Medicina intensiva最新文献

{"title":"Macklin-effect pneumomediastinum in severe diabetic ketoacidosis.","authors":"Soraia G Araujo, Cecília Vilaça","doi":"10.1016/j.medine.2026.502625","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502625","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502625"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067036","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":"Reintubation in the ICU, a non-solved problem. What can a decade of automated data show us?: Reintubación en UCI, un problema sin resolver. ¿Qué nos puede decir una década de datos automatizados?","authors":"Sara Manrique, Pau Orts, Gonzalo Sirgo, Laura Pérez, Julen Berrueta, Alejandro García-Martínez, María Bodí","doi":"10.1016/j.medine.2026.502604","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502604","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for reintubation in critically ill patients after planned extubation using clinical data automatically extracted from the clinical information system.</p><p><strong>Design: </strong>A retrospective observational study was conducted.</p><p><strong>Setting: </strong>Intensive Care Unit (ICU) of Joan XXIII University Hospital (Tarragona, Spain) (2014-2024).</p><p><strong>Patients: </strong>Adult patients admitted to the ICU who required invasive mechanical ventilation (IMV) for more than 48 h.</p><p><strong>Interventions: </strong>Automated extraction of clinical, ventilatory, hemodynamic, and laboratory test data (Centricity Critical Care®). Median, maximum, and minimum values were calculated within predefined time windows of 6 and 24 h prior to extubation.</p><p><strong>Main variables of interest: </strong>Reintubation rate, pressure support (PS), heart rate (HR), prior administration of antibiotics, ICU stay, incidence of ventilator-associated pneumonia (VAP), and mortality.</p><p><strong>Results: </strong>The overall reintubation rate was 11%. Multivariate analysis showed that higher mean PS (OR: 1.36; 95%CI: 1.10-1.67) and higher HR (OR: 1.22; 95%CI: 1.00-1.49) in the previous 6 h were independent predictors of reintubation. Antibiotic administration in the previous 24 h showed a protective effect (OR: 0.55; 95%CI: 0.37-0.82). The model achieved an AUC of 0.63 (95%CI, bootstrap: 0.52-0.72). Reintubated patients had a longer ICU stay, a higher incidence of VAP, and greater mortality.</p><p><strong>Conclusions: </strong>Higher heart rate and pressure support values before extubation were associated with an increased risk of reintubation, whereas antibiotic therapy within 24 h before extubation appeared to have a protective effect. The automated analysis of longitudinal data obtained from electronic health records allowed the identification of clinically plausible associations related to reintubation.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502604"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083368","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":"Observation of opioid and sedative weaning and iatrogenic withdrawal syndrome practices in patients receiving invasive mechanical ventilation.","authors":"Scott Bolesta, Lisa Burry, Marc M Perreault, Céline Gélinas, Kathryn E Smith, Federico C Carini, Rebekah Eadie, Richard R Riker, Brian L Erstad","doi":"10.1016/j.medine.2026.502627","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502627","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502627"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121116","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":"Combined phrenic and vagal nerve dysfunction after bilateral lung transplantation.","authors":"Blanca Lourdes More Sánchez, Manuel Valdivia Marchal, José Manuel Serrano Simón","doi":"10.1016/j.medine.2026.502626","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502626","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502626"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067078","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":"Narrative review of pediatric sepsis and septic shock: update on ultrasound-guided monitoring, diagnostic criteria and treatment.","authors":"María Slöcker Barrio, Cristina Schüffelmann, Ana Díaz Vico, Eider Oñate Vergara","doi":"10.1016/j.medine.2026.502543","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502543","url":null,"abstract":"<p><p>Sepsis is a common cause of admission to pediatric intensive care and is associated with high morbidity and mortality. Since 2005, diagnostic criteria have evolved, culminating in the Phoenix Criteria (2023), which define sepsis as organ dysfunction secondary to a dysregulated immune response. Given its heterogeneity, monitoring and treatment should be tailored to the phase of shock. During resuscitation, the goal is to restore perfusion with fluids and vasopressors. In the optimization, stabilization, and de-escalation phases, the aim is to maintain perfusion and remove excess fluids without compromising tissue flow. Current strategies favor a more restrictive fluid approach and an early use of vasoactive drugs. Monitoring should be continuous and multimodal, integrating clinical signs, technology, and laboratory test parameters. In this context, ultrasound has become essential, allowing individualized assessment of volemia, cardiac function, fluid responsiveness, and fluid overload. Ultrasound plays a key role in decision-making throughout the management process.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502543"},"PeriodicalIF":0.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009685","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 static to dynamic Ultrasound assessment in mechanical ventilation weaning.","authors":"Gemma Rialp","doi":"10.1016/j.medine.2026.502572","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502572","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502572"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993292","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 dysglycemia and mortality in patients with delirium: Based on the MIMIC-IV database.","authors":"Jingwen Zhu, Xinyu Zhao, Wei Pan, Yiyang Hu, Zixin Zhai","doi":"10.1016/j.medine.2026.502609","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502609","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the influence of chronic hyperglycemia on the association between acute glycemic metrics and in-hospital mortality in patients with delirium.</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Setting: </strong>Medical Information Mart for Intensive Care (MIMIC-IV) database.</p><p><strong>Patients or participants: </strong>3152 patients with delirium and available HbA1c measurements.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main variables of interest: </strong>Chronic hyperglycemia (categories based on HbA1c: <6.5%, 6.5-7.9%, ≥8.0%); acute glycemic metrics (mean glucose, number of hyperglycemic events, glucose variability, cumulative hyperglycemic dose); in-hospital mortality.</p><p><strong>Results: </strong>Patients with HbA1c 6.5-7.9% showed higher mortality risk compared to the HbA1c <6.5% group (OR = 1.518; P = 0.040). The association between acute hyperglycemia and mortality was modified by chronic glycemic status: mean glucose was associated with mortality only in patients with HbA1c <6.5% (OR = 1.254; P < 0.001) and 6.5-7.9% (OR = 1.190; P = 0.009). The number of hyperglycemic events increased mortality risk only in non-diabetic patients (OR = 1.043; P = 0.005). Glycemic variability and cumulative hyperglycemic dose were associated with mortality exclusively in the HbA1c <6.5% group.</p><p><strong>Conclusions: </strong>The impact of acute glycemic dysregulation on mortality in delirious patients is moderated by underlying chronic hyperglycemia. Individualized glucose management based on chronic glycemic status may be preferable to uniform strict control.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502609"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984442","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":"Emergencies in the critically ill cancer patient.","authors":"Alba López-Fdez, Rocío Ruiz-Cacho, Sonia Mas-Font, Pedro Castro","doi":"10.1016/j.medine.2026.502542","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502542","url":null,"abstract":"<p><p>Patients with cancer are an increasingly frequent population in Intensive Care Units (ICUs) worldwide. Although the main reasons for ICU admission are similar to those of other critically ill patients, cancer patients may experience severe complications that are specific to their underlying oncological condition. Such complications are known as oncological emergencies. These conditions differ from other critical illnesses in their pathophysiology and management, and prompt recognition is essential to improving patient outcomes. This article describes key features of selected oncological emergencies, outlines general management principles, and highlights the diagnostic and therapeutic particularities of the most relevant conditions.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502542"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979033","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":"Not all respiratory failure is asthma.","authors":"Eva Sampedro Calavia, Jessica Gimenez Lecina, Sara Noblejas Drouot","doi":"10.1016/j.medine.2026.502563","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502563","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502563"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979081","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":"Introduction to the «Update series»: «ECMO. Current uses and challenges of extracorporeal membrane oxygenation in adults».","authors":"Eduard Argudo, Fernando Suárez Sipmann","doi":"10.1016/j.medine.2026.502430","DOIUrl":"https://doi.org/10.1016/j.medine.2026.502430","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502430"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946482","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}