Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Utilización del índice biespectral (BIS®) en pacientes adultos bajo sedación profunda con ventilación mecánica en las unidades de cuidados intensivos","authors":"Álvaro Luis Ochoa Solana ,&nbsp;Juan José Molina Acosta ,&nbsp;Francisco José Molina Saldarriaga","doi":"10.1016/j.acci.2025.10.002","DOIUrl":"10.1016/j.acci.2025.10.002","url":null,"abstract":"<div><div>The prevalence of deep sedation levels varies between 35 and 68% in adult patients with mechanical ventilation, which is associated with multiple complications, increased hospital stay and increased costs, making the rational and safe use of sedation imperative. We describe how to use the BIS® monitor, its different parameters of clinical use for the appropriate use of sedation in critical care. In turn, we review the literature demonstrating with different studies its advantages: first, as a complement to the Richmond Agitation Sedation Scale (RASS), the BIS can reliably identify deep sedation; second, it is associated with a decrease in the use of medications and costs; third, it is related to a reduction of medical complications such as respiratory depression, aspiration, delirium and prolonged ICU stays derived from excessive sedation.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100576"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418702","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":"Es tiempo de actuar: Implementación de programas de movilidad temprana en Unidades de Cuidado Intensivo","authors":"Genis Castillo ,&nbsp;Bladimir Gil ,&nbsp;Jhonatan Manrique ,&nbsp;César Morales ,&nbsp;Sandra Rodríguez ,&nbsp;Albert Valencia ,&nbsp;Esther Wilches ,&nbsp;Sara Zuluaga","doi":"10.1016/j.acci.2025.08.011","DOIUrl":"10.1016/j.acci.2025.08.011","url":null,"abstract":"<div><div>In November 2024, a multidisciplinary meeting was held in Bogotá, bringing together professionals with expertise in critical care, rehabilitation, physiotherapy, nursing, and clinical management. The primary objective of this meeting was to share experiences on the implementation of early mobility programs in intensive care units (ICUs) across Colombia, review the available scientific evidence, and establish a collective call to transform clinical practice in this area.</div><div>The meeting involved representatives from leading healthcare centers in the implementation of early mobility programs, as well as researchers affiliated with universities and scientific societies. Discussions emphasized that early mobilization of critically ill patients is a safe, feasible, and evidence-based strategy. The implementation of structured protocols has consistently demonstrated significant clinical benefits, including reduced hospital and ICU length of stay, lower incidence of complications related to mechanical ventilation, improved functional recovery, and greater patient and family satisfaction. These findings underscore the importance of integrating early mobility as a core component of comprehensive critical care management.</div><div>Participants also identified logistical, cultural, and administrative barriers that hinder the implementation of these strategies, as well as practical solutions adapted to diverse institutional contexts. This document represents a call to action aimed at healthcare institutions and clinical teams to promote the adoption of early mobility as a standard of care in ICUs, with the goal of optimizing clinical outcomes and improving patients’ quality of life in the short, medium, and long term.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100570"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418703","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":"Extubación paliativa en cuidado crítico: una revisión narrativa","authors":"Camila Cruz-Capacho ,&nbsp;Camilo Molineros-Baron ,&nbsp;Luisa Fernanda Rodriguez-Campos","doi":"10.1016/j.acci.2025.10.004","DOIUrl":"10.1016/j.acci.2025.10.004","url":null,"abstract":"<div><div>Invasive mechanical ventilation is an artificial life support strategy to support respiratory system functions when the respiratory system is unable to cope with the metabolic demands of the body due to a specific pathology. Once medical interventions aimed at restoring the body's homeostasis have been exhausted, adequate control of the disease that led the patient to require mechanical ventilation has not been achieved, or there is no reasonable rehabilitative potential, mechanical ventilation is considered to have become futile, so the removal of the endotracheal tube becomes a strategy for the adequacy of therapeutic efforts.</div><div>This narrative review aims to study the methods used in the palliative extubation procedure, thus describing the order of steps to be followed to achieve an ideal management of the end-of-life situation in patients requiring ventilatory support. In addition, the use of some medications that are useful at the time of palliative extubation is described, as well as the legal and ethical considerations of this procedure, and the important role of the family. An exhaustive search of scientific databases was conducted to compile and analyze the relevant literature on palliative extubation in order to develop a comprehensive narrative review of the topic. A brief algorithm is proposed as a guide for decisions and behaviors in the context of palliative extubation, following four stages of the process: preparation, pre-extubation, extubation and post-extubation.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100578"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418705","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":"Implicaciones de ANDROMEDA-SHOCK-2 para la fisioterapia en el paciente crítico: la perfusión como señal de seguridad","authors":"Luis Alexander Peña-López ,&nbsp;Henry Mauricio Parada-Gereda ,&nbsp;María Angelica Rodríguez-Scarpetta ,&nbsp;Wilson Mauricio Lozano ,&nbsp;Manuel Garay-Fernández ,&nbsp;Esther Cecília Wilches-Luna","doi":"10.1016/j.acci.2025.100579","DOIUrl":"10.1016/j.acci.2025.100579","url":null,"abstract":"","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100579"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418815","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":"AI integration and its importance in critical care medicine: Augmented Critical Care Ecosystems (ACCEs)","authors":"Ever Leonardo Rojas-Díaz ,&nbsp;Ledys Izquierdo ,&nbsp;Andrés Rico ,&nbsp;Natali Mercado Solorzano ,&nbsp;Andrés F. Cardona ,&nbsp;Luis Pino","doi":"10.1016/j.acci.2025.08.008","DOIUrl":"10.1016/j.acci.2025.08.008","url":null,"abstract":"","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100567"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418814","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":"Ventilator-associated pneumonia (VAP): The role of the intensive care physiotherapist in ultrasound-based functional assessment","authors":"Johana Carolina Pazmiño Ordóñez ,&nbsp;María Paula Guerrero ,&nbsp;Verónica Arturo Rodríguez ,&nbsp;Ana María Pinza Ortega ,&nbsp;Diana Ávila Reyes ,&nbsp;Jorge Ignacio Martínez","doi":"10.1016/j.acci.2025.100580","DOIUrl":"10.1016/j.acci.2025.100580","url":null,"abstract":"","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100580"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418813","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":"Combinación del cociente diferencia veno-arterial de dióxido de carbono / diferencia arteriovenosa de oxígeno (Pv-aCO2/Ca-VO2) y lactato como predictor de mortalidad en pacientes con choque séptico","authors":"Javier Hernán Lasso Estupiñán ,&nbsp;Daniela Alejandra Getial Mora ,&nbsp;Diego Luis Lagos Caicedo ,&nbsp;Gloria María Sierra Hincapié","doi":"10.1016/j.acci.2025.08.009","DOIUrl":"10.1016/j.acci.2025.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association between the veno-arterial carbon dioxide difference / arterio-venous oxygen difference ratio (Pv-aCO2/Ca-VO2) and lactate as a predictor of mortality in patients with septic shock admitted to the intensive care unit (ICU).</div></div><div><h3>Design</h3><div>Prospective cohort study conducted between June 2017 and October 2020.</div></div><div><h3>Setting</h3><div>Intensive care.</div></div><div><h3>Patients</h3><div>Adults with septic shock admitted to the ICU were included. Pregnant patients, patients with chronic kidney failure on hemodialysis, liver cirrhosis, or chronic obstructive pulmonary disease were excluded.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Lactate, venous-arterial carbon dioxide difference (Pv-aCO2), venous oxygen saturation (ScVO2), Pv-aCO2/Ca-VO2 ratio and mortality. The exposed group were those patients with Pv-aCO2/Ca-VO2<!--> <!-->&gt;<!--> <!-->=<!--> <!-->1,4 and lactate<!--> <!-->&gt;<!--> <!-->=<!--> <!-->2 mmol/L.</div></div><div><h3>Results</h3><div>137 patients were analyzed. Median age was 68 years. 59% of the patients died. The variables reported by the model were: Pv-aCO2/Ca-VO2<!--> <!-->&gt;<!--> <!-->=<!--> <!-->1,4 and lactate<!--> <!-->&gt;<!--> <!-->=<!--> <!-->2 mmol/L RR_adjust 2,29 95% CI (1,57–3,32), oncological diagnosis RR_adjust 1,55 95% CI (1,03-2,26), SOFA RR_adjust 1,30 95% CI (1,13-1,50) and days of stay in ICU RR_adjust 0,92 95% CI (0,85-0,99), all of them with p<!--> <!-->&lt;<!--> <!-->0.05 and a model prediction capacity of 88.1% reported by the area under the ROC curve.</div></div><div><h3>Conclusions</h3><div>According to the predictive model, patients with septic shock who present a Pv-aCO2/Ca-VO2 ratio ≥ 1.4 and lactate levels ≥ 2 mmol/L have a 29% increased risk of mortality.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100568"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418809","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":"Relación entre la carga laboral de enfermería en las unidades de cuidado intensivo de un hospital de alta complejidad y la ocurrencia de eventos adversos","authors":"Andrés Guzmán Gutiérrez ,&nbsp;Efraín Alonso Gómez López","doi":"10.1016/j.acci.2025.09.001","DOIUrl":"10.1016/j.acci.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the nursing workload and analyze its relationship with the occurrence of adverse events in two high-complexity intensive care units in Bogotá.</div></div><div><h3>Design</h3><div>Observational, analytical, cross-sectional study.</div></div><div><h3>Patients</h3><div>Unit of analysis: shift. Unit of observation: Nursing Activity Score (NAS) measurements and adverse event reports for each shift.</div></div><div><h3>Materials and methods</h3><div>NAS measurements were collected for 158 shifts, along with the number of adverse events and nursing professionals per shift. Logistic regression was applied to explore associations, using a significance level of 0.05.</div></div><div><h3>Results</h3><div>The average workload was 66.4% (range: 26-126%), being higher in the afternoon shift. The nurse/patient ratio averaged 2.6 patients per nurse in the night shift. Logistic regression showed that workload (β=0.074; <em>P</em>=.005; OR<!--> <!-->=<!--> <!-->1.08) and nurse-to-patient ratio (β=1.53; <em>P</em>=.029; OR<!--> <!-->=<!--> <!-->4.63) were significantly associated with the occurrence of adverse events. The type of unit had a marginal effect (<em>P</em>=.062). Other variables, such as mean age, number of patients, and number of professionals, showed no significant association (<em>P</em>&gt;.1). The model had a McFadden pseudo-R² of 0.131, explaining approximately 13% of the variability in the occurrence of events.</div></div><div><h3>Conclusions</h3><div>High workload and nurse-to-patient ratio are associated with a higher occurrence of adverse events, highlighting the need to optimize the allocation of nursing staff in intensive care units as a patient safety strategy.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100571"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418808","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":"Falla gastrointestinal en pacientes con ventilación mecánica: prevalencia y factores asociados","authors":"Sandra Paola Avila Villalobos ,&nbsp;Jessica Garduño López ,&nbsp;Marcos Antonio Amezcua Gutiérrez ,&nbsp;Fernando Gabriel Delgado Mejía ,&nbsp;Freud Piaget Hernández Bielma ,&nbsp;Hugo Armando Vélez Dávila ,&nbsp;Francisco Javier Ramírez Almaraz ,&nbsp;Juan Ángel Morales Ferrer ,&nbsp;Javier Vázquez Falconi Justiniani ,&nbsp;Ricardo Daniel Estrada Moreno","doi":"10.1016/j.acci.2025.100582","DOIUrl":"10.1016/j.acci.2025.100582","url":null,"abstract":"<div><h3>Background</h3><div>Enteral nutrition intolerance occurs in approximately 30% of patients undergoing invasive mechanical ventilation (IMV) for more than 72<!--> <!-->hours and is associated with worse clinical outcomes. Gastrointestinal dysfunction includes the digestive symptoms frequently observed in this context, while gastrointestinal failure (GIF) represents its most severe form. The aim of this study was to determine the prevalence of GIF in patients receiving IMV and to analyze its relationship with hemodynamic, pharmacological, and ventilatory factors.</div></div><div><h3>Materials and methods</h3><div>This was a prospective, single-center cohort study conducted over six months in an intensive care unit (ICU). Patients admitted for medical or surgical causes with an intact gastrointestinal tract on admission and receiving enteral nutrition via feeding tube were included. GIF was classified according to standardized clinical criteria, and associated hemodynamic, ventilatory, and pharmacological variables were evaluated.</div></div><div><h3>Results</h3><div>A total of 77 patients were included; 22 developed GIF, corresponding to a prevalence of 28.5%. Among these, 63.6% (n<!--> <!-->=<!--> <!-->14) presented grade II GIF, 22.7% (n<!--> <!-->=<!--> <!-->5) grade III, and 13.6% (n<!--> <!-->=<!--> <!-->3) grade IV. No significant differences were found in vasopressor use, lactate levels, or opioid administration between GIF severity groups. Body mass index (BMI), PEEP, and intra-abdominal pressure were associated with greater severity in the bivariate analysis.</div></div><div><h3>Conclusions</h3><div>The prevalence of gastrointestinal failure is a relatively frequent complication in critically ill patients receiving enteral nutrition. Body mass index, PEEP levels, and intra-abdominal pressure were associated with greater severity, highlighting the importance of these parameters in the assessment and monitoring of patients at risk of gastrointestinal failure. The findings in this study suggest the need for further research into factors associated with the progression of gastrointestinal failure to optimize clinical management in the ICU.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100582"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418806","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":"Pathogenicity of sepsis and its effects on cell physiology","authors":"Qurban Ali ,&nbsp;Mohammad Arshad Javed ,&nbsp;Mohd Amir ,&nbsp;Ajaz Ahmad","doi":"10.1016/j.acci.2025.08.010","DOIUrl":"10.1016/j.acci.2025.08.010","url":null,"abstract":"<div><div>Sepsis is a serious medical condition with a high mortality rate where patients experience a severe infection. In a normal operation, the immune and physiological systems work together to eliminate dangerous infections. On the other hand, sepsis occurs when the body cannot control these normal physiological reactions. In an ideal situation, the first interaction between the immune system and a pathogen would result in the total elimination of the infection and a quick return to balance in the host's body. Increased macrophage and neutrophil activity can accelerate the septic response. Sepsis happens because of many things, such as more cell and tissue damage, faster lymphocyte cell death, longer neutrophil cell death, and too many lymphocytes costimulatory molecules being made. Various interactions between the coagulation system and the inflammatory response result in an imbalanced reaction from both systems. Identifying patients who could potentially benefit from immunomodulatory therapy and assisting in diagnosing sepsis are important applications of biomarkers.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 1","pages":"Article 100569"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147418810","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}