Medicina intensiva最新文献

{"title":"Comparison of non-invasive ventilation on bilevel pressure mode and CPAP in the treatment of COVID-19 related acute respiratory failure. A propensity score–matched analysis","authors":"Andrés Carrillo-Alcaraz ,&nbsp;Miguel Guia ,&nbsp;Laura Lopez-Gomez ,&nbsp;Pablo Bayoumy ,&nbsp;Aurea Higon-Cañigral ,&nbsp;Elena Carrasco González ,&nbsp;Pilar Tornero Yepez ,&nbsp;Juan Miguel Sánchez-Nieto","doi":"10.1016/j.medine.2025.502146","DOIUrl":"10.1016/j.medine.2025.502146","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>The purpose of this study was to analyze the differences in the effectiveness and complications of CPAP versus non-invasive ventilation on </span>bilevel positive airway pressure (BiPAP) in the treatment of COVID-19 associated </span>acute respiratory failure (ARF).</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>ICU.</div></div><div><h3>Patients</h3><div>All COVID-19 patients, admitted to an ICU between March 2020 and February 2023, who required CPAP or BiPAP were analyzed.</div></div><div><h3>Interventions</h3><div>Use of CPAP or BiPAP in COVID-19 associated ARF.</div></div><div><h3>Main variables of interest</h3><div>Initial clinical variables, CPAP and BiPAP failure rate, complications, in-hospital mortality.</div></div><div><h3>Results</h3><div>429 patients were analyzed, of whom 328 (76.5%) initially received CPAP and 101 (23.5%) BiPAP. Initial respiratory rate was 30 ± 8 in the CPAP group and 34 ± 9 in BiPAP (p &lt; 0.001), while PaO₂/FiO₂<span><span> was 120 ± 26 and 111 ± 24 mmHg (p = 0.001), respectively. The most frequent complication related to the device was claustrophobia/discomfort, 23.2% in CPAP and 25.7% in BiPAP (p = 0.596), while the most frequent complications not related to the device were severe ARDS, 58.6% and 70.1% (p = 0.044), and </span>hyperglycemia, 44.5% and 37.6%, respectively (p = 0.221). After adjusting by propensity score matched analysis, neither failure of the device (OR 1.37, CI 95% 0.72–2.62) nor in-hospital mortality (OR 1.57, CI 95% 0.73–3.42) differed between both groups.</span></div></div><div><h3>Conclusions</h3><div>Either non-invasive ventilatory device failure or mortality rate differed in patients initially treated with CPAP versus BiPAP.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 10","pages":"Article 502146"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019110","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":"Reduction of norepinephrine versus vasopressin in the stabilization phase of septic shock: RENOVA clinical trial","authors":"Cássio Mallmann ,&nbsp;Thizá Maria Bianchi Galiotto ,&nbsp;Michele Salibe de Oliveira ,&nbsp;Rafael Barberena Moraes","doi":"10.1016/j.medine.2025.502147","DOIUrl":"10.1016/j.medine.2025.502147","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the incidence of hypotension during the weaning phase of vasopressors.</div></div><div><h3>Design</h3><div>A single-center, open-label randomized clinical trial between May and December 2022.</div></div><div><h3>Setting</h3><div>a tertiary care academic medical center.</div></div><div><h3>Patients</h3><div>91 adult patients over 18 years of age with septic shock (according to Sepsis-3).</div></div><div><h3>Intervention</h3><div>Patients were divided into two groups: initial reduction of norepinephrine<span> or initial reduction of vasopressin.</span></div></div><div><h3>Main variables of interest</h3><div><span>The primary outcome was the incidence of hypotension within the first 24 h after reducing vasopressors. Additionally, the clinical impact of this hypotension was assessed through mortality, length of hospital stay, duration of vasopressor use, incidence of arrhythmias, and prevalence of </span>hemodialysis.</div></div><div><h3>Results</h3><div>Out of a total of 91 patients, 78 were included in the analysis: 39 in the norepinephrine group and 39 in the vasopressin group. Despite a numerically significant difference in the incidence of hypotension between the groups (norepinephrine 43.6%, vasopressin 25.6%), there was no statistical difference (<em>p</em> =  0.153, relative risk = 1.7, 95% confidence interval: 0.9–3.2). In this sample, vasopressin withdrawal was predominantly titrated. There were no differences between the groups in terms of the evaluated clinical outcomes.</div></div><div><h3>Conclusion</h3><div>No differences were detected in the incidence of hypotension when weaning was initiated with norepinephrine or vasopressin, although it was non significantly higher in norepinephrine group. In our sample, vasopressin withdrawal was titrated, which differs from North American practice. Brazilian Clinical Trials Registry (REBEC: RBR-10smbw65). ClinicalTrials.gov platform (NCT 05506319).</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 10","pages":"Article 502147"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076806","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":"Association between lactate-to-albumin ratio and all-cause mortality in cirrhosis patients: Analysis of the MIMIC-IV database","authors":"Yusong Ye ,&nbsp;Shu Huang ,&nbsp;Xiaohong Wang ,&nbsp;Wensen Ren ,&nbsp;Xiaomin Shi ,&nbsp;Sha Liu ,&nbsp;Wei Zhang ,&nbsp;Lei Shi ,&nbsp;Muhan Lü ,&nbsp;Xiaowei Tang","doi":"10.1016/j.medine.2025.502145","DOIUrl":"10.1016/j.medine.2025.502145","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates the predictive value of the lactate/albumin ratio (LAR) for all-cause mortality in cirrhosis patients.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Intensive care unit (ICU).</div></div><div><h3>Patients or participants</h3><div>626 first-time ICU-admitted cirrhosis patients in the USA (MIMIC-IV v2.2).</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>LAR index, 28-day, and 90-day all-cause mortality.</div></div><div><h3>Results</h3><div>Of 626 patients (60.86% male), 27.80% and 39.14% died within 28 and 90 days, respectively. Multivariate Cox analysis showed a significant association between higher LAR and mortality. Adjusted for confounders, elevated LAR increased the 28-day mortality risk [HR: 1.31 (1.21–1.42), P &lt; 0.001]. A restricted cubic spline analysis revealed non-linear relationships between LAR and mortality. For 28-day mortality, the inflection point was 1.583: below this, HR was 2.29 (95% CI: 1.61–3.27, P &lt; 0.001); above, HR was 1.16 (95% CI: 1.02–1.31, P = 0.021; P = 0.002). For 90-day mortality, the inflection point was 1.423: below, HR was 1.60 (95% CI: 1.04–2.47, P = 0.033); above, HR was 0.94 (95% CI: 0.75–1.16, P = 0.542; P = 0.012).</div></div><div><h3>Conclusions</h3><div>LAR predicts 28-day and 90-day mortality with a segmented effect. An LAR ≥1.583 signals high 28-day mortality risk, necessitating intensified monitoring and potential ICU admission. For 90-day mortality, LAR near 1.423 serves as an early warning for high-risk patients and guides interventions. Continuous LAR monitoring aids management, but prospective studies are needed to confirm clinical utility.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 10","pages":"Article 502145"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434631","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":"Endobronchial actinomycosis","authors":"Chih-Jung Chang ,&nbsp;Yi-Han Hsiao","doi":"10.1016/j.medine.2025.502228","DOIUrl":"10.1016/j.medine.2025.502228","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 10","pages":"Article 502228"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217974","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":"Linezolid continuous infusion protects from subtherapeutic linezolid concentrations in critically ill patients.","authors":"Leonardo Lorente, Jonathan González García, Sergio Pérez Reyes, Cristo Yared Pérez Martín, Mario Rodín, Santiago Viera, Alejandro Jiménez","doi":"10.1016/j.medine.2025.502268","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502268","url":null,"abstract":"<p><strong>Objective: </strong>Different studies have determined blood linezolid concentrations. However, the largest studies reporting data on factors associated with subtherapeutic linezolid concentrations in critically ill patients account for less than 60 patients. Thus, the objective of our study was to determine what factors were associated with subtherapeutic linezolid concentrations in critically ill patients in a larger series of patients.</p><p><strong>Design: </strong>Historical cohort study.</p><p><strong>Setting: </strong>One Spanish Intensive Care Unit.</p><p><strong>Patients: </strong>Critically ill adult patients who received linezolid due to suspected or confirmed infection by multidrug-drug-resistant Gram-positive bacteria during 2022 and 2023.</p><p><strong>Interventions: </strong>Blood samples were collected to determine linezolid concentrations (C_min) immediately before dosing after at least 48 h from starting linezolid therapy.</p><p><strong>Main variable of interest: </strong>Subtherapeutic linezolid concentrations.</p><p><strong>Results: </strong>We included a total of 168 patients. We found 79 (47.0%) patients with and 89 (53.0%) patients without subtherapeutic linezolid concentrations. Multiple logistic regression showed that linezolid continuous infusion (OR = 0.192; 95% CI = 0.053-0.694; P = .01) and older age (OR = 0.952; 95% CI = 0.926-0.980; P = .001) were associated with lower risk of subtherapeutic linezolid concentrations.</p><p><strong>Conclusions: </strong>As far as we know, this is the largest study reporting data on factors associated with subtherapeutic linezolid concentrations in critically ill patients. To our knowledge, our study is the first to report that linezolid continuous infusion was independently associated with lower risk of subtherapeutic linezolid concentrations in critically ill patients.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502268"},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182324","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":"Unexplained hyperammonemia in critically ill oncological patients: An emerging complication of gemcitabine-cisplatin therapy.","authors":"Patricia Escudero-Acha, Marta Arroyo Diez, Alfredo Abajo Miranda, Junkal Martínez Elizalde, Lourdes Fisac Cuadrado, José Antonio Fernández Ratero","doi":"10.1016/j.medine.2025.502270","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502270","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502270"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180751","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":"Intestinal perforation by clam shell: An uncommon surgical emergency.","authors":"Paulo Fernandes, Ana Carina Baldino, Rita Ruivo","doi":"10.1016/j.medine.2025.502307","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502307","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502307"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139921","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":"Quality of life and disability 16 months after critical care illness: Comparison between COVID-19 and non-COVID-19 survivors.","authors":"Liliana Cristina da Silva Ferreira Fontes, Bárbara Peleteiro, Paulo Jorge Ribeiro Costa, Joana Carolina João Fernandes, Tatiana Santos Vieira, António José Falcão Braga, Sónia Patrícia Vilar Martins, Ana Rita Leal Ferreira, Isabel Maria Metelo Coimbra, Lia Paula Nogueira Sousa Fernandes, José Artur Osório de Carvalho Paiva","doi":"10.1016/j.medine.2025.502309","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502309","url":null,"abstract":"<p><strong>Objective: </strong>Describe and compare the Quality of Life (QoL) and disability of critical care survivors with COVID-19 and NON-COVID-19 critical illness, admitted during and after the pandemic period. We hypothesize that both COVID-19 disease and the pandemic context have a significant impact on long-term outcomes of Intensive Care Unit (ICU) survivors.</p><p><strong>Design: </strong>Post-hoc analysis of prospectively collected data.</p><p><strong>Setting: </strong>Intensive Care Department of Unidade Local de Saúde São João between 1st October 2020 and 31st December 2021.</p><p><strong>Participants: </strong>Three groups of adult critical care survivors; Group 1: critical COVID-19 patients; Group 2: critical patients with other diagnosis, admitted in the pandemic period; Group 3: critical patients admitted in the post-pandemic period due to non-COVID-19 causes.</p><p><strong>Intervention: </strong>Telephone consultation 16 months after discharge home, assessing QoL and disability.</p><p><strong>Main variables of interest: </strong>QoL five dimensions, EuroQol Visual Analog Scale (EQ-VAS) and Health and disability 6 domains.</p><p><strong>Results: </strong>Of the 185 survivors, Group 1 reported less problems in\"Self-care\" (OR = 0.15, 95%CI: 0.04-0.55), \"Usual activities\" (OR = 0.20, 95%CI: 0.08-0.0.52), and \"Anxiety/Depression\" (OR = 0.36, 95%CI: 0.14-0.97) dimensions. Health and disability domains assessment showed Group 1 had less difficulties in \"Cognition\" (OR = 0.37, 95%CI: 0.15-0.91), \"Mobility\" (OR = 0.25, 95%CI: 0.09-0.68), \"Self-care\" (OR = 0.15, 95%CI: 0.05-0.40) and \"Life activities\" (OR = 0.32, 95%CI: 0.13-0.76).</p><p><strong>Conclusions: </strong>Sixteen months after discharge home, survivors of non-COVID-19 admitted during the pandemic period present worse QoL and functional status than COVID-19 survivors admitted during the same period and greater post-hospital discharge healthcare needs.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502309"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133174","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":"U-shaped association between triglyceride/HDL ratio and all-cause mortality in obese sepsis patients: A retrospective study based on eICU database.","authors":"Yaozhou Wu, Yingying Sun, Ruirui Wang, Qianqian Liu, Wenjie Wang, Rubing Guo, Wei Zhao, Lianhua Wei","doi":"10.1016/j.medine.2025.502308","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502308","url":null,"abstract":"<p><strong>Objective: </strong>This study explored the link between the TG/HDL ratio and mortality in obese sepsis patients using the eICU database.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Intensive Care Medicine.</p><p><strong>Patients: </strong>According to Sepsis 3.0 criteria, sepsis is diagnosed with infection and a SOFA score ≥2. This study included adults (age ≥18) with ICU stays ≥48 h to ensure data stability. Patients with diabetes, acute pancreatitis, or those on lipid-lowering or antidiabetic treatments were excluded due to their impact on lipid and glucose metabolism, which could bias the analysis of the TG/HDL ratio and all-cause mortality.</p><p><strong>Interventions: </strong>938 obese sepsis patients were selected, and statistical methods (variable assessment, difference test, regression model, curve fitting, subgroup analysis) were used. The study was carried out using R 4.3.2 software.</p><p><strong>Main variables of interest: </strong>TG/HDL.</p><p><strong>Results: </strong>The TG/HDL ratio varied across quartiles and was significantly linked to mortality in obese sepsis patients. Regression and curve fitting showed a U-shaped relationship for TG/HDL < 8, with an inflection point at 3.59. The K-M curve confirmed this U-shaped pattern, and subgroup analysis revealed a significant interaction with hypertension.</p><p><strong>Conclusions: </strong>A U-shaped relationship exists between TG/HDL and mortality in obese sepsis patients, with both low and high levels increasing death risk.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502308"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133226","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":"Noninvasive bedside neuromonitoring in acute brain injury. A narrative review.","authors":"Daniel Agustín Godoy, Jon Pérez-Bárcena, Francisco de Paula Delgado-Moya, Jesús Abelardo Barea-Mendoza, Juan Antonio Llompart-Pou","doi":"10.1016/j.medine.2025.502305","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502305","url":null,"abstract":"<p><p>Clinical neurological examination remains the gold standard to detect, diagnose, and follow-up responses to treatment in acute neurological conditions in the critical care setting. However, in patients with severe neurological deficits at baseline or those requiring sedatives, detecting neurological deterioration can be challenging. In this scenario, noninvasive bedside neuromonitoring as a part of multimodal strategies can be useful in the avoidance of secondary brain injury and in the selection of which patient with acute brain injury would benefit from invasive neuromonitorization.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502305"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133218","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}