Medicina intensiva最新文献

{"title":"Left ventricular systolic function and mechanical ventilation weaning failure: An updated systematic review and meta-analysis with trial sequential analysis.","authors":"Cristina Santonocito, Simone Messina, Mateusz Zawadka, Pruszczyk Andrzej, Elena Bignami, Andrea Morelli, Sabino Scolletta, Alberto Noto, Filippo Sanfilippo","doi":"10.1016/j.medine.2025.502231","DOIUrl":"10.1016/j.medine.2025.502231","url":null,"abstract":"<p><strong>Objective: </strong>The impact of left ventricular (LV) systolic dysfunction on weaning failure is unclear.</p><p><strong>Design: </strong>Updated meta-analysis assessing the association between LV ejection fraction (LVEF) and weaning failure.</p><p><strong>Setting: </strong>A systematic search of MEDLINE and EMBASE for prospective studies reporting weaning according to echocardiographic data measured before starting a spontaneous breathing trial (SBT).</p><p><strong>Patients or participants: </strong>Studies included in the meta-analysis that reported on weaning and echocardiographic data.</p><p><strong>Main variables of interest: </strong>LVEF, E/e' ratio, E velocity, deceleration time of the E wave, and e' velocity.</p><p><strong>Results: </strong>Three studies were added in this update (n = 14, sample 20-30% larger). Lower LVEF (n = 12) was associated with weaning failure: MD: -4.71 95%CI [-9.18, -0.23]; p = 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 n = 745/1378). E/e' ratio (MD: 1.90, 95%CI [0.48,3.32]; p = 0.009, I² = 84%), E velocity (MD: 8.32, 95%CI [2.59,14.05]; p = 0.004, I² = 54%) and shorter deceleration time of the E wave (MD: -12.01, 95%CI [-21.13, -2.89]; p = 0.01, I² = 0%) were associated with weaning failure, whilst e' velocity was not (MD: -0.59, 95%CI [-1.51,0.32]; p = 0.20, I² = 64%).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502231"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","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":"Respiratory rate remains the forgotten vital sign.","authors":"Enrique Chicote-Álvarez, Adolfo Calvo-Martínez, María Macías-Pascual","doi":"10.1016/j.medine.2025.502225","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502225","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502225"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328246","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":"Neutrophil CD64 as a prognostic biomarker for mortality in sepsis: A systematic review and meta-analysis.","authors":"Seo Hee Yoon, Sohyun Eun","doi":"10.1016/j.medine.2025.502251","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502251","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis remains a major cause of mortality worldwide. While neutrophil CD64 (nCD64) has demonstrated superior performance in detecting sepsis compared to conventional biomarkers, its prognostic value remains unclear. This meta-analysis evaluates the performance of nCD64 in predicting mortality in patients with sepsis.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Settings: </strong>A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted up to January 28, 2025, to identify relevant studies.</p><p><strong>Patients: </strong>Patients aged 16 years or older diagnosed with sepsis based on Sepsis-1, Sepsis-2, or Sepsis-3 criteria.</p><p><strong>Interventions: </strong>Studies assessing the predictive accuracy of nCD64 for mortality and providing sufficient data for contingency table construction were included.</p><p><strong>Main variables of interest: </strong>Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated with 95% confidence intervals (CIs). Overall predictive accuracy was assessed using the area under the summary receiver operating characteristic curve.</p><p><strong>Results: </strong>Eight studies involving 756 patients were included. The pooled sensitivity, specificity, and DOR of nCD64 for predicting mortality were 0.79 (95% CI: 0.68-0.87), 0.67 (95% CI: 0.56-0.77), and 7.71 (95% CI: 4.38-13.57), respectively. The predictive accuracy was 0.80.</p><p><strong>Conclusions: </strong>Our findings suggest that nCD64 may serve as a valuable auxiliary biomarker for identifying patients with sepsis at higher risk of mortality.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502251"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304142","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":"Serum phosphate abnormalities in critically ill children.","authors":"Nuria Del Amo Carramiñana, Paula Lasarte Merino, Celia Pascual Alonso, Jesús López-Herce, Rafael González Cortés","doi":"10.1016/j.medine.2025.502217","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502217","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502217"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277097","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 due to a large apical pseudoaneurysm of the left ventricle: A rare complication.","authors":"Jaime Andrés Romero León, Elena Morente García, Eva Peregrina Caño","doi":"10.1016/j.medine.2025.502212","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502212","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502212"},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251664","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":"Cardiac hydatid disease.","authors":"Emilio Curiel Balsera, Javier Muñoz Bono, Hugo Molina Diaz","doi":"10.1016/j.medine.2025.502218","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502218","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502218"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236344","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":"Key laboratory changes in severe trauma, a different pattern for each clinical phenotype.","authors":"Adrián Marcos-Morales, Jesús Abelardo Barea Mendoza, Marcos Valiente Fernández, Carlos García Fuentes, Fernando Calvo Boyero, Cecilia Cueto-Felgueroso, Judith Gutiérrez Gutiérrez, Francisco de Paula Delgado Moya, Carolina Mudarra Reche, Susana Bermejo Aznárez, Alfonso Lagares, Mario Chico Fernández","doi":"10.1016/j.medine.2025.502227","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502227","url":null,"abstract":"<p><strong>Objective: </strong>to compare the different evolution of conventional laboratory parameters between three severe trauma phenotypes.</p><p><strong>Design: </strong>Observational study of a prospectively collected cohort of severe trauma patients, with retrospective database completion, studied between 2012 and 2022.</p><p><strong>Setting: </strong>A trauma intensive care unit (ICU).</p><p><strong>Patients: </strong>Severe trauma patients were defined by an Abbreviated Injury Scale of ≥ 3 in at least one aspect. Three groups were stablished according to hemodynamic status and Glasgow coma scale (GCS), and they were subsequently subdivided in prematurely deceased and survivors after > 72 h (h). Laboratory parameters were followed up to 96 h, statistical analysis between groups and subgroups was performed at 0 and 24 h.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main variables of interest: </strong>Prehospital, clinical variables on admission, prognostic variables (prospective gathering); blood count, biochemistry, coagulation, blood gas analysis (retrospectively collected).</p><p><strong>Results: </strong>1631 patients were included, 8% prematurely deceased. Initial leukocytosis and hyperglycemia were common in all groups. Hemodynamically stable patients with a GCS < 14 stood out due to a high neutrophil-to-lymphocyte ratio (NLR) and hypernatremia, both of them at 24 h, together with initial coagulopathy in the prematurely deceased. Hemodynamically unstable patients exhibited an initial pattern of lactic acidosis, coagulopathy, and decreased platelet-to-lymphocyte ratio, hemoglobin, albumin and calcium, all these changes being most prominent in the prematurely deceased. A 24 h peak in NLR was found in both the hemodynamically unstable and GCS < 14 groups.</p><p><strong>Conclusion: </strong>Evolution of laboratory parameters differ according to the patient's phenotype. They complete the initial severity evaluation and in hemodynamically stable patients they act as a warning for potential neurological damage.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502227"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228013","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":"Evaluation of training models as a method to improve the acquisition of skills in Intensive Care Medicine","authors":"Ana Rodríguez Alcaraz ,&nbsp;Federico Gordo Vidal","doi":"10.1016/j.medine.2025.502141","DOIUrl":"10.1016/j.medine.2025.502141","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502141"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371471","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 impact of mechanical insufflation-exsufflation on the weaning success rate of tracheostomized patients on prolonged mechanical ventilation: a pilot and feasibility study of a randomized controlled trial","authors":"Cristiane Bastos Netto ,&nbsp;Maycon Moura Reboredo ,&nbsp;Rodrigo Souza Vieira ,&nbsp;Lídia Maria Carneiro da Fonseca ,&nbsp;Elivaldo Cyrillo Júnior ,&nbsp;André Luís Dias de Souza ,&nbsp;Erich Vidal Carvalho ,&nbsp;Bruno Valle Pinheiro","doi":"10.1016/j.medine.2024.502125","DOIUrl":"10.1016/j.medine.2024.502125","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility of adding mechanical insufflation-exsufflation (MI-E) to a weaning protocol for tracheostomized patients undergoing prolonged mechanical ventilation (MV).</div></div><div><h3>Design</h3><div>Single-center, open-label, randomized, controlled pilot and feasibility study.</div></div><div><h3>Setting</h3><div>Intensive care unit in Brazil.</div></div><div><h3>Patients</h3><div>Tracheostomized adults who were invasively ventilated for more than 14 days and who were weaned from MV.</div></div><div><h3>Interventions</h3><div>Patients were randomized into two groups: intervention group (IG) or a control group (CG). During weaning with a tracheostomy collar, the IG received two daily sessions of MI-E, each with 5 cycles (insufflation and exsufflation pressures of 45 cm H₂O). The CG received conventional chest physiotherapy.</div></div><div><h3>Main variables of interest</h3><div>The primary outcomes were the feasibility of adding MI-E to the weaning protocol and the rate of successful weaning.</div></div><div><h3>Results</h3><div>A total of 47 patients were randomized, with 25 in the IG and 22 in the CG. All patients randomized to the MI-E group received the proposed protocol, completing all the scheduled MI-E sessions. Adverse events occurred in 14% of the MI-E sessions, but they did not lead to treatment interruption. Weaning success was observed in 76% of IG patients and 73% of CG patients (relative risk, 1.05; 95% CI, 0.75–1.46). No significant differences were observed between the IG and CG regarding ICU mortality (16% and 18%, respectively, p = 0.99) or hospital mortality (40% and 41%, respectively, p = 0.99).</div></div><div><h3>Conclusions</h3><div>The addition of MI-E to the standard weaning protocol is feasible, but not result in a greater rate of successful weaning in tracheostomized patients.</div></div><div><h3>Clinical trial registration number</h3><div>U1111-1302-9035.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502125"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184803","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":"Tranexamic acid applications in neurocritical patients: A narrative review","authors":"Eva Esther Tejerina Álvarez ,&nbsp;Irene Cavada Carranza ,&nbsp;Marcos González Bermejo ,&nbsp;Teresa Molina García ,&nbsp;José Ángel Lorente Balanza","doi":"10.1016/j.medine.2025.502139","DOIUrl":"10.1016/j.medine.2025.502139","url":null,"abstract":"<div><div>In patients with spontaneous or traumatic intracranial hemorrhage, hematoma expansion is associated with poorer neurological outcomes and increased mortality. The administration of an antifibrinolytic agent like tranexamic acid (TXA) may potentially improve clinical outcomes in patients with acute brain injury by preventing such intracranial expansion. However, studies on the impact of TXA in these patients have yielded variable results, and its efficacy, appropriate dosing and optimal timing of administration remain unclear. The present review summarizes the clinical evidence regarding the proper use of tranexamic acid in the treatment of intracranial traumatic and non-traumatic hemorrhage, and its implications for clinical practice.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502139"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076808","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}