Medicina intensiva最新文献

{"title":"Pooled uncertainty and hypoxemia thresholds in a meta-analysis of noninvasive ventilation for preoxygenation.","authors":"Rongtao Dai","doi":"10.1016/j.medine.2026.502647","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502647","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502647"},"PeriodicalIF":0.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The conundrum of zero-reference points for arterial blood pressure measurement in neurocritical care patients.","authors":"Daniel Agustín Godoy, Jon Pérez-Bárcena, Juan Antonio Llompart-Pou","doi":"10.1016/j.medine.2026.502645","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502645","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502645"},"PeriodicalIF":0.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarker profiles in COVID-19 and non-covid ARDS: Similar patterns with high-flow nasal cannula and mechanical ventilation, distinct by ARDS etiology.","authors":"Joan Ramon Masclans-Enviz, Berta Jové, Irene Dot Jordana, Clara Vilà-Vilardell, Francisco José Parrilla Gómez, Andrea Castellvi-Font, Daniel Molano Franco, Marina García-de-Acilu, Oriol Roca, Purificación Pérez-Terán, Rosana Muñoz-Bermúdez","doi":"10.1016/j.medine.2026.502629","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502629","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies in non-COVID acute respiratory distress syndrome (ARDS) demonstrated that hypoxemic patients treated with high-flow nasal cannula (HFNC) and those receiving invasive mechanical ventilation (MV) have comparable biomarker profiles. We aimed to determine whether these findings apply to COVID-19 ARDS and to compare biomarker profiles between COVID-19 and non-COVID ARDS.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Medical-surgical intensive care units of two tertiary hospitals.</p><p><strong>Patients: </strong>Adults with COVID-19 ARDS managed with MV or HFNC and a previously published non-COVID ARDS cohort.</p><p><strong>Intervention: </strong>None.</p><p><strong>Main variables of interest: </strong>Baseline demographics, clinical, respiratory hemodynamic, and laboratory variables were collected. Plasma concentrations of epithelial lung injury markers (receptor for advanced glycation end products [RAGE], surfactant protein D [SP-D]), endothelial injury marker (angiopoietin-2 [Ang-2]), and inflammatory cytokines (IL-6 and IL-8) were measured.</p><p><strong>Results: </strong>A total of 135 patients with COVID-19 were included (22 MV, 113 HFNC); 53 [46.9%] HFNC patients subsequently required intubation. In matched analyses, biomarker concentrations did not differ significantly between MV and HFNC groups. Within the HFNC cohort, higher RAGE concentrations were associated with HFNC failure [cutoff ≥ 3338.5 pg/mL; adjusted OR∼15 (95%CI 1.9-65.0)]. Patients with HFNC failure exhibited biomarker profiles similar to those of invasively ventilated patients. Comparison according to ARDS etiology showed higher RAGE and IL-6 concentrations in COVID-19 ARDS, whereas SP-D and Ang-2 concentrations were higher in non-COVID ARDS.</p><p><strong>Conclusions: </strong>Patients with COVID-19 acute hypoxemic respiratory failure managed with HFNC or MV exhibited broadly similar epithelial, endothelial and inflammatory biomarker profiles. These findings support further investigation into the inclusion of non-intubated patients fulfilling ARDS criteria apart from PEEP requirements within the ARDS spectrum. Differences in biomarker profiles between COVID-19 and non-COVID ARDS suggest biological heterogeneity according to ARDS etiology. Elevated RAGE concentrations were associated with HFNC failure and may reflect the prognostic relevance of epithelial injury in COVID-19 ARDS.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502629"},"PeriodicalIF":0.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the optic nerve sheath: Terson syndrome detected by bedside ocular ultrasound.","authors":"Álvaro Velasco Villagarcía, Ana María Bueno González, Elena Bustamante Munguira","doi":"10.1016/j.medine.2026.502607","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502607","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502607"},"PeriodicalIF":0.0,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From risk factors to prediction: Artificial intelligence as the next frontier in preventing CRRT interruption","authors":"Mattia Madeo,&nbsp;Stefano Fresilli,&nbsp;Zaninni Caroleo,&nbsp;Eugenio Garofalo,&nbsp;Andrea Bruni","doi":"10.1016/j.medine.2026.502527","DOIUrl":"10.1016/j.medine.2026.502527","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502527"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teleassistance and augmented reality in difficult airway management: Between technological promise and clinical evidence","authors":"Josep Trenado-Álvarez","doi":"10.1016/j.medine.2026.502560","DOIUrl":"10.1016/j.medine.2026.502560","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502560"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of beta-blockers on cardiovascular outcomes in myocardial infarction patients with preserved or mildly reduced ejection fraction: Systematic review and meta-analysis of randomized trials","authors":"Leonardo David Neira-Chunga,&nbsp;Diego Alexis Moncada-Gutiérrez,&nbsp;Gustavo Adolfo Vásquez-Tirado,&nbsp;Marcos Israel Morales-Piscoya,&nbsp;Wilson Marcial Guzmán-Aguilar,&nbsp;Claudia Vanessa Quispe-Castañeda,&nbsp;Edinson Dante Meregildo-Rodríguez,&nbsp;Angie Farfán-Castillo,&nbsp;Víctor Serna-Alarcón,&nbsp;Mariano Ortiz-Pizarro,&nbsp;Milene Villarreal-Jara","doi":"10.1016/j.medine.2026.502544","DOIUrl":"10.1016/j.medine.2026.502544","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between beta-blocker therapy and major cardiovascular outcomes in patients with acute myocardial infarction (AMI) and preserved or mildly reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis of randomized clinical trials.</div></div><div><h3>Setting</h3><div>A comprehensive search of five electronic databases was conducted using a predefined PICO strategy to identify published studies. Seven studies were selected and included in the meta-analysis.</div></div><div><h3>Participants</h3><div>Patients with AMI and preserved or mildly reduced LVEF who received beta-blocker therapy.</div></div><div><h3>Intervention</h3><div>Use of beta-blockers.</div></div><div><h3>Main outcome measures</h3><div>Primary composite outcome including mortality, reinfarction, cardiovascular-related hospitalization, and other cardiovascular events.</div></div><div><h3>Results</h3><div>This meta-analysis included four studies comprising a total of 18,504 patients with a history of AMI and an LVEF ≥ 40%. Among them, 2223 patients had mildly reduced LVEF, while 15,908 belonged to the preserved LVEF group. Beta-blocker therapy did not reduce the primary composite outcome (death, reinfarction, and hospitalization) in patients with LVEF ≥ 40% (hazard ratio [HR]: 0.90; 95% confidence interval [95% CI]: 0.81–1.01). Subsequent subgroup analyses showed that beta-blocker therapy did not reduce the primary composite outcome in patients with preserved LVEF (HR: 0.94; 95% CI: 0.87–1.03); however, in patients with mildly reduced LVEF, it was associated with a reduction in the same primary composite outcome (HR: 0.82; 95% CI: 0.70−0.97).</div></div><div><h3>Conclusions</h3><div>In this meta-analysis, beta-blocker use was not associated with a significant reduction in the primary composite outcome or in mortality or reinfarction. The association observed in patients with mildly reduced ejection fraction derives from a subgroup and should be interpreted with caution in the context of an overall neutral result.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502544"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the algorithm: Rethinking the role of pH in acid–base interpretation","authors":"Juan Francisco Piedra","doi":"10.1016/j.medine.2026.502545","DOIUrl":"10.1016/j.medine.2026.502545","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502545"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-acute myocardial infarction mechanical complications: Comparison of the clinical profile, type of complication, and mortality between a historical national cohort and a contemporary local cohort","authors":"Cristina García Laborda,&nbsp;Pablo Ruiz de Gopegui Miguelena,&nbsp;Cristina Royo Villa,&nbsp;Isabel Sancho Val,&nbsp;María Barrera Sánchez,&nbsp;Javier Miguelena Hycka,&nbsp;Andrés Carrillo López","doi":"10.1016/j.medine.2026.502528","DOIUrl":"10.1016/j.medine.2026.502528","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502528"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the potential role of augmented-reality smart glasses in the management of the difficult airway. The SMART-INTUBATION study","authors":"Emilio Rodriguez-Ruiz,&nbsp;Silvia Aranda-García,&nbsp;Rita García-Fernández,&nbsp;Carmen Elisa Espinosa-Pereiro,&nbsp;Maitane Campelo-Izquierdo,&nbsp;Jorge Fernández-Rodríguez,&nbsp;Gloria Prada-Hervella,&nbsp;Ana Estany-Gestal,&nbsp;Miguel A. Rodríguez-Vargas,&nbsp;Antonio Rodríguez-Núñez","doi":"10.1016/j.medine.2026.502524","DOIUrl":"10.1016/j.medine.2026.502524","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the potential role of augmented-reality smart glasses (A-SGs) for the assistance of residents in airway management.</div></div><div><h3>Design</h3><div>Observer-blinded, parallel-group, randomised trial.</div></div><div><h3>Setting</h3><div>An integrated clinical simulation centre.</div></div><div><h3>Participants</h3><div>Residents involved in critically ill patient care.</div></div><div><h3>Interventions</h3><div>Each participant performed a baseline endotracheal intubation (ETI) trial and a follow-up ETI trial (M1). Before M1 participants were randomly assigned either to the control group (unguided) or to the intervention group (tele-guided with A-SGs). No support was provided to participants during the M0 or during M1 in the control group. Residents allocated to A-SGs received real-time audio and video guidance from an expert in airway management.</div></div><div><h3>Main variables</h3><div>Sociodemographic variables, the execution of each ETI step, the ETI efficacy ETI, and all procedural times.</div></div><div><h3>Results</h3><div>The 39 residents obtained comparable results at M0. During M1, participants tele-guided with A-SGs performed the ETI in a more organised and structured way, especially when inserting the endotracheal tube (<em>p</em> = 0.003) and checking its proper placement (<em>p</em> &lt; 0.001). Higher ETI efficacy was observed in the intervention group compared with the control (<em>p</em> &lt; 0.001). Within the intervention group itself, significant improvement in intubation efficacy was observed between M0 and M1 (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>A-SGs tele-assistance while the trainee shares the airway view with a remote expert is feasible and may have a positive impact on training residents on difficult airway management.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502524"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}