Medicina intensiva最新文献_第10页

Medicina intensiva Pub Date : 2025-04-01 DOI: 10.1016/j.medine.2024.10.010

Marcos Valiente Fernández, Alejandro Caballo Manuel, José Ginestal Calvo, Lidia Orejon García

引用次数: 0

β-lactam antibiotics to prevent ventilator-associated pneumonia (VAP) in coma patients: A systematic review and meta-analysis of randomized controlled trials. β-内酰胺抗生素预防昏迷患者呼吸机相关性肺炎（VAP）：随机对照试验的系统回顾和荟萃分析

Medicina intensiva Pub Date : 2025-03-25 DOI: 10.1016/j.medine.2025.502199

Edinson Dante Meregildo-Rodriguez, Mariano Ortiz-Pizarro, Martha Genara Asmat-Rubio, Carlos Geraldo Fernandez-Narváez, Gustavo Adolfo Vásquez-Tirado

{"title":"β-lactam antibiotics to prevent ventilator-associated pneumonia (VAP) in coma patients: A systematic review and meta-analysis of randomized controlled trials.","authors":"Edinson Dante Meregildo-Rodriguez, Mariano Ortiz-Pizarro, Martha Genara Asmat-Rubio, Carlos Geraldo Fernandez-Narváez, Gustavo Adolfo Vásquez-Tirado","doi":"10.1016/j.medine.2025.502199","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502199","url":null,"abstract":"Objective: To evaluate the effect of parenteral β-lactam antibiotics on outcomes related to ventilator-associated pneumonia (VAP) in adult patients in coma due to acute brain injury (ABI).Design: Systematic review and meta-analysis.Setting: Randomized controlled trials (RCTs) published up toSeptember 30, 2024.Patients or participants: Adult patients in coma due to ABI.Interventions: Parenteral β-lactam antibiotics.Main variables of interest: Incidence and outcomes related to VAP.Results: Three RCTs involving 483 patients met inclusion criteria; 231 patients received β-lactam prophylaxis. Among these, there were 115 cases of early-onset VAP (EO-VAP), 49 of late-onset VAP (LO-VAP), and 102 deaths. All studies were conducted in Europe. Causes of coma included trauma, stroke, and CO poisoning. Intravenous β-lactams (ampicillin/sulbactam, cefuroxime, and ceftriaxone) reduced EO-VAP risk by 57% (RR 0.43; 95% CI 0.30-0.61), and all-VAP by 35% (RR 0.65; 95% CI 0.53-0.80). No impact was observed on LO-VAP (RR 0.95; 95% CI 0.54-1.67), 28-day mortality (RR 0.76; 95% CI 0.53-1.09), intubation duration (SMD -0.13; 95% CI -0.46-0.21), or ICU length of stay (SMD -0.22; 95% CI -0.55-0.12). Heterogeneity and the risk of bias were low, with high overall evidence certainty.Conclusions: In adult patients in coma due to ABI, intravenous β-lactam antibiotics reduce EO-VAP and all-VAP risk.","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502199"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723048","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}

引用次数: 0

SARS-CoV-2 vaccination reduces the risk of thrombotic complications in severe COVID-19. SARS-CoV-2疫苗可降低重症COVID-19患者血栓性并发症的风险。

Medicina intensiva Pub Date : 2025-03-21 DOI: 10.1016/j.medine.2025.502167

M Ángeles Alonso Fernández, Carola Bledig, Madian Manso Álvarez, Raquel Gómez Guardiola, Marina Blancas García, Irene Bartolomé, Manuel Quintana Díaz, Pilar Marcos Neira, Jose Alberto Silva Obregón, Ainhoa Serrano Lázaro, Salvador Campillo Morales, Blanca López Matamala, Carmen Martín Parra, Ángela Algaba Calderón, Rafael Blancas Gómez-Casero, Óscar Martínez González

{"title":"SARS-CoV-2 vaccination reduces the risk of thrombotic complications in severe COVID-19.","authors":"M Ángeles Alonso Fernández, Carola Bledig, Madian Manso Álvarez, Raquel Gómez Guardiola, Marina Blancas García, Irene Bartolomé, Manuel Quintana Díaz, Pilar Marcos Neira, Jose Alberto Silva Obregón, Ainhoa Serrano Lázaro, Salvador Campillo Morales, Blanca López Matamala, Carmen Martín Parra, Ángela Algaba Calderón, Rafael Blancas Gómez-Casero, Óscar Martínez González","doi":"10.1016/j.medine.2025.502167","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502167","url":null,"abstract":"Objectives: 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.Design: Observational, descriptive, prospective, multicentre study.Setting: Intensive care units of five university hospitals.Patients: 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.Main variables of interest: Vaccination status against SARS-CoV-2 and thrombotic events.Results: 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; p = 0.0037) and death (OR 5.161; 95% CI: 1.075-24.787; p = 0.04). ICU mortality was not associated with the occurrence of thrombotic complications.Conclusions: 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.","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502167"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694984","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}

引用次数: 0

Short- and long-term mortality in critically ill patients with solid cancer. The Vall d'Hebron Intensive Care Unit-Vall d'Hebron Institute of Oncology Cohort: a retrospective study. 实体癌危重病人的短期和长期死亡率。Vall d'Hebron重症监护病房-Vall d'Hebron肿瘤研究所队列：回顾性研究。

Medicina intensiva Pub Date : 2025-03-18 DOI: 10.1016/j.medine.2025.502176

Cándido Díaz-Lagares, Alejandra García-Roche, Andrés Pacheco, Javier Ros, Erika P Plata-Menchaca, Adaia Albasanz, David Pérez, Nadia Saoudi, Isabel Ruiz-Camps, Elena Élez, Ricard Ferrer

{"title":"Short- and long-term mortality in critically ill patients with solid cancer. The Vall d'Hebron Intensive Care Unit-Vall d'Hebron Institute of Oncology Cohort: a retrospective study.","authors":"Cándido Díaz-Lagares, Alejandra García-Roche, Andrés Pacheco, Javier Ros, Erika P Plata-Menchaca, Adaia Albasanz, David Pérez, Nadia Saoudi, Isabel Ruiz-Camps, Elena Élez, Ricard Ferrer","doi":"10.1016/j.medine.2025.502176","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502176","url":null,"abstract":"Objective: To describe in-hospital and one-year mortality and to identify prognostic variables associated with mortality.Design: Retrospective cohort study.Setting: Tertiary referral hospital in Barcelona (Spain).Patients: Consecutive patients with solid cancer and unplanned admission to the ICU over a ten year period (2010-2019).Main variables of interest: In-hospital mortality, one-year mortality, type of cancer, metastatic disease, ECOG, APACHE, SOFA, invasive mechanical ventilation, vasoactive drugs, renal replacement therapy.Results: Three hundred and ninety-five patients were admitted to the ICU; 193 (48.8%) had metastatic disease, and 22 (5.9%) presented neutropenia. The median SOFA score on day 1 of ICU admission was 6 (3-9). ICU, in-hospital, and one-year mortality were 27.9% (110 patients), 39% (139 patients), and 61.1% (236 patients), respectively. A non-surgical admission, a higher ECOG, a SOFA score > 9 on day 1, a non-decreasing SOFA score on day 5, and requiring invasive mechanical ventilation were factors associated with in-hospital mortality. ECOG, inability to resume anticancer therapy, and ICU admission due to respiratory failure were associated with one-year mortality in hospital survivors.Conclusion: Survival in critically ill solid cancer patients is substantial, even when metastatic disease exists. Short-term outcomes were associated with ECOG and organ dysfunction, not cancer per se. The prognosis of patients with a non-decreasing SOFA score on day 5 is poor, especially when the SOFA score on day 1 was >9. Long-term mortality was associated with functional status and inability to resume anticancer therapy.","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502176"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665801","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}

引用次数: 0

Artificial intelligence in intensive care medicine, the gradual revolution. 人工智能在重症监护医学中，逐渐发生革命。

Medicina intensiva Pub Date : 2025-03-18 DOI: 10.1016/j.medine.2025.502164

Alejandro González-Castro

引用次数: 0

Mortality time frame variability in septic shock clinical trials: A systematic review. 感染性休克临床试验的死亡率时间框架可变性：一项系统综述。

Medicina intensiva Pub Date : 2025-03-15 DOI: 10.1016/j.medine.2025.502172

Andres Laserna, John A Cuenca, Peyton Martin, Cosmo Fowler, Julian Barahona-Correa, Nirmala Manjappachar, Clara Fowler, Maria A Lopez-Olivo, Marcio Borges, Charles L Sprung, Joseph L Nates

{"title":"Mortality time frame variability in septic shock clinical trials: A systematic review.","authors":"Andres Laserna, John A Cuenca, Peyton Martin, Cosmo Fowler, Julian Barahona-Correa, Nirmala Manjappachar, Clara Fowler, Maria A Lopez-Olivo, Marcio Borges, Charles L Sprung, Joseph L Nates","doi":"10.1016/j.medine.2025.502172","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502172","url":null,"abstract":"Objective: We sought to delineate the mortality outcome time frames reported in septic shock randomized control trials (RCTs).Design: Systematic review of PubMed, EMBASE, and the Cochrane Database of Systematic Reviews.Setting: Intensive care units.Participants: Studies that included adult patients with septic shock.Interventions: Any type of intervention.Main variables of interest: Information about the study, specific patient population, type of study intervention, specific intervention, and number of patients. Mortality time frames were analyzed for geographical differences and changes over time.Results: The search yielded 2660 unique citations. After screening, 132 eligible studies were identified. A total of 234 mortality time frames were collected from the included studies, of which 15 timeframes were unique. The most frequently reported time frame was 28-day mortality (n = 98, 74% of trials), followed by hospital mortality (n = 35, 27%), ICU mortality (n = 30, 23%), and 90-day mortality (n = 29, 22%). The most reported mortality time frame was 28 days in studies from every continent except Africa. The studies published between 2008 and 2013 (25%) more frequently reported hospital and ICU mortality combination than studies published between 2014 and 2019 (11.4%) (P = 0.043).Conclusions: There was considerable variability in the mortality time frames reported in ICU-based septic shock trials. This variability may lead to under or overestimation of the problem, overlooking the effectiveness of the interventions studied, and further limiting the application of trials and their pooling in meta-analyses. A consensus regarding time frame reporting in septic shock trials is long overdue.","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502172"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639937","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}

引用次数: 0

Exploring volatile anesthetics in critical care: Facts and uncertainties. 探索挥发性麻醉药在重症监护：事实和不确定性。

Medicina intensiva Pub Date : 2025-03-11 DOI: 10.1016/j.medine.2025.502174

José Manuel Añón, María Paz Escuela, Javier Oliva-Navarro, Arís Pérez-Lucendo, Fernando Suarez-Sipmann

引用次数: 0

Does early surfactant improve outcome in late preterm newborn? Retrospective study in a neonatal intensive care unit. 早期表面活性剂能改善晚期早产儿的预后吗？新生儿重症监护病房回顾性研究。

Medicina intensiva Pub Date : 2025-03-10 DOI: 10.1016/j.medine.2025.502161

Jorge Bartual Bardisa, Carolina Vizcaíno Díaz, María Jesús Ferrández Berenguer

{"title":"Does early surfactant improve outcome in late preterm newborn? Retrospective study in a neonatal intensive care unit.","authors":"Jorge Bartual Bardisa, Carolina Vizcaíno Díaz, María Jesús Ferrández Berenguer","doi":"10.1016/j.medine.2025.502161","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502161","url":null,"abstract":"Objective: To compare the early administration of surfactant, before 12 h of life, versus late, in late preterm neonates (born between 34+0 and 36+6 weeks of gestation), with moderate-severe respiratory distress.Design: Retrospective, observational, analytical, case-control study, with late preterm infants admitted between 2012-2021. It is divided into 2 groups: surfactant administered ≤ 12 h of life and >12 h and evolution is compared using univariate analysis.Setting: Neonatal Intensive Care Unit (NICU) level III of a Universitary Hospital.Patients or participants: 57 patients, 30 in the early group and 27 in the late group.Inclusion criteria: neonates from 34+0 to 36+6 weeks of gestation, with respiratory distress syndrome, in need of non-invasive ventilation and surfactant.Interventions: None.Main variables of interest: Sociodemographic, clinical and evolutionary: redosing, duration of respiratory support, oxygen and time to stop requiring it after surfactant. Also, complications and length of hospitalization.Results: In the early group there was less need for redosing (3.3% vs 48.1%, P < .001) and a decrease in duration, in days, of stay in the NICU (7 vs 10.5, P .002), invasive mechanical ventilation (2.4 vs 3.9, P .034), total respiratory support (4.6 vs 6.6, P .005) and oxygen therapy (0.4 vs 2.8, P < .001). Also, lower incidence of pneumothorax (0% vs 33.3%, P .001). Furthermore, 12 h after administration, 83.4% maintained FiO2 0.21, compared to 44.4% in the late administration.Conclusions: In our study, early administration in late preterm infants provides benefits in terms of respiratory assistance and complications. We suggest expanding studies to establish recommendations in this group of patients.","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502161"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607528","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}

引用次数: 0

Effectiveness of non-invasive ventilation in critical patients with acute respiratory failure and do not intubate order. 对急性呼吸衰竭且未下达插管指令的危重病人进行无创通气的效果。

Medicina intensiva Pub Date : 2025-03-10 DOI: 10.1016/j.medine.2025.502169

Andres Carrillo-Alcaraz, Miguel Guia, Pilar Tornero-Yepez, Laura López-Gomez, Nuria Alonso-Fernandez, Juan Gervasio Martin Lorenzo, Juan Miguel Sanchez Nieto

{"title":"Effectiveness of non-invasive ventilation in critical patients with acute respiratory failure and do not intubate order.","authors":"Andres Carrillo-Alcaraz, Miguel Guia, Pilar Tornero-Yepez, Laura López-Gomez, Nuria Alonso-Fernandez, Juan Gervasio Martin Lorenzo, Juan Miguel Sanchez Nieto","doi":"10.1016/j.medine.2025.502169","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502169","url":null,"abstract":"Objective: The main purpose of this study was to analyze the prevalence of do-not-intubate (DNI) orders in patients admitted to an Intensive Care Unit (ICU) due to acute respiratory failure (ARF) and who were treated with non-invasive ventilation (NIV). The secondary objective was to correlate the presence of a DNI order with the patient's prognosis.Design: Retrospective observational study.Setting: Polyvalent ICU.Patients: All consecutively admitted ICU patients for ARF between January 1st, 1997, and December 31st, 2022, who were treated with NIV.Main variables of interest: Initial clinical variables, NIV failure rate, complications, in-hospital and one-year mortality.Results: 5972 patients were analyzed, 1275 (21.3%) presenting a DNI order. The mean age was 68.2 ± 14.9; 60.2% were male. The most frequent cause of DNI order was chronic respiratory disease (452 patients; 35.5%). Patients with DNI order were older, had higher Charlson comorbidity index and higher frailty. NIV failure occurred in 536 (42.0%) patients in the DNI order group vs. 1118 (23.8%) in the non-DNI order group (p < 0.001). In-hospital mortality was higher in patients with DNI order (57.9% vs 16.4%; p < 0.001). The adjusted OR for inhospital mortality was 2.14 (95% CI 1.98 to 2.31).Conclusions: DNI orders are common in patients with ARF treated with NIV and they related to worse short and long-term prognosis.","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502169"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607495","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}

引用次数: 0

Complication of cardiogenic shock and use of ultrasound. 心源性休克的并发症及超声的应用。

Medicina intensiva Pub Date : 2025-03-06 DOI: 10.1016/j.medine.2025.502150

Julia Macías Clemente, Nora Palomo López, Gerardo Ferrigno Bonilla

引用次数: 0