagnosed with COVID-19 through reverse transcriptase reaction or rapid antigen test.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Demographic and clinical variables, 65 inflammatory biomarkers, mortality.</div></div><div><h3>Results</h3><div>Combinations of two or three proteins yield higher predictive value when compared to individual proteins or the full set of the 65 proteins. A proliferation-inducing ligand (APRIL) and cluster of differentiation 40 ligand (CD40L) consistently emerge among the highest-ranking combinations, suggesting a potential synergistic effect in predicting clinical outcomes. The network structure suggested a dysregulated immune response in non-survivors characterized by the failure of regulatory cytokines to temper an overwhelming inflammatory reaction.</div></div><div><h3>Conclusion</h3><div>Our results highlight the value of feature selection and careful consideration of biomarker combinations to improve prediction accuracy in COVID-19 patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502200"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578953","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":"0.9% sodium chloride versus ringer’s lactate in the management of severe diabetic ketoacidosis: A randomized trial","authors":"Ahlem Trifi ,&nbsp;Ikram Ben Braik ,&nbsp;Hounaida Galai ,&nbsp;Noussair Azzouz ,&nbsp;Badis Tlili ,&nbsp;Asma Mehdi ,&nbsp;Lynda Messaoud ,&nbsp;Eya Seghir ,&nbsp;Asma Ouhibi ,&nbsp;Sami Abdellatif","doi":"10.1016/j.medin.2025.502203","DOIUrl":"10.1016/j.medin.2025.502203","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to compare the effect of 0.9% sodium chloride (SC) versus ringer’s lactate (RL) in the resolution of diabetic ketoacidosis (DKA).</div></div><div><h3>Design</h3><div>Open randomized trial.</div></div><div><h3>Setting</h3><div>A medical ICU from November 2022 to September 2023.</div></div><div><h3>Patients</h3><div>All patients older than 16 years admitted to the ICU for severe DKA.</div></div><div><h3>Intervention</h3><div>The enrolled patient was assigned to receive RL or 0.9% SC according to the randomization scheme. Insulin therapy protocol was conducted similarly for all patients.</div></div><div><h3>Main variables of interest</h3><div>Resolution of DKA at H48 defined by a composite endpoint (glycemia &lt; 11 mmol/l, bicarbonates &gt; 15 mmol/l or pH &gt; 7.30 and anion gap &lt; 16), change in base excess, insulin needs, fluid administration volume, electrolytes (sodium, potassium, chloride), ICU length of stay, and 28-day mortality.</div></div><div><h3>Results</h3><div>88 patients were included: SC arm (n = 42) versus RL arm (n = 46). No significant differences were observed in diabetic ketoacidosis resolution, other variables of interest or in the subgroup analysis. The monitored biomarkers showed in the RL group: a better improvement of bicarbonate at H12 (p = 0.05), best potassium level both at H24 (p = 0.008) and H48 (0.041), lower chloride at H48 (p = 0.002) and higher glycemia at H24.</div></div><div><h3>Conclusion</h3><div>RL did not lead to faster resolution of diabetic ketoacidosis but decreased the risk of hyperchloremia and hypokalemia without increasingthe chance of hyperlactatemia.</div></div><div><h3>Clinical Trial registration number</h3><div>NCT05808972.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502203"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578954","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":"Coma secundario a neumoencéfalo a tensión en fosa posterior","authors":"Luis Patricio Maskin,&nbsp;Florencia A. Cabañuz,&nbsp;Federico Rodriguez Lucci","doi":"10.1016/j.medin.2025.502348","DOIUrl":"10.1016/j.medin.2025.502348","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502348"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578778","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":"Lesión pulmonar asociada al consumo de cigarrillos electrónicos o vapeo: una revisión narrativa","authors":"Alba Cebrián-Cortés ,&nbsp;Isabel Sánchez-Gaona ,&nbsp;José Miguel Pérez-Villares ,&nbsp;Antonio Cárdenas-Cruz","doi":"10.1016/j.medin.2025.502345","DOIUrl":"10.1016/j.medin.2025.502345","url":null,"abstract":"<div><div>EVALI (e-cigarette or vaping product use-associated lung injury) is a rapidly developing toxic inhalation syndrome that has been linked to electronic cigarettes. It is characterized by a wide variety of radiological and histological patterns, with diffuse alveolar damage and acute respiratory distress syndrome being the most severe forms. This condition mainly affects young people and typically has a nonspecific clinical presentation. The diagnosis is one of exclusion, making it essential to thoroughly investigate into the medical history in order to perform a broad differential diagnosis that allows other causes to be ruled out. Treatment is based on supportive measures. Corticosteroids may be beneficial, although there is no standardized protocol and their use is highly heterogeneous. The lack of evidence on the long-term effects of vaping highlights the need for longitudinal studies and preventive strategies aimed at reducing its consumption.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502345"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578961","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":"Usefulness of vector velocity imaging in the descending thoracic aorta","authors":"Manuel Ruiz-Bailén ,&nbsp;Javier Hidalgo-Martín ,&nbsp;Julia Manetsberger ,&nbsp;Fernando Clau-Terré ,&nbsp;Javier Martínez-Gámez ,&nbsp;Johannes Dagomar Lohman ,&nbsp;María Leyre Lavilla-Lerma ,&nbsp;Diego Fernando Matallana-Zapata ,&nbsp;Marta Ballesteros-Barroso ,&nbsp;Ricardo Rivera-Fernández ,&nbsp;Pedro José Sánchez de Toro Hernández ,&nbsp;José Ángel Ramos-Cuadra","doi":"10.1016/j.medin.2025.502224","DOIUrl":"10.1016/j.medin.2025.502224","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the Speckle Tracking values in the descending thoracic aorta (DTA) of a healthy population.</div></div><div><h3>Desing</h3><div>This is an observational study.</div></div><div><h3>Setting</h3><div>Hospital Universitario de Jaén.</div></div><div><h3>Participants</h3><div>Our study included 242 healthy people (102 women) with a mean age of 42.35<!--> <!-->±<!--> <!-->16.37 years.</div></div><div><h3>Interventions</h3><div>Evaluation of Speckle Tracking in DTA.</div></div><div><h3>Main variables of interest</h3><div>Strain, velocity and displacement values in the DTA were evaluated.</div></div><div><h3>Results</h3><div>The DAT rotational velocity was 55.91<!--> <!-->±<!--> <!-->0.22º/s, the DTA radial velocity was 0.98<!--> <!-->±<!--> <!-->0.28<!--> <!-->cm/s, the circumferential strain of the DTA was −8.98<!--> <!-->±<!--> <!-->0.87%, while the circumferential strain rate was −0.96<!--> <!-->±<!--> <!-->0.15/s. The rotational displacement of the DTA was determined at 8.87<!--> <!-->±<!--> <!-->0.36º, while radial displacement was 0.82<!--> <!-->±<!--> <!-->0.11<!--> <!-->mm. Logistic regression found an association between the rotational values of the aorta and the longitudinal strain of both ventricles. In thirty people, strain, rotational velocity and displacement were also evaluated in the apical 4-chamber views and in the parasternal long-axis view. Both projections showed similar values.</div></div><div><h3>Conclusion</h3><div>Speckle Tracking could be used to study the descending thoracic aorta, and its values could suggest or rule out the presence of cardiovascular pathology.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502224"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578955","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":"Visión simultánea del paciente y la imagen ecográfica mediante gafas de realidad aumentada. ¿Supone alguna ventaja en la canalización vascular?","authors":"Eduardo Villanueva Torreiro ,&nbsp;Antonio Rodríguez-Núñez ,&nbsp;Miguel A. Rodríguez-Vargas ,&nbsp;Emilio Rodriguez-Ruiz","doi":"10.1016/j.medin.2025.502393","DOIUrl":"10.1016/j.medin.2025.502393","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502393"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578769","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":"Hiperamonemia inexplicada en pacientes oncológicos críticos: una complicación emergente del tratamiento con gemcitabina-cisplatino","authors":"Patricia Escudero-Acha,&nbsp;Marta Arroyo Diez,&nbsp;Alfredo Abajo Miranda,&nbsp;Junkal Martínez Elizalde,&nbsp;Lourdes Fisac Cuadrado,&nbsp;José Antonio Fernández Ratero","doi":"10.1016/j.medin.2025.502270","DOIUrl":"10.1016/j.medin.2025.502270","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502270"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578768","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}