Medicina intensiva最新文献

{"title":"Evaluation and impact of the ABCDEF bundle in a neurocritical patient population: a prospective observational study","authors":"Vanessa Campozano,&nbsp;Presley Gruezo-Realpe,&nbsp;Israel Rosero-Basurto,&nbsp;Xavier Grandes,&nbsp;Luis Montalvo Alvarado,&nbsp;Francisco Mercado Villamar,&nbsp;Carola Giménez-Esparza,&nbsp;Daniel Agustín Godoy","doi":"10.1016/j.medine.2026.502561","DOIUrl":"10.1016/j.medine.2026.502561","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical impact of adherence to the ABCDEF bundle in neurocritical patients admitted to an Intensive Care Unit (ICU) in Ecuador.</div></div><div><h3>Design</h3><div>A retrospective, observational, single-center study conducted between 2022 and 2024.</div></div><div><h3>Setting</h3><div>The ICU of a tertiary-level hospital in Guayaquil, Ecuador.</div></div><div><h3>Patients or participants</h3><div>Sixty adult neurocritical patients with ICU stays longer than 48 h were included. Patients were classified into two groups according to their adherence to the ABCDEF bundle: high adherence (≥4 components) and low adherence (≤3 components).</div></div><div><h3>Interventions</h3><div>Implementation of the ABCDEF bundle, including pain assessment, individualized sedation, delirium screening, early mobilization, and family participation.</div><div>The main outcome measures were ICU mortality, duration of mechanical ventilation (MV), ICU length of stay, and incidence of delirium.</div></div><div><h3>Results</h3><div>High adherence was associated with a shorter MV duration (median 11 [IQR 7–15.8] vs. 15 [15–18] days; <em>p</em> = 0.001) and shorter ICU stay (15 [10–20] vs. 20 [18–21.8] days; <em>p</em> =  0.016). Mortality was lower in the high-adherence group (23.3% vs. 46.7%), although this difference was not statistically significant in the bivariate analysis (<em>p</em> = 0.104). In the multivariate analysis, low adherence was independently associated with higher mortality (OR: 4.51; 95%CI: 1.07–19.05; <em>p</em> = 0.040). The incidence of delirium was higher in the high-adherence group (53.3% vs. 0%; <em>p</em> &lt; 0.001), a finding that requires further investigation to clarify its clinical significance.</div></div><div><h3>Conclusions</h3><div>Adherence to the ABCDEF bundle was associated with improved clinical outcomes in neurocritical patients, supporting its implementation in ICUs with limited resources.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502561"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027324","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":"3D transoesophageal echocardiography in thoracic endovascular aneurysm repair","authors":"Manuel Ruiz-Bailén","doi":"10.1016/j.medine.2026.502546","DOIUrl":"10.1016/j.medine.2026.502546","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502546"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297711","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":"Breath stacking and the challenge of inferring mechanism from ventilator waveforms","authors":"Antuani Rafael Baptistella,&nbsp;Diego de Carvalho,&nbsp;Aline Almeida Gulart,&nbsp;Ângelo Roncalli Miranda Rocha,&nbsp;Lluís Blanch","doi":"10.1016/j.medine.2026.502535","DOIUrl":"10.1016/j.medine.2026.502535","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502535"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378781","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":"Cardiogenic shock in Takotsubo syndrome: Insights into phenotype-tailored management","authors":"Marco Tomasino,&nbsp;Francisco González-Santorum,&nbsp;Lluis Admella,&nbsp;Aitor Uribarri","doi":"10.1016/j.medine.2026.502517","DOIUrl":"10.1016/j.medine.2026.502517","url":null,"abstract":"<div><div>Takotsubo syndrome (TTS) is an acute and reversible condition that mimics acute coronary syndromes but occurs in the absence of coronary disease. Cardiogenic shock in TTS (CS-TTS) represents its most severe complication, affecting up to 25% of the cases and multiplying by six by six in-hospital mortality. CS-TTS is heterogeneous, arising from multiple and often overlapping mechanisms. Beyond classical pump failure due to severe systolic dysfunction, distinct phenotypes include dynamic left ventricular outflow tract obstruction (LVOTO) with mitral regurgitation, isolated or combined right ventricular failure, and rare mechanical complications. Additionally, vasoplegic and mixed shock can further expand the hemodynamic spectrum. Phenotype recognition guides therapy: pure pump failure may require cautious short-term inotropes or unloading mechanical support; LVOTO-mediated shock contraindicates catecholamines and favors cautious volume, pure vasopressors, and short-acting β-blockers; vasoplegia requires vasopressors; RV failure needs inotropes and preload optimization. Prospective phenotype-guided trials are urgently needed.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502517"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous vs intermittent meropenem administration in critically ill patients and renal function. A secondary post-hoc analysis of the MERCY trial.","authors":"Martina Baiardo Redaelli, Domenico Pontillo, Fabio Toffoletto, Andrey Grechko, Eugenio Garofalo, Barbara Ferrara, Gianluca Paternoster, Tiziana Bove, Luca Brazzi, Matteo Marzaroli, Antonella Cotoia, Yuki Kotani, Francesco Corradi, Aidos Konkayev, Sofia Ananiadou, Simon Rauch, Rosalba Lembo, Andrea Della Selva, Nikola Bradic, Sergio Torrente, Giovanni Landoni, Alberto Zangrillo, Giacomo Monti","doi":"10.1016/j.medine.2026.502628","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502628","url":null,"abstract":"<p><strong>Objective: </strong>In septic patients renal function changes are common, potentially affecting antibiotic therapies. Time-dependent antibiotics, administered as continuous infusion, can improve the time above the minimal inhibitory concentration, but the relationship between meropenem administration strategy and renal function remains unclear. This study aimed to investigate such relationship for a composite primary outcome of 28-day mortality and emergence of pandrug (PDR) or extensively drug-resistant (XDR) pathogens. Secondary aims were to investigate the impact of renal function on clinical and microbiological outcomes, regardless of meropenem administration strategy.</p><p><strong>Design: </strong>Secondary analysis of the MERCY randomized controlled trial (Continuous Infusion versus Intermittent Administration of MERopenem in CriticallY Ill Patients).</p><p><strong>Setting: </strong>Thirty-one ICUs in 4 countries.</p><p><strong>Patients: </strong>MERCY patients with available estimated glomerular filtration rate (eGFR).</p><p><strong>Interventions: </strong>Meropenem administration as continuous infusion or intermittent boluses.</p><p><strong>Main variables of interest: </strong>eGFR, mortality, PDR/XDR pathogens.</p><p><strong>Results: </strong>Among MERCY patients, eGFR was available at randomization for 586 patients: 311 had an eGFR <60 ml/min/1.73m², 181 between 60-129 ml/min/1.73m², and 94 patients ≥130 ml/min/1.73m². Meropenem administration strategy did not affect the primary outcome across eGFR categories (p for interaction = 0.60). Considering renal subgroups regardless of randomization arm, patients with eGFR <60 ml/min/1.73m² had a lower incidence of new XDR/PDR pathogens compared with the normal renal function group (adjusted RR 0.65, 95% CI 0.45 to 0.95, p = 0.026).</p><p><strong>Conclusions: </strong>Among the MERCY population, there was no benefit from meropenem continuous infusion or intermittent boluses in any renal function subgroup. Having a lower eGFR was associated with a reduced emergence of PDR/XDR pathogens.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502628"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121201","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":"Obesity paradox in sepsis: a systematic review and meta-analysis of short- and long-term mortality risks","authors":"Sa Yang,&nbsp;Shuying Yang,&nbsp;Hongjie Li,&nbsp;Hua Xu,&nbsp;Dingbin Liu,&nbsp;Hongmei Gao","doi":"10.1016/j.medine.2026.502562","DOIUrl":"10.1016/j.medine.2026.502562","url":null,"abstract":"<div><h3>Objective</h3><div>To clarify the association of elevated BMI with short- and long-term mortality in sepsis, and to evaluate this association specifically in patients with a BMI ≥ 40 kg/m².</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>PubMed, Embase, and the Cochrane Library were searched for studies published up to December 2025. Twelve studies met the inclusion criteria.</div></div><div><h3>Participants</h3><div>Twelve retrospective studies with 130755 adult sepsis patients. Elevated BMI was defined as ≥30 kg/m²; normal weight as 18.5–25.0 kg/m².</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main variables of interest</h3><div>Exposure: BMI ≥ 30 kg/m². Outcomes: short-term (28-day, 30-day, ICU, in-hospital) and long-term (1-year) mortality. A separate analysis targeted BMI ≥ 40 kg/m².</div></div><div><h3>Results</h3><div>An elevated BMI was associated with reduced short-term mortality (8 studies: OR 0.75, 95% CI 0.69–0.81; I² = 11.8%), 28-/30-day mortality (5 studies: OR 0.74, 95% CI 0.68–0.81; I² = 7.7%), and long-term mortality (2 studies: OR 0.68, 95% CI 0.60–0.77; I² = 0.0%). This inverse association persisted in patients with BMI ≥ 40 kg/m² (4 studies: OR 0.70, 95% CI 0.62–0.79; I² = 26.3%). Sensitivity analyses confirmed robustness.</div></div><div><h3>Conclusions</h3><div>Elevated BMI is associated with lower short- and long-term mortality in sepsis, consistent with the obesity paradox. The inverse association also persisted in patients with a BMI ≥ 40 kg/m².</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502562"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474998","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":"Immunotherapy in the critically ill cancer patient: What the intensivist should know","authors":"María Verónica Nievas,&nbsp;Alejandra García-Roche,&nbsp;Maricela Jiménez-López,&nbsp;Cándido Díaz-Lagares","doi":"10.1016/j.medine.2026.502518","DOIUrl":"10.1016/j.medine.2026.502518","url":null,"abstract":"<div><div>Immunotherapy has produced a revolution in the treatment of cancer. It involves manipulating the patient's immune system to identify and destroy malignant cells. There has been an explosion in the development of these therapies in recent decades, with the emergence of monoclonal and bispecific antibodies, immune checkpoint inhibitors, and cellular therapies, including T cells modified with a chimeric antigen receptor (CAR-T cells) and tumor-infiltrating lymphocytes (TILs). While these new therapies offer new hope to patients, they have also introduced a new profile of adverse effects, resulting from the action of a hyperactive immune system, such as infusion reactions, autoimmune phenomena, cytokine release syndrome, and neurotoxicity associated with immune effector therapies, as well as capillary leak syndrome.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502518"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922345","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":"Necrotizing pneumonia with lung abscess in a severe infection caused by Legionella pneumophila","authors":"Johanna Marcela Abril Victorino,&nbsp;Lidia Martínez Camarero,&nbsp;Isabel Mainar Gil","doi":"10.1016/j.medine.2026.502521","DOIUrl":"10.1016/j.medine.2026.502521","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"50 10","pages":"Article 502521"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610558","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 treatment: Ethical decision-making and palliative care in critically ill patients with cancer.","authors":"Eric Mayor-Vázquez, Beatriz Lobo-Valbuena, Santiago Cruz Montesinos, Rubén D Camargo","doi":"10.1016/j.medine.2026.502556","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502556","url":null,"abstract":"<p><p>Over recent decades, advances in cancer diagnosis and treatment have improved survival and quality of life, leading to a growing number of cancer patients being admitted to Intensive Care Units (ICUs). In this setting, clinical decision-making is challenged by prognostic uncertainty, intensive technology use, and therapeutic interventions whose proportionality may be uncertain, generating relevant ethical conflicts in clinical practice. The application of bioethics to critical oncology provides a deliberative framework based on the principles of autonomy, beneficence, nonmaleficence, and justice, aimed at ensuring value-based, dignity-centered care. This review addresses three key decisions in managing critically ill oncology patients: ICU admission criteria, integration of palliative care, and definition of terminal illness, offering ethical tools to support prudent, proportionate, and humane decision-making.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502556"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067045","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":"Dedicated speech and language therapist in the ICU: a one-year experience in a tertiary hospital in Italy.","authors":"Giada Spinazza, Martina Baiardo Redaelli, Elisa Ulfo, Alessandro Corradino, Alessandra Agnese Grossi, Luca Cabrini","doi":"10.1016/j.medine.2026.502624","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502624","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502624"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121163","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}