Medicina intensiva最新文献

{"title":"The value of local validation of a predictive model. A nomogram for predicting failure of non-invasive ventilation in patients with SARS-COV-2 pneumonia","authors":"Héctor Hernández Garcés ,&nbsp;Alberto Belenguer Muncharaz ,&nbsp;Francisco Bernal Julián ,&nbsp;Irina Hermosilla Semikina ,&nbsp;Luis Tormo Rodríguez ,&nbsp;Estefanía Granero Gasamans ,&nbsp;Clara Viana Marco ,&nbsp;Rafael Zaragoza Crespo","doi":"10.1016/j.medine.2025.502148","DOIUrl":"10.1016/j.medine.2025.502148","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to determine predictors of non-invasive ventilation (NIV) failure and validate a nomogram to identify patients at risk of NIV failure.</div></div><div><h3>Design</h3><div>Observational, analytical study of a retrospective cohort from a single center, compared with an external cohort (March 2020 to August 2021).</div></div><div><h3>Setting</h3><div>Two intensive care units (ICUs).</div></div><div><h3>Patients</h3><div>Patients with pneumonia due to severe acute respiratory syndrome (SARS-CoV-2) and NIV &gt; 24 h (154 and 229 in each cohort).</div></div><div><h3>Interventions</h3><div>The training cohort identified NIV failure predictors. A nomogram, created via logistic regression, underwent validation with the Hosmer-Lemeshow (HL), calibration curve and test and area under the curve (AUC). Its external validity was tested using AUC.</div></div><div><h3>Main variables of interest</h3><div>Demographics, comorbidities, severity scores, NIV settings, vital signs, blood gases, and oxygenation at the start and 24 h after NIV, NIV failure.</div></div><div><h3>Results</h3><div>NIV failure was 37.6% and 18% in the training and validation cohorts, respectively. Risk factors for NIV failure inluded age, obesity, sequential organ failure assessment (SOFA) score at admission, and heart rate (HR) and heart rate, acidosis, consciousness, oxygenation, respiratory rate (HACOR) 24 h post-NIV. The model's HL test result was 0.861, with an AUC of 0.89 (confidence interval [CI] 0.839–0.942); validation AUC was 0.547 (CI 0.449–0.645).</div></div><div><h3>Conclusions</h3><div>A predictive model using age, obesity, SOFA score, HR, and HACOR at 24 h predicts NIV failure in our COVID-19 patients but may not apply to other ICUs.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 5","pages":"Article 502148"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019144","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":"Macroscopic findings in Tracheobronchial Aspergillosis during Bronchoscopy","authors":"Leandro Tapia Barredo,&nbsp;Santiago Menjura Gómez,&nbsp;Carmen Angela Centeno Clemente","doi":"10.1016/j.medine.2025.502364","DOIUrl":"10.1016/j.medine.2025.502364","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 5","pages":"Article 502364"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644095","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":"Hemodynamic monitoring in shock: from essentials to advanced approaches","authors":"Patricia Escudero-Acha,&nbsp;Rodrigo Albillos-Almaraz,&nbsp;Miguel Pajares Calvo,&nbsp;José Antonio Fernández-Ratero","doi":"10.1016/j.medine.2026.502390","DOIUrl":"10.1016/j.medine.2026.502390","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 5","pages":"Article 502390"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101237","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":"Solid consequences of enteral nutrition: Facing the therapeutic challenge of esophageal bezoars – A case report","authors":"Marta de Antonio-Cuscó ,&nbsp;Lucía Picazo ,&nbsp;Agustí Albalat-Torres ,&nbsp;Mónica Marín-Casino ,&nbsp;Francisco José Parrilla-Gómez ,&nbsp;Javier Mateu-de Antonio","doi":"10.1016/j.medine.2025.502311","DOIUrl":"10.1016/j.medine.2025.502311","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 5","pages":"Article 502311"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800896","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":"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.medine.2025.502231","DOIUrl":"10.1016/j.medine.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":94139,"journal":{"name":"Medicina intensiva","volume":"50 5","pages":"Article 502231"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340729","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":"Safety and effects of early mobilization with in-bed cycloergometry versus conventional physiotherapy in critically ill patients: A randomized control trial.","authors":"Gemma Rialp, Isabel Gil, Maria Romero, Catalina Morey, Fiorella Sarubbo, Catalina Forteza","doi":"10.1016/j.medine.2026.502512","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502512","url":null,"abstract":"<p><strong>Objective: </strong>To compare the safety of conventional physiotherapy alone versus its combination with cycloergometry by analysing session interruptions and physiological tolerance in critically ill patients. Secondarily, efficacy was assessed through strength and functional related outcomes.</p><p><strong>Design: </strong>Single-centre, parallel, two-arm, randomized clinical trial.</p><p><strong>Setting: </strong>Intensive Care Department.</p><p><strong>Participants: </strong>Mechanically ventilated patients.</p><p><strong>Intervention: </strong>Control group received 30-min of conventional physiotherapy; intervention group received 15-min of cycloergometry and 15-min of conventional physiotherapy.</p><p><strong>Main variables of interest: </strong>Safety was evaluated by recording session interruptions and changes in blood pressure, heart rate, respiratory rate, SpO₂, FiO₂ and tidal volume before and after sessions. Muscle strength (modified Medical Research Council score, quadriceps and handgrip strength) was evaluated at first cooperation of participants, ICU discharge, 28-day and 6-month follow-up; Activities of Daily Living score and mobility scale at ICU discharge, 28 days and 6 months; and six-minute walking test and Short Form-36 at 28 days and 6 months.</p><p><strong>Results: </strong>46 participants completed 732 sessions. Both interventions produced significant but comparable physiological changes. Cycloergometry sessions were longer (30 vs. 25 min, p < 0.001) and had more interruptions (13% vs. 7%, p = 0.008), mainly due to fatigue and lack of cooperation. With the applied methodology no significant differences were observed in muscle strength or functional outcomes at any time point.</p><p><strong>Conclusion: </strong>Partially replacing conventional physiotherapy with cycloergometry was safe and well tolerated in critically ill patients. However, due to methodological limitations and the small sample size, no firm conclusions regarding efficacy can be drawn.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502512"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825254","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":"Consensus statement on the definition, diagnostic criteria, and treatment of refractory septic shock using a Delphi methodology.","authors":"David Andaluz-Ojeda, Ricard Ferrer, José Garnacho-Montero, Emilio Maseda-Garrido, Ana Ochagavía","doi":"10.1016/j.medine.2026.502448","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502448","url":null,"abstract":"<p><p>Refractory septic shock is a critical condition within the spectrum of sepsis, characterized by an inadequate response to standard hemodynamic resuscitation. In the absence of a consensus operational definition, a consensus study was conducted using the Delphi methodology. Thirty experts in sepsis and hemodynamics participated. Statements related to the definition, diagnostic criteria, and therapy strategies for RSS were evaluated. Consensus was reached on 23 of 28 statements, allowing RSS to be defined as a clinical entity characterized by persistent hypotension and signs of global hypoperfusion for more than one hour, despite optimized initial treatment. Consensus was reached on the use of hydrocortisone, the inclusion of elevated lactate as a marker of hypoperfusion, the utility of advanced hemodynamic monitoring and echocardiography, and general recommendations on the use of combined vasopressors were evaluated. This study lays the groundwork for future research and clinical algorithms.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502448"},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825284","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":"Reply to: \"β-lactams antibiotics to prevent ventilator-associated pneumonia in coma patients\".","authors":"Edinson Dante Meregildo-Rodriguez, Martha Genara Asmat-Rubio, Gustavo Adolfo Vásquez","doi":"10.1016/j.medine.2026.502445","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502445","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502445"},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793437","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":"Updated management of acute pancreatitis in intensive care medicine.","authors":"Felix Zubia-Olaskoaga, Eva Santafosta Gómez, Sonia López Cuenca, Ignacio Sáez de la Fuente","doi":"10.1016/j.medine.2026.502433","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502433","url":null,"abstract":"<p><p>Acute pancreatitis is defined as acute inflammation of the pancreas. The diagnosis of the condition is made on the basis of three key factors: epigastric pain, elevated enzymes levels and abnormal imagine tests. The classification of such cases is determined by the presence or absence of organ failure and the stage of (peri)pancreatic necrosis. Cases with persistent organ failure should be referred to the Intensive Care Unit. Management strategies emphasize supportive measures, adequate hydration, effective pain management, and the early initiation of nutrition. The use of antibiotics as a prophylactic measure is to be avoided. Surgery is indicated in cases of hollow organ perforation, intestinal ischemia, or failure of medical treatment in compartment syndrome. In general, the management of infected necrosis should be conservative or minimally invasive. However, should the condition develop before encapsulation and be associated with organ failure, noninvasive drainage is indicated. If such management proves ineffective, open necrosectomy should be considered.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502433"},"PeriodicalIF":0.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793382","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":"Transforming the management of the critically ill cancer patient: Teamwork, rapid response systems and quality of care.","authors":"Elena Cuenca Fito, María Cruz Martín Delgado, Jimena Lázaro González, Ana Hernangómez Vázquez","doi":"10.1016/j.medine.2026.502446","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502446","url":null,"abstract":"<p><p>In recent years, the paradigm of the critically ill onco-hematologic patient has shifted, driven by new therapies and organizational models that require individualized assessment. Early detection of clinical deterioration is essential and relies on tools such as NEWS2, Rapid Response Teams, and biomarkers, together with the integration of multidisciplinary meetings, which improve survival and optimize resource use. In the ICU, the main reasons for admission are respiratory failure, shock, organ failure, and sepsis. Early admission and dynamic reassessment of the support provided are crucial. Traditional scoring systems such as SOFA and APACHE II have limitations, prompting exploration of predictive models tailored to this population. Their care requires complex healthcare structures, highly specialized resources, and coordinated processes to ensure continuity and quality throughout all stages of treatment. In this context, the creation of multidisciplinary teams becomes a key element for shared decision-making and comprehensive management.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502446"},"PeriodicalIF":0.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793428","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}