Medicina intensiva最新文献

{"title":"Penetrating trauma in Spain: analysis of the Spanish trauma registry (RETRAUCI)","authors":"Judit Gutiérrez-Gutiérrez ,&nbsp;Jesús Abelardo Barea-Mendoza ,&nbsp;Carlos García-Fuentes ,&nbsp;Juan Antonio Llompart-Pou ,&nbsp;Begoña Guardiola-Grau ,&nbsp;Mikel Durán-Suquía ,&nbsp;María Ángeles Ballesteros-Sanz ,&nbsp;Javier González-Robledo ,&nbsp;Lluís Serviá-Goixart ,&nbsp;Cristina Méndez-Benegassi Cid ,&nbsp;Jose Maria Toboso Casado ,&nbsp;Mario Chico-Fernández ,&nbsp;on behalf of the Neurointensivism and Trauma Working Group of the SEMICYUC","doi":"10.1016/j.medine.2025.502165","DOIUrl":"10.1016/j.medine.2025.502165","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the epidemiology of penetrating trauma, mortality associated factors and its management in Spanish intensive care units.</div></div><div><h3>Design</h3><div>Multicenter, prospective registry. A comparison is established between two cohorts defined by the type of trauma (blunt and penetrating).</div></div><div><h3>Patients</h3><div>Patients with traumatic injury admitted to the participating ICUs from June 2015 to June 2022.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variable of interest</h3><div>Epidemiology, injury pattern, prehospital and hospital care, resource utilization, and clinical outcomes.</div></div><div><h3>Results</h3><div>12,806 patients were eligible, of whom 821 (6.4%) suffered penetrating trauma; 418 patients (50.9%) from stab wounds, 93 (11.3%) from gunshot wounds, and 310 (37.8%) from other objects. The most common intent was assault (47.7%). The mean ISS was 15.2 ± 10.6 in penetrating trauma and 19.8 ± 11.9 in blunt trauma (p &lt; 0.001). ICU mortality was 7.8% compared to 11.7% in blunt trauma, with deaths more frequently occurring within the first 24 hours (64% vs. 39%). Factors associated with mortality included female sex, prior use of antithrombotic agents, older age, higher NISS score, and the presence of cranial trauma or shock.</div></div><div><h3>Conclusions</h3><div>Penetrating trauma is an emergent pathology in our context with high complexity, highlighting the need for focused study and documentation, protocol development, and resource optimization to provide quality care.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502165"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723047","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":"Analgesia, sedation, and neuromuscular blocking agents: A standardized protocol of analgosedation in COVID-19.","authors":"Cecilia Inés Loudet, Marisol García Sarubbio, María Julia Meschini, Jacqueline Vilca Becerra, María Agustina Mazzoleni, Vanesa Aramendi, Agustina Barbieri, Carolina Colavita, Gustavo Cerri, Sofía Pacho, Eliseo Hernán Ferrari, Rosa Reina","doi":"10.1016/j.medine.2025.502223","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502223","url":null,"abstract":"<p><strong>Objectives: </strong>Primary: To evaluate the level of sedation, use, daily doses, and duration of analgosedative drugs in COVID-19 patients on mechanical ventilation (MV) using a standardized protocol, comparing survivors and non-survivors. Secondary: To identify independent predictors of hospital mortality.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Medical-surgical ICU.</p><p><strong>Patients: </strong>Adults with SARS-CoV-2 infection requiring invasive MV and continuous infusion of analgosedation and/or neuromuscular blocking agents (NMBAs) for at least 48 h.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main variables of interest: </strong>Level of sedation, use, daily doses, and duration of analgosedative drugs; hospital mortality and associated factors.</p><p><strong>Results: </strong>Among 198 patients (nurse-to-patient ratio 1:2.4; 65% staff turnover), median global RASS was -4.5. Kaplan-Meier analysis showed lower survival with deeper sedation. Fentanyl (99%) and midazolam (97%) were the most used, followed by NMBAs (81%), propofol and dexmedetomidine (48%). Non-benzodiazepine sedatives were precribed more in survivors (88%) than non-survivors (53%) (p < 0.01). Survivors had more days of fentanyl, midazolam, and dexmedetomidine; no differences in NMBA use or drug doses were observed. Mortality was 63%. Independent predictors of mortality included APACHE II, SOFA₂₄, Charlson score, median RASS, and non-benzodiazepine sedative use.</p><p><strong>Conclusions: </strong>Standardized protocols emphasizing the ACD components of the ABCDEF bundle, along with appropriate use of analgosedation and NMBAs despite limited staffing, effectively supported the management of sedation without significant dose differences between survivors and non-survivors. Sedation level and the use of non-benzodiazepine sedatives were independently associated with better outcomes, highlighting the importance of the light sedation and the ABCDEF bundle.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502223"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228012","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":"Usefulness of vector velocity imaging in the descending thoracic aorta.","authors":"Manuel Ruiz-Bailén, Javier Hidalgo-Martín, Julia Manetsberger, Fernando Clau-Terré, Javier Martínez-Gámez, Johannes Dagomar Lohman, María Leyre Lavilla-Lerma, Diego Fernando Matallana-Zapata, Marta Ballesteros-Barroso, Ricardo Rivera-Fernández, Pedro José Sánchez de Toro Hernández, José Ángel Ramos-Cuadra","doi":"10.1016/j.medine.2025.502224","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502224","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the Speckle Tracking values in the descending thoracic aorta (DTA) of a healthy population.</p><p><strong>Desing: </strong>This is an observational study.</p><p><strong>Setting: </strong>Hospital Universitario de Jaén.</p><p><strong>Participants: </strong>Our study included 242 healthy people (102 women) with a mean age of 42.35±16.37 years.</p><p><strong>Interventions: </strong>Evaluation of Speckle Tracking in DTA.</p><p><strong>Main variables of interest: </strong>Strain, velocity and displacement values in the DTA were evaluated.</p><p><strong>Results: </strong>The DAT rotational velocity was 55.91±0.22º/s, the DTA radial velocity was 0.98±0.28cm/s, the circumferential strain of the DTA was -8.98±0.87%, while the circumferential strain rate was -0.96±0.15/s. The rotational displacement of the DTA was determined at 8.87±0.36º, while radial displacement was 0.82±0.11mm. Logistic regression found an association between the rotational values of the aorta and the longitudinal strain of both ventricles. In thirty people, strain, rotational velocity and displacement were also evaluated in the apical 4-chamber views and in the parasternal long-axis view. Both projections showed similar values.</p><p><strong>Conclusion: </strong>Speckle Tracking could be used to study the descending thoracic aorta, and its values could suggest or rule out the presence of cardiovascular pathology.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502224"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228014","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":"We use non-invasive ventilation every day, but are we aware, in our center, of its real effectiveness?","authors":"Rafael Fernández Fernández","doi":"10.1016/j.medine.2025.502213","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502213","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502213"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112383","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":"Hypernatremia and renal dysfunction after sevoflurane sedation in the intensive care unit: Three case reports.","authors":"Marta Bauça Socias, Dolly Andrea Caicedo, Eva Benveniste-Pérez, Georgina de la Rosa Loppacher, Eva Montané","doi":"10.1016/j.medine.2025.502215","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502215","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502215"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096523","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":"Bridging the nutritional gap between the intensive care unit and the ward: A plea for action to ensure continuity of care.","authors":"David Pérez-Torres, Isabel Canas-Pérez, Cristina Díaz-Rodríguez, Ana Isabel Martín-Luengo","doi":"10.1016/j.medine.2025.502222","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502222","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502222"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096519","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":"The role of point-of-care ultrasonography in central venous catheter insertion: A randomized controlled trial of safety and cost-effectiveness.","authors":"Ahmed Beniamen, Ahmed Mosallem, Hossam Tharwat Ali, Hanaa A Nofal, Essamedin M Negm","doi":"10.1016/j.medine.2025.502221","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502221","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the study was to compare landmark-based and ultrasound-guided techniques of central venous catheter insertion (CVC).</p><p><strong>Design: </strong>Randomized controlled trial (2021-2023).</p><p><strong>Setting: </strong>Zagazig University Hospitals (ZUH), a tertiary care center.</p><p><strong>Patients: </strong>Adult patients in whom CVC insertion is indicated.</p><p><strong>Main variables of interest: </strong>Demographic and clinical peri-procedural data, the safety of the technique, time of performance, and cost-effectiveness were compared.</p><p><strong>Results: </strong>Patient ages ranged from 17 to 80 years with 56% being males. Urgent indications were found in around 22% without significant differences between groups. Regarding the time of performance, the ultrasound-guided method had slightly but significantly less time of performance (25.7 ± 4.3; range: 18-33) compared to the blind technique (26.9 ± 7.4; range: 15-45) (P-value < 0.001) with a higher but non-significant number of patients without complications (64% vs 52%; P-value = 0.2). Failure to insert the CVC into the IJV occurred in 12 patients (12%) with the blind technique and in eight patients (8%) with the ultrasound-guided technique (P-value = 0.04). Carotid artery puncture with neck hematoma occurred in only 8 (8%) patients with the blind technique (P-value = 0.04). Excess cost was consumed in only 36 patients (36%) in the blind technique group (P-value = 0.001).</p><p><strong>Conclusion: </strong>Point-of-care ultrasonography bundle for CVC insertion is considered superior to, safer, and more cost-effective than the blind technique.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502221"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082954","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":"Physiotherapy in the ICU: Past, present, and future.","authors":"Gonzalo Ballesteros-Reviriego, Joan-Daniel Martí","doi":"10.1016/j.medine.2025.502205","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502205","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502205"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082949","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":"Utility of airway occlusion pressure in traumatic diaphragmatic rupture.","authors":"Noemi Merino Pizarro, Manuel Valdivia Marchal, Carmen Bermudez Ruiz, Juan Francisco Martinez Carmona, Ashlen Rodriguez Carmona, Jose Manuel Serrano Simon","doi":"10.1016/j.medine.2025.502214","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502214","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502214"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056170","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":"Post-myocardial infarction ventricular septal defect.","authors":"Curiel Balsera Emilio, Guillermo Gómez Gallego, Alejandro Navarro Cruz","doi":"10.1016/j.medine.2025.502202","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502202","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502202"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028472","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}