Medicina Intensiva最新文献

{"title":"Las terapias biológicas en las crisis de asma de riesgo vital","authors":"María Lozano-Espinosa , Darío Antolín-Amérigo","doi":"10.1016/j.medin.2025.502391","DOIUrl":"10.1016/j.medin.2025.502391","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502391"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578956","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":"Nocardiosis diseminada por Nocardia asteroides resistente a trimetoprim/sulfametoxazol","authors":"Irene Barrero García , Cristina León Moya , Nerissa Álvarez Chicote , José Garnacho Montero , José López Barba , María Luisa Cantón Bulnes","doi":"10.1016/j.medin.2025.502315","DOIUrl":"10.1016/j.medin.2025.502315","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502315"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578957","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":"Key laboratory changes in severe trauma, a different pattern for each clinical phenotype","authors":"Adrián Marcos-Morales ,&nbsp;Jesús Abelardo Barea Mendoza ,&nbsp;Marcos Valiente Fernández ,&nbsp;Carlos García Fuentes ,&nbsp;Fernando Calvo Boyero ,&nbsp;Cecilia Cueto-Felgueroso ,&nbsp;Judith Gutiérrez Gutiérrez ,&nbsp;Francisco de Paula Delgado Moya ,&nbsp;Carolina Mudarra Reche ,&nbsp;Susana Bermejo Aznárez ,&nbsp;Alfonso Lagares ,&nbsp;Mario Chico Fernández","doi":"10.1016/j.medin.2025.502227","DOIUrl":"10.1016/j.medin.2025.502227","url":null,"abstract":"<div><h3>Objective</h3><div>to compare the different evolution of conventional laboratory parameters between three severe trauma phenotypes.</div></div><div><h3>Design</h3><div>Observational study of a prospectively collected cohort of severe trauma patients, with retrospective database completion, studied between 2012 and 2022.</div></div><div><h3>Setting</h3><div>A trauma intensive care unit (ICU).</div></div><div><h3>Patients</h3><div>Severe trauma patients were defined by an Abbreviated Injury Scale of ≥ 3 in at least one aspect. Three groups were stablished according to hemodynamic status and Glasgow coma scale (GCS), and they were subsequently subdivided in prematurely deceased and survivors after &gt; 72 h (h). Laboratory parameters were followed up to 96 h, statistical analysis between groups and subgroups was performed at 0 and 24 h.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Prehospital, clinical variables on admission, prognostic variables (prospective gathering); blood count, biochemistry, coagulation, blood gas analysis (retrospectively collected).</div></div><div><h3>Results</h3><div>1631 patients were included, 8% prematurely deceased. Initial leukocytosis and hyperglycemia were common in all groups. Hemodynamically stable patients with a GCS &lt; 14 stood out due to a high neutrophil-to-lymphocyte ratio (NLR) and hypernatremia, both of them at 24 h, together with initial coagulopathy in the prematurely deceased. Hemodynamically unstable patients exhibited an initial pattern of lactic acidosis, coagulopathy, and decreased platelet-to-lymphocyte ratio, hemoglobin, albumin and calcium, all these changes being most prominent in the prematurely deceased. A 24 h peak in NLR was found in both the hemodynamically unstable and GCS &lt; 14 groups.</div></div><div><h3>Conclusion</h3><div>Evolution of laboratory parameters differ according to the patient’s phenotype. They complete the initial severity evaluation and in hemodynamically stable patients they act as a warning for potential neurological damage.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502227"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578959","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":"Traumatismo pediátrico, ¿dónde estamos y hacia dónde vamos? Revisión narrativa de la evidencia reciente","authors":"Luis Renter Valdovinos ,&nbsp;Ander Ceña Setien ,&nbsp;Javier Rodríguez-Fanjul ,&nbsp;Jesús Abelardo Barea-Mendoza","doi":"10.1016/j.medin.2025.502388","DOIUrl":"10.1016/j.medin.2025.502388","url":null,"abstract":"<div><div>Trauma is the leading cause of death in children and adolescents. This article reviews recent advances in the management of severe pediatric trauma, emphasizing the importance of well-organized trauma systems, effective triage, and protocols specifically adapted to pediatric physiology. Current strategies for damage-control resuscitation are discussed, including the use of blood products, vasoactive support, and novel predictive indices for shock severity. In traumatic brain injury, the role of multimodal neuromonitoring and individualized management of intracranial and cerebral perfusion pressures is reviewed. The need to move beyond adult-centered approaches and tailor care to pediatric-specific characteristics is strongly emphasized. Finally, the main research priorities in pediatric trauma are outlined, which are essential for improving survival and functional recovery in this vulnerable population.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 4","pages":"Article 502388"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578960","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":"SARS-CoV-2 vaccination reduces the risk of thrombotic complications in severe COVID-19","authors":"M. Ángeles Alonso Fernández ,&nbsp;Carola Bledig ,&nbsp;Madian Manso Álvarez ,&nbsp;Raquel Gómez Guardiola ,&nbsp;Marina Blancas García ,&nbsp;Irene Bartolomé ,&nbsp;Manuel Quintana Díaz ,&nbsp;Pilar Marcos Neira ,&nbsp;Jose Alberto Silva Obregón ,&nbsp;Ainhoa Serrano Lázaro ,&nbsp;Salvador Campillo Morales ,&nbsp;Blanca López Matamala ,&nbsp;Carmen Martín Parra ,&nbsp;Ángela Algaba Calderón ,&nbsp;Rafael Blancas Gómez-Casero ,&nbsp;Óscar Martínez González","doi":"10.1016/j.medin.2025.502167","DOIUrl":"10.1016/j.medin.2025.502167","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to evaluate the association between SARS-CoV-2 vaccination and the occurrence of thrombotic complications in patients admitted to intensive care for severe COVID-19 pneumonia.</div></div><div><h3>Design</h3><div>Observational, descriptive, prospective, multicentre study.</div></div><div><h3>Setting</h3><div>Intensive care units of five university hospitals.</div></div><div><h3>Patients</h3><div>A total of 255 patients admitted to the intensive care unit (ICU) with SARS-CoV-2 pneumonia, confirmed by RT-PCR in throat swab or tracheal aspirate, starting the date the first vaccinated patient against SARS-CoV-2 was admitted in one of the participating ICUs, were included in the analysis.</div></div><div><h3>Main variables of interest</h3><div>Vaccination status against SARS-CoV-2 and thrombotic events.</div></div><div><h3>Results</h3><div>18.8% of patients had received some form of vaccination. Thrombotic events occurred in 21.2% of patients. Lack of vaccination was associated with thrombotic events (OR 5.024; 95% CI: 1.104−23.123; <em>p</em> = 0.0037) and death (OR 5.161; 95% CI: 1.075–24.787; <em>p</em> = 0.04). ICU mortality was not associated with the occurrence of thrombotic complications.</div></div><div><h3>Conclusions</h3><div>In this series of patients, vaccination against SARS-CoV-2 reduced the risk of thrombotic events and mortality in patients with severe COVID-19 admitted to the ICU. Thrombotic complications did not alter ICU mortality.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502167"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414363","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":"De lo que no hablan las escalas predictivas","authors":"Marcos Valiente Fernández ,&nbsp;Cristina Serrano Gómez ,&nbsp;Amanda Lesmes González de Aledo ,&nbsp;Isaías Martín Badía","doi":"10.1016/j.medin.2025.502158","DOIUrl":"10.1016/j.medin.2025.502158","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502158"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414373","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":"Neumatosis portal y endofuga aórtica en paciente con cirugía valvular aórtica reciente","authors":"Raquel Varona Sáez de Ibarra,&nbsp;Pedro Jiménez Cabrera,&nbsp;Lourdes Fisac Cuadrado","doi":"10.1016/j.medin.2025.502346","DOIUrl":"10.1016/j.medin.2025.502346","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502346"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414375","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":"Simulación en la UCIP: formación en situaciones críticas","authors":"Alicia Ogando Martínez ,&nbsp;Amelia Martínez de Azagra ,&nbsp;Vianor Pablo Silvero Enríquez ,&nbsp;Santiago Mencía Bartolomé","doi":"10.1016/j.medin.2025.502316","DOIUrl":"10.1016/j.medin.2025.502316","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div><div>In this review, we will focus on the usefulness of clinical simulation for the training of Pediatric Critical Care Unit (PICU) staff, especially in non-technical skills such as effective communication and teamwork in critical situations.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502316"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414362","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":"Valor pronóstico de los nuevos biomarcadores neuroespecíficos en el paciente recuperado de una parada cardiorrespiratoria","authors":"Javier Puerma Jiménez ,&nbsp;Ana Carrasco Cáliz ,&nbsp;José Miguel Pérez Villares ,&nbsp;Antonio Cárdenas Cruz","doi":"10.1016/j.medin.2025.502295","DOIUrl":"10.1016/j.medin.2025.502295","url":null,"abstract":"<div><div>Neurological prognosis of patients recovered from a cardiac arrest remains a challenge for intensive medicine specialists. Given the complexity of this scenario and the ensuing ethical dilemmas, current guidelines from the major scientific societies recommend a multimodal prognostic model for patients recovered from cardiac arrest. This model combines several clinical parameters, neurophysiological studies, such as electroencephalogram and somatosensory evoked potentials, and neuroimaging studies such as computed tomography scan and magnetic resonance imaging, as well as biomarkers for brain injury. More recently, several biomarkers associated with brain injury, originating from different regions of the brain, have been identified as potential prognostication tools within a multimodal approach. Based on the preliminary evidence gathered around them, several novel and promising biomarkers have been put forward. This literature review aims to examine four of them: ubiquitin carboxy-terminal hydrolase L1, glial fibrillary acidic protein, neurofilament light and tau protein.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502295"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414365","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":"Impact of empiric anti-MRSA therapy on survival outcome in severe acute pancreatitis: a MIMIC-IV cohort study","authors":"Yinghui Hong ,&nbsp;Mingliang Ye ,&nbsp;Junshi Wang ,&nbsp;Yuhang Chen ,&nbsp;Bin Huang ,&nbsp;Xi Li ,&nbsp;Lei Huang","doi":"10.1016/j.medin.2025.502363","DOIUrl":"10.1016/j.medin.2025.502363","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of early empirical anti-Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) therapy on the survival outcomes of patients with severe acute pancreatitis (SAP) in the intensive care units (ICUs).</div></div><div><h3>Design</h3><div>Secondary Analysis of the the Medical Information Mart for Intensive Care-IV (MIMIC-IV v3.1) on MRSA therapy in Intensive Care Units (ICUs).</div></div><div><h3>Setting</h3><div>94,458 ICU hospitalization records from 65,366 unique patients between 2008 and 2019.</div></div><div><h3>Patients</h3><div>494 patients diagnosed with acute pancreatitis first admitted to the ICU.</div></div><div><h3>Interventions</h3><div>Anti-MRSA (vancomycin or linezolid) agents.</div></div><div><h3>Main variables of interest</h3><div>28-day and 90-day mortality rates, incidence of renal impairment, and total hospitalization costs.</div></div><div><h3>Results</h3><div>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, <em>p</em> = 0.14) or hospital mortality (aRR, 0.53; 95% CI, 0.21–1.33, <em>p</em> = 0.18) between the two groups. Similarly, 28-day mortality and 90-day mortality did not significantly differ (<em>p</em> &gt; 0.05). Empirical anti-MRSA therapy was associated with significantly longer ICU and hospital LOS (<em>p</em> &lt; 0.001). Subgroup analysis revealed that anti-MRSA therapy significantly increased acute kidney injury incidence (<em>p</em> = 0.002), particularly in patients without pre-existing kidney disease (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502363"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414366","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}