Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Escalas FOUR y Glasgow: herramientas para el cuidado de la persona con lesión cerebral adquirida: revisión integrativa","authors":"James Isaac Murillo Vaca,&nbsp;Juan Fernando Álvarez Chica,&nbsp;Manuel Alejandro Granada Gómez","doi":"10.1016/j.acci.2026.100638","DOIUrl":"10.1016/j.acci.2026.100638","url":null,"abstract":"<div><div>Acquired brain injury (ABI) is the second leading cause of death worldwide. Nursing plays a crucial role in the use of assessment tools that allow monitoring of neurological status in intensive care units (ICU). The objective of this review was to evaluate the current scientific evidence on the Full Outline Of UnResponsiveness Scale (FOUR) and Glasgow Coma Scale (GCS) as tools for ICU nursing neurological assessment of patients with ABI. An integrative review guided by the PRISMA statement was conducted; bibliographic material was searched in PUBMED, LILACS, SCIENCEDIRECT, EMBASE, and EBSCO. A database was constructed to systematize the search and compile the information; the results were integrated in narrative form. Eleven studies were included, grouped into 4 categories: cross-cultural adaptation, ease of use and application, validity and reliability, and prediction of clinical outcomes. Mainly prospective and clinimetric studies from different countries were analyzed, mostly from Asia and Europe. Ninety-point-nine percent of the studies showed a low risk of bias and high agreement among evaluators, including nurses. The included studies suggest that the FOUR Scale is a valid and reliable alternative to the GCS, with advantages particularly evident in intubated patients or those with verbal communication difficulties. These conclusions should be interpreted in the context of the 11 included studies, primarily from Asia and Europe, which limits direct generalization to the Latin American setting. The ease of use and predictive capacity of the FOUR Scale are highlighted.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100638"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746848","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":"Reanimación en choque séptico: de las metas fijas a la perfusión personalizada","authors":"Cristyan Camilo Corrales Morales,&nbsp;Santiago Benjumea Henao,&nbsp;Luis Fernando Sabogal Franco,&nbsp;Bladimir Alejandro Gil Valencia","doi":"10.1016/j.acci.2026.100616","DOIUrl":"10.1016/j.acci.2026.100616","url":null,"abstract":"<div><div>Septic shock represents a medical emergency with a persistent mortality rate of 20-40%. Traditionally, resuscitation has been based on fixed goals applied uniformly, without considering individual phenotypic heterogeneity, which is likely associated with the lack of improvement in outcomes for these patients. This review examines the evidence supporting personalized strategies based on: capillary refill time as a superior marker to lactate, hemodynamic phenotyping, the Windkessel model as a guide for management, dynamic predictors of volume responsiveness, and early de-resuscitation. Based on this evidence review, a therapeutic approach is proposed that personalizes management according to the clinical and physiological characteristics of patients with septic shock in order to improve their prognosis.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100616"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746255","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":"Microbiota del eje intestino-pulmón en el paciente con sepsis: una revisión narrativa","authors":"Cristian Vera Marín,&nbsp;Johanna M. Vanegas,&nbsp;Francisco José Molina","doi":"10.1016/j.acci.2026.100637","DOIUrl":"10.1016/j.acci.2026.100637","url":null,"abstract":"<div><div>It has been proposed that intestinal microbiota imbalance represents a significant factor in sepsis and organ dysfunction, as it modulates host susceptibility and the response to infection through immune and metabolic pathways. Although the characterization of microbial communities and their impact has been well described from the perspective of the gut microbiota, evidence at the pulmonary level has been less conclusive. This is largely due to the invasive nature of procedures required to obtain samples from the lower respiratory tract, which has limited in-depth investigation of the lung microbiota. Nevertheless, available evidence suggests that dysbiosis affecting both the intestinal and pulmonary microbiota disrupts essential homeostatic functions in the host—particularly immune and metabolic processes—mediated through the gut–lung axis. This review examines the current literature on the main features of the gut and lung microbiota in patients with sepsis, with particular emphasis on the gut–lung axis and its dynamics during intensive care unit (ICU) stay. A narrative review was conducted following SANRA guidelines. A search in PubMed/MEDLINE, Web of Science, and Google Scholar included relevant studies on sepsis and the gut–lung axis, which were analyzed using an integrative approach.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100637"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746261","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":"Difusión de imágenes diagnósticas en cuidados intensivos: entre el valor educativo y la responsabilidad ética","authors":"Jhojan Sebastian Herrera-Vargas","doi":"10.1016/j.acci.2026.100614","DOIUrl":"10.1016/j.acci.2026.100614","url":null,"abstract":"","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100614"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746849","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":"Pronóstico de pacientes con encefalopatía hipóxico-isquémica en una unidad de cuidados intensivos: una cohorte de pacientes (2021-2025)","authors":"Ana María Acosta Murcia,&nbsp;Luis Fermín Naranjo Atehortúa,&nbsp;David Yepes Gómez,&nbsp;José Bareño Silva,&nbsp;Jaisan Jesue Granados Glenn","doi":"10.1016/j.acci.2026.100613","DOIUrl":"10.1016/j.acci.2026.100613","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypoxic-ischemic encephalopathy (HIE) in adults is a severe neurological condition associated with high mortality and disability, with limited local data regarding its prognosis in intensive care units (ICUs).</div></div><div><h3>Objective</h3><div>To evaluate clinical and neurological outcomes of adult patients with HIE admitted to an ICU between 2021 and 2025, and to explore factors associated with mortality and neurological recovery.</div></div><div><h3>Methods</h3><div>Observational, descriptive, retrospective study. Among 2,284 ICU admissions between January 2021 and March 2025, 29 adult patients with confirmed HIE were identified. Sociodemographic, clinical, organ support, and neurological variables were collected. Outcomes were in-hospital mortality and functional status at discharge assessed using the modified Rankin Scale (mRS). Descriptive and exploratory bivariate analyses were performed.</div></div><div><h3>Results</h3><div>In-hospital mortality was 44.8%, and 37.9% of patients achieved a favorable neurological outcome (mRS 0–3). Mean age was 62.2<!--> <!-->±<!--> <!-->12.8 years; 86.2% were older adults and 55.2% were male. Vasopressor support was required in 96.6% of patients and renal replacement therapy in 48.3%. Brain computed tomography was performed in 69% of cases, showing hypoxic-ischemic findings in 45%. Brain magnetic resonance imaging was performed in 20.7%, and electroencephalography in 27.6%. In exploratory analysis, absence of brain magnetic resonance imaging was associated with higher mortality (OR 16.7; 95% CI 0.84–331.5; p<!--> <!-->=<!--> <!-->0.013). No robust clinical predictors of adverse neurological outcome were identified.</div></div><div><h3>Conclusions</h3><div>Adult HIE patients admitted to the ICU show high mortality and substantial neurological disability. Multimodal neurological assessment may provide relevant prognostic information. Prospective studies are needed to identify reliable predictors and optimize post-resuscitation care.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100613"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746850","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":"Impact of intensive care unit monitoring on complications after DIEP flap reconstruction","authors":"Victor Hugo Nieto Estrada,&nbsp;Valeria Rocha Yaruro,&nbsp;Horacio Rodriguez Escallon,&nbsp;Liceth Lorena Patarroyo Villalobos,&nbsp;Sergio Cervera Bonilla,&nbsp;Sandra Ximena Franco,&nbsp;María Alejandra Bravo,&nbsp;José Joaquin Caicedo,&nbsp;Ana María Osorio Ruiz,&nbsp;Catalina Muñoz Morales,&nbsp;Susana Margarita Correa,&nbsp;Marcela Sanchez,&nbsp;William Armando Mantilla Duran","doi":"10.1016/j.acci.2026.100617","DOIUrl":"10.1016/j.acci.2026.100617","url":null,"abstract":"<div><h3>Introduction</h3><div>Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is a well-established option after breast cancer surgery. However, the role of structured postoperative monitoring in the intensive care unit (ICU) and its impact on complication rates remain underreported, particularly in low- and middle-income countries, where access to breast reconstruction may be limited. This study aimed to evaluate postoperative outcomes in patients undergoing DIEP flap reconstruction with standardized ICU monitoring at a comprehensive cancer center in Bogota, Colombia.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 39 patients who underwent DIEP flap breast reconstruction was analyzed. Clinical and demographic variables were collected. Quantitative data were analyzed descriptively according to the assumption of their distribution, whereas qualitative variables were evaluated using contingency tables with absolute and relative frequencies. Odds ratios (OR) and areas under the receiver operating characteristic curve (AUC) were calculated for key risk factors. Postoperative complications included thrombosis, hematoma, bleeding, total or partial flap loss, fat necrosis, abdominal wall hernia, and infection.</div></div><div><h3>Results</h3><div>The overall complication rate was 23%, with only one case of total flap loss (2.6%). Hyperlactatemia, prolonged surgical time, and reintervention were associated with higher complication risk, whereas immediate reconstruction emerged as a protective factor. Lactate at ICU admission showed predictive value for complications (AUC<!--> <!-->=<!--> <!-->0.72).</div></div><div><h3>Conclusion</h3><div>Standardized ICU monitoring for patients undergoing DIEP flap reconstruction after breast cancer surgery is associated with low flap loss rates and facilitates early detection of complications. These findings support the integration of structured, multilevel monitoring protocols to improve safety and outcomes in microsurgical breast reconstruction.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100617"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746852","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":"Intervenciones de terapia ocupacional para adultos críticamente enfermos según el nivel de sedación y agitación: propuesta de marco de trabajo basado en la Richmond Agitation-Sedation Scale","authors":"Florencia Ampuero-Sánchez,&nbsp;Sthefany Quezada-Hernández,&nbsp;Francisco Salinas-Barahona,&nbsp;Ruvistay Gutiérrez-Arias","doi":"10.1016/j.acci.2026.100620","DOIUrl":"10.1016/j.acci.2026.100620","url":null,"abstract":"<div><div>Critically ill patients admitted to intensive care units (ICUs) often experience complications arising from prolonged bed rest, systemic inflammation, and sensory overload, including ICU-acquired weakness (ICU-AW), cognitive impairment, sensory dysfunction, and reduced functional independence. Occupational therapy has taken on an increasingly important role in this context, intervening from the early stages through strategies such as self-care, cognitive stimulation, sensory modulation, and progressive mobilization. This article proposes a framework to guide occupational therapy interventions for critically ill adults, tailored to different levels of sedation and agitation as measured by the Richmond Agitation-Sedation Scale (RASS). Four components of intervention—motor, cognitive, sensory, and cross-cutting—are described, including optimization of positioning, orthotic management, early mobilization, multisensory stimulation, cognitive stimulation, non-pharmacological management of delirium, participation in activities of daily living (ADL), and family education. These interventions are organized progressively across the ten levels of the RASS scale (from −5 to +4), ranging from passive strategies in deep sedation to active and functional interventions in alert patients or those with mild agitation, and to safety-focused strategies during severe agitation.</div><div>The proposed framework demonstrates that occupational therapy interventions can be safely and consistently applied across all levels of analgosedation in critically ill patients. Using the RASS scale as a guide allows the type and intensity of interventions to be tailored to the patient's level of alertness and individual functional capacity, thereby contributing to the prevention of complications, early functional recovery, and preparation for hospital discharge.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100620"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746256","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":"Nutrición parenteral en el paciente crítico: Consenso colombiano de expertos","authors":"Fernando José Pereira Paternina,&nbsp;Nestor David Caicedo Buitrago,&nbsp;Claudia Milena Ardila Melendez,&nbsp;José Luis Aldana Diaz,&nbsp;Lina María Saucedo Jaramillo,&nbsp;Ana María Jaillier Ramírez,&nbsp;Beatriz Elena Restrepo Cardona,&nbsp;Erika Aguirre Marulanda,&nbsp;Janeth Barbosa Barbosa,&nbsp;Juan Camilo Gómez Montoya,&nbsp;Juan Luis Echeverri Ospina,&nbsp;Juan Rodrigo Moreno Restrepo,&nbsp;Norha Elena Múnera Betancur,&nbsp;Santiago Adolfo Parraga Garabi,&nbsp;Willington Anibal Montenegro Acosta,&nbsp;Agamenon Quintero Villarreal,&nbsp;Víctor Hugo Nieto Estrada,&nbsp;Manuel Ándres Garay Fernández,&nbsp;Bladimir Alejandro Gil Valencia,&nbsp;Linda Ibatá Bernal,&nbsp;Julieth Carolina Castillo Cañón","doi":"10.1016/j.acci.2026.100636","DOIUrl":"10.1016/j.acci.2026.100636","url":null,"abstract":"<div><h3>Introduction</h3><div>Parenteral nutrition is a fundamental intervention in critically ill patients when oral or enteral feeding is not feasible or is insufficient. Despite the availability of international guidelines, considerable variability in clinical practice persists, particularly in resource-limited settings where implementation depends on local conditions.</div></div><div><h3>Methods</h3><div>A national consensus was developed through a modified Delphi process involving multidisciplinary experts in critical care medicine, clinical nutrition, and related fields in Colombia. A structured literature review (MEDLINE, Embase, and LILACS; October 2025) was conducted to support the formulation of consensus statements. Recommendations were rated using a five-point Likert scale, with consensus defined as ≥80% agreement (scores 4–5).</div></div><div><h3>Results</h3><div>A total of 140 recommendations were formulated, covering nutritional assessment, indications, timing of initiation, formulation, administration, monitoring, transition, and management of complications related to parenteral nutrition in critically ill adult patients. The recommendations emphasize early and ongoing nutritional assessment, prioritization of the enteral route whenever possible, and timely initiation of parenteral nutrition when enteral nutrition is contraindicated or insufficient. Operational criteria are established for the indication of supplemental parenteral nutrition, progression of nutritional support, and metabolic monitoring. Recommendations are also provided regarding vascular access, lipid selection, micronutrient supplementation, prevention of catheter-associated infections, and management of metabolic and hepatic complications.</div></div><div><h3>Conclusions</h3><div>This document represents the first Colombian consensus on parenteral nutrition in critically ill adult patients. It integrates available evidence with local expert consensus and provides operational recommendations adapted to the national context. Its implementation may help reduce clinical variability and improve the safety and effectiveness of nutritional support in intensive care units.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100636"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746851","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":"Effect of time of thromboprophylaxis initiation on the incidence of complications in patients with subarachnoid hemorrhage","authors":"Andrés Gempeler,&nbsp;Carlos Mario Vaca,&nbsp;Aimi Shinchi,&nbsp;Luis Enrique Figueroa,&nbsp;Leidy Gaviria,&nbsp;Laura Ballen Galeano,&nbsp;Jorge Mejía-Mantilla","doi":"10.1016/j.acci.2026.100633","DOIUrl":"10.1016/j.acci.2026.100633","url":null,"abstract":"<div><h3>Background</h3><div>Ideal time for thromboprophylaxis initiation (TI) in subarachnoid hemorrhage (SAH) patients remains elusive as evidence is scarce and anticoagulation could have harmful effects on hemorrhage risk, but beneficial effects on delayed cerebral ischemia (DCI), as micro-thrombosis is part of its pathophysiology. We aimed to assess the effects of time to TI on the incidence of brain hemorrhages, DCI, thromboembolic events and death in patients with SAH treated in the ICU.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of SAH patients that received thromboprophylaxis during ICU stay between 2011 and 2020, at a tertiary care university hospital. We excluded patients without aneurysmal control. All outcomes were assessed until hospital discharge. We used multivariable logistic regression and time-to-event models to assess the association of TI from aneurysm control with the occurrence of intracranial hemorrhages, thromboembolic events, DCI and death; and explored differences in outcomes between early vs delayed TI using different cut-off points (24, 48 and 72<!--> <!-->h). Adjusted odds ratios (aOR) and hazard ratios (aHR) with 95% confidence intervals (CI) are reported.</div></div><div><h3>Results</h3><div>138 patients were included for analyses. Overall, patients were around 58 years of age, 30.4% had high grade SAH according to WFNS<!--> <!-->=<!--> <!-->4 or 5, and all patients received enoxaparin for thromboprophylaxis, with a median (IQR) TI after aneurysm control of 3 (2–5) days. TI did not had an effect on risk of hemorrhage (aOR<!--> <!-->=<!--> <!-->0.97, CI: 0.82–1.14), DCI (aOR<!--> <!-->=<!--> <!-->0.93, CI: 0.83–1.04) or death (aOR<!--> <!-->=<!--> <!-->0.98, CI: 0.85–1.12). We found no effect of early vs delayed TI on the incidence of DCI with any of the different cut-off point definitions (aHR<!--> <!-->=<!--> <!-->∼0.85, CI: ∼0.45–1.65).</div></div><div><h3>Conclusions</h3><div>Variation in the timing of thromboprophylaxis initiation after aneurysm control did not influence hemorrhagic events, DCI or mortality. Our findings support earlier adoption of LMWH once surgical or endovascular control has been confirmed and no contraindications are present. Prospective trials are needed to establish whether ultra-early initiation could confer any neuroprotective benefits.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100633"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148746856","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":"Recomendaciones de consenso sobre el manejo del trauma encefalocraneal en la altitud (COMATEC-ALTITUD) del Comité de Expertos de Medicina Intensiva en la altitud de la Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva","authors":"Adrian Avila-Hilari,&nbsp;Jesús Abelardo Barea Mendoza,&nbsp;Manuel Luis Avellanas-Chavala,&nbsp;Jorge Vélez-Páez,&nbsp;Víctor Hugo Nieto Estrada,&nbsp;Felipe de Jesús Montelongo,&nbsp;Amilcar Tinoco-Solórzano,&nbsp;Michael H. Eduardo Kessler,&nbsp;Fausto Maldonado Coronel,&nbsp;Daniel Molano Franco,&nbsp;Roger Huanca Payehuanca,&nbsp;Jorge Rosendo Sánchez Medina","doi":"10.1016/j.acci.2026.100615","DOIUrl":"10.1016/j.acci.2026.100615","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of severe traumatic brain injury is well established at sea level; however, its application at high altitude poses additional challenges due to hypobaric hypoxia and limited healthcare resources, particularly in neuromonitoring. Evidence in this setting remains scarce and heterogeneous.</div></div><div><h3>Objective</h3><div>To develop clinical recommendations for the diagnosis, monitoring, and management of traumatic brain injury at altitude, adapted to altitude-related physiology and resource-limited settings.</div></div><div><h3>Methods</h3><div>A modified Delphi consensus was conducted. A non-systematic literature review was performed across major biomedical databases (PubMed, Embase, Scielo, Cochrane Library, among others) and grey literature, identifying 125 relevant references. A multidisciplinary panel of 12 international experts evaluated 36 recommendations using a 9-point Likert scale. Consensus was defined as<!--> <!-->≥<!--> <!-->80% agreement (scores<!--> <!-->≥<!--> <!-->7). Recommendations were graded based on strength and quality of evidence using a previously validated system for critical care consensus, given the limited altitude-specific evidence.</div></div><div><h3>Results</h3><div>A total of 36 recommendations across 10 clinical domains were developed. After 2 Delphi rounds, all recommendations achieved consensus (≥<!--> <!-->80%). Twenty recommendations were supported by altitude-specific evidence, while the remainder were adapted from sea-level guidelines. Key domains included hemodynamic resuscitation, altitude-adjusted oxygenation and ventilation strategies, osmotic therapy, and multimodal neurological monitoring, with emphasis on non-invasive techniques when invasive monitoring is unavailable.</div></div><div><h3>Conclusions</h3><div>This consensus provides a structured clinical framework for managing traumatic brain injury at altitude, integrating the best available evidence and expert opinion. It serves as a practical tool for high-altitude settings, particularly in resource-limited environments, and highlights the need for further research in this field.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 3","pages":"Article 100615"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148745625","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}