Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Pacientes oncológicos valorados por la Unidad de Cuidados Intensivos. Factores predictores de mortalidad a 3 meses","authors":"","doi":"10.1016/j.acci.2024.01.004","DOIUrl":"10.1016/j.acci.2024.01.004","url":null,"abstract":"<div><h3>Objective</h3><p>To understand the clinical-epidemiological profile of patients with solid organ tumors who are evaluated by intensive care physicians to determine their admission to the ICU or not.</p></div><div><h3>Materials and methods</h3><p>Prospective observational study in the ICU of a tertiary hospital. The study was approved by the Research Ethics Committee (CEI) of Cantabria. Patients over 18 years of age with a solid organ tumor, for whom an assessment was requested by the intensive medicine team for ICU admission, were included. The study included both patients who were admitted and those whose admission was declined. Informed consent was obtained from all patients for inclusion in the registry. Clinical data were reviewed, and patients were followed up 3 months after ICU evaluation.</p></div><div><h3>Results</h3><p>215 patients were evaluated, of which 173 were admitted to the ICU. The main factors associated with mortality at 3 months after ICU evaluation were the type of tumor, the status of the tumor, the presence of hypertriglyceridemia, and a functional status upon admission with an ECOG score<!--> <!-->&gt;2 or Karnofsky &lt;<!--> <!-->70.</p></div><div><h3>Conclusions</h3><p>The main factors associated with mortality at 3 months after being evaluated by ICU were the type of tumor, the status of the tumor, the presence of hypertriglyceridemia, and a functional status upon admission with an ECOG score<!--> <!-->&gt;2 or Karnofsky &lt;<!--> <!-->70.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 198-207"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466082","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":"Hipo (singulto), una causa de asincronía y deterioro de la oxigenación en paciente con ventilación mecánica invasiva: reporte de caso","authors":"","doi":"10.1016/j.acci.2023.08.003","DOIUrl":"10.1016/j.acci.2023.08.003","url":null,"abstract":"<div><p>We present the case of a 19-year-old woman, with a history of LADA type diabetes mellitus, who presented an acute decompensation of her metabolic pathology secondary to pneumonia of viral origin due to SARS COV2, with a torpid clinical evolution due to hypoxemic respiratory failure. with the need for invasive mechanical ventilation and secondary ARDS (Acute Respiratory Distress Syndrome), in whom hiccups (Singultos), ventilatory asynchrony and impaired oxygenation were evidenced.</p><p>In our patient, hiccups were considered the cause of ventilatory asynchrony, and treatment with levomepromazine was started with adequate resolution of the singultus, leading to a marked improvement in oxygenation and successful extubation.</p><p>Hiccups are a benign, common and self-limited phenomenon that affects almost all people throughout their lives, which can be associated with unfavorable results, such as malnutrition, fatigue, weight loss, insomnia, depression, anxiety, edema. and decreased quality of life and in patients with invasive mechanical ventilation it can result in respiratory alkalosis from hyperventilation, ventilator-associated pneumonia, impaired oxygenation indices, and asynchrony.</p><p>Hiccups are a little-recognized pathology in patients undergoing ventilatory support, with unfavorable results, evidenced by prolonged stays and the need for invasive mechanical ventilation and management in the intensive care unit (ICU), and of course everything that this includes.</p><p>Knowledge of hiccups, as a possible cause of asynchrony and oxygenation disorder in ventilated patients, can allow timely recognition, which allows management in the acute phase, is a fundamental part of minimizing complications associated with ventilation and prolonged stays in ICU.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 255-260"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134917398","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":"Resuscitative thoracotomy as an approach to penetrating cardiac trauma: A case report","authors":"","doi":"10.1016/j.acci.2024.01.007","DOIUrl":"10.1016/j.acci.2024.01.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Cardiac trauma is a significant cause of death. Thoracotomy is an advanced resuscitation technique aimed at restoring cardiac output by relieving cardiac tamponade and repairing cardiac injuries.</p></div><div><h3>Objective</h3><p>A case report of a patient who suffered a penetrating precordial wound that was resolved with a resuscitative thoracotomy was conducted. A narrative review of the current state of the art is presented.</p></div><div><h3>Conclusions</h3><p>Thoracic trauma associated with cardiac injury is a potentially lethal condition. Despite early diagnosis, overall survival is anecdotal. Medical teams familiar with advanced resuscitation techniques such as resuscitative thoracotomy are required.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 290-295"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091436","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":"Urgencias endocrinas en la unidad de cuidados intensivos: síndrome poliglandular autoinmune con crisis adrenal y bloqueo cardíaco avanzado: reporte de un caso","authors":"","doi":"10.1016/j.acci.2024.02.003","DOIUrl":"10.1016/j.acci.2024.02.003","url":null,"abstract":"<div><p>We present a case of a rare medical emergency with multiple risk factors and several causes, with high mortality when not diagnosed and treated in a timely manner. Knowing and linking to the description of this case can help the scientific community prepare for rare situations like this. This is a 48-year-old patient with a history of polyglandular autoimmune syndrome under treatment with corticosteroids, who consulted for asthenia, adynamia, weakness and polydipsia. Clinically, hypotension, hypoglycemia, hydroelectrolyte disturbances, acid-base imbalance, elevated thyroid stimulating hormone (TSH) with decreased free thyroxine (T4L) and low paratohormone (PTH) were identified. An adrenal crisis was diagosticated and was admitted to the ICU. During her stay in the intensive care unit (ICU), she presented with an advanced cardiac block that required a pacemaker implant with appropriate evolution. Adrenal crisis is a rare condition, diagnosis requires a high rate of suspicion even when the history of adrenal insufficiency is known. It is necessary to investigate thoroughly the history, background, clinical manifestations, adherence to corticosteroid therapy, perform a complete physical examination and request relevant paraclinical studies for a comprehensive evaluation. Recognize that cardiac block may be refractory to steroid therapy and require electrical support may be essential for patient survival.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 296-301"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282491","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":"Lactato de sodio 0,5 molar vs. suero salino hipertónico al 3% en el traumatismo de cráneo grave con hipertensión intracraneana: estudio clínico piloto","authors":"","doi":"10.1016/j.acci.2024.02.002","DOIUrl":"10.1016/j.acci.2024.02.002","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the effectiveness of hypertonic sodium lactate (HSL) 0.5 molar in the treatment of intracranial hypertension (ICH) compared to 3% hypertonic saline (HS) in critically ill patients with severe traumatic brain injury (TBI).</p></div><div><h3>Methods</h3><p>Prospective, experimental, randomised study conducted in an Intensive Care Unit (ICU) of a university hospital in critically ill patients with TBI and ICH. Those with ICH were randomised into two groups to receive LSH 0.5M or SSH 3% 500 cc with crossover of intervention according to pH or chloremia. Intracranial pressure (ICP) and internal milieu variables were determined.</p></div><div><h3>Results</h3><p>11 patients were enrolled (54.5% to LSH; 45.5% to SSH). Sixty-four infusions were performed, 45 LSH, 19 SSH. Non-crossover was 90.9% vs. 75%, respectively (p = 0.098). ICP decreased 11.66±6.49mmHg (p &lt; 0.0001) with LSH vs. 10.1±9.19mmHg with SSH (p&lt; 0.0001), without significant difference between both groups. Natraemia increased 3.11±1.87 mEq/L with LSH (p &lt; 0.0001) and 5.43±4.41 mEq/L with SSH (p &lt; 0.0001), in favour of SSH (p = 0.004). The chloremia decreased 1.95±2.60 mEq/L with LSH (p &lt; 0.0001) and increased 5.78±3.7 mEq/L with SSH (p &lt; 0.0001), significant difference of p &lt; 0.0001.</p></div><div><h3>Conclusions</h3><p>LSH 0.5M is as effective as SSH 3% in the control of ICH in patients with TBI, causing a smaller increase in plasma sodium and chloride levels, preventing the development of hyperchloremic acidosis.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 226-235"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272716","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":"Cetoacidosis diabética","authors":"","doi":"10.1016/j.acci.2024.04.004","DOIUrl":"10.1016/j.acci.2024.04.004","url":null,"abstract":"<div><p>Diabetes mellitus is one of the most prevalent non-communicable chronic conditions worldwide. Among its acute complications, diabetic ketoacidosis (DKA) is the most common emergency. For its diagnosis, it is essential to know the most common clinical manifestations and diagnostic criteria established by different scientific societies. The treatment of DKA is based on three key elements, early fluid administration, insulin therapy and correction of electrolyte disorders. However, in special situations the above measures must be individualized. With appropriate and prompt treatment, the morbidity-free survival rate can reach up to 100%. In this review, based on a clinical case, we will provide more recent information regarding the comprehensive approach to DKA in critically ill patients.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 243-254"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141025752","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":"Hemoperitoneo espontáneo: una complicación poco conocida y asociada al consumo de cocaína","authors":"","doi":"10.1016/j.acci.2024.05.006","DOIUrl":"10.1016/j.acci.2024.05.006","url":null,"abstract":"<div><p>Spontaneous hemoperitoneum is a rare condition considered a medical emergency, usually diagnosed through exclusion. Among the main associated causes are congenital aneurysms, rupture of solid tumors, complications of peritoneal dialysis, and coagulopathies. In this article, we present the clinical case of a young man with no previous pathological or traumatic history, but with a history of cocaine use 24<!--> <!-->hours before admission to the emergency room. He presented with generalized, sudden, and intense abdominal pain, and an abdominal ultrasound revealed free intraperitoneal fluid. He underwent exploratory laparotomy, which found 1200<!--> <!-->mL of hemoperitoneum, completely evacuated. However, during the exploration of the cavity and subsequent follow-up in two new surgical procedures, the source of bleeding could not be identified. There were no recurrences or related complications during the follow-up.</p><p>Cocaine is an alkaloid with a powerful vasoconstrictor effect, generating endothelial lesions and an increase in blood pressure, resulting in the spontaneous rupture of blood vessels, constitutes a possible etiology of spontaneous hemoperitoneum.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 315-319"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404038","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":"Hemorragia intraparenquimatosa como complicación neurológica de endocarditis de válvula nativa: a propósito de un caso","authors":"","doi":"10.1016/j.acci.2023.12.008","DOIUrl":"10.1016/j.acci.2023.12.008","url":null,"abstract":"<div><p>Patients with infective endocarditis are generally referred to the intensive care unit due to one or more complications of this pathology. Neurological complications are one of the most important, since they complicate the course of IE and dramatically increase morbidity and mortality rates. Most of these occur early and are a hallmark of left-sided native or prosthetic valve abnormalities. A wide spectrum of neurological disorders can be observed in this scenario, among which is intracerebral hemorrhage. Clinical findings in this entity are associated with the location and extent of it and particularly those patients who develop it have worse outcomes. The objective of this article is to report a case of a patient with intraparenchymal hemorrhage as a neurological complication of IE, emphasizing its clinical, pathophysiological, diagnostic and therapeutic characteristics.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 268-272"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139538926","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":"Sobreinfecciones intrahospitalarias y su relación con la mortalidad en pacientes obesos o diabéticos con COVID-19 críticamente enfermos","authors":"","doi":"10.1016/j.acci.2023.12.002","DOIUrl":"10.1016/j.acci.2023.12.002","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze hospital-acquired superinfections and their relationship with mortality in critically ill obese or diabetic patients with COVID-19.</p></div><div><h3>Design</h3><p>Correlational analysis in an intensive care unit of the public network of Barranquilla (Colombia) between January and December 2021.</p></div><div><h3>Patients</h3><p>Patients with obesity or type<!--> <!-->2 diabetes mellitus and severe SARS-CoV-2 pneumonia requiring cultures of bronchial secretion, blood cultures, and urine cultures 48<!--> <!-->h after admission.</p></div><div><h3>Measurements</h3><p>We compared the presence and absence of superinfection using the Mann-Whitney U, Chi-square, and Fischer tests. To evaluate mortality, it was evaluated using the Kaplan-Meier method, and instantaneous ratio risks were determined.</p></div><div><h3>Results</h3><p>Seventy-eight patients with a median age of 61<!--> <!-->years (51.5-67.8) were included. Superinfection in obese people was 51.6% (n<!--> <!-->=<!--> <!-->16) and diabetics 61.3% (n<!--> <!-->=<!--> <!-->19). On the fifth in-hospital day, in-hospital superinfections increased. A total of 31 microorganisms isolated: 16.1% gram-positive, 80.6% gram-negative and 3.2% yeast. Overall mortality was 85.9% (n<!--> <!-->=<!--> <!-->67). Superinfection was associated with an increase in mortality during the hospital stay (HR: 1.89; 95%<!--> <!-->CI: 1.13-3.15; <em>P</em> <!-->=<!--> <!-->.015) and in the intensive care unit (HR: 1.72; 95%<!--> <!-->CI: 1.02-2.89; <em>P</em> <!-->=<!--> <!-->.040).</p></div><div><h3>Conclusions</h3><p>In critically ill obese or diabetic patients, the presence of in-hospital superinfections represents a fatal complication during the hospital stay; however, no statistically significant differences were found between mortality associated with the presence or absence of superinfection.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 187-197"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633792","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":"Lophomoniasis broncopulmonar: a propósito de varios casos y revisión de la literatura","authors":"","doi":"10.1016/j.acci.2024.02.004","DOIUrl":"10.1016/j.acci.2024.02.004","url":null,"abstract":"<div><p>Lophomoniasis is a parasitic infection caused by a commensal protozoan located in arthropods such as cockroaches and termites. It is transmitted to humans through inhalation of the cystic forms of the parasite that are contained in the feces produced by these insects, and is associated with relatively close contact. between the reservoir and the man.</p><p>It is an infection of recent epidemiological importance due to the considerable increase in the reporting of cases in recent decades in Latin American countries, especially those in the tropics and on the Asian continent. There are many gaps in the literature about its life cycle, interaction with humans, epidemiological factors, and risk factors for transmission and infection.</p><p>Its clinical importance lies in the bronchopulmonary disease it produces, with symptoms indistinguishable from other acute infectious lung pathologies, but which can additionally become chronic by activation of the host's immune response, simulating non-infectious chronic respiratory diseases. These non-specific characteristics explain the low clinical suspicion, erroneous approaches, the non-administration of specific management and the lack of response to treatments for the most common respiratory diseases.</p><p>The diagnosis is made by direct visualization of the protozoan in respiratory samples and the first-line treatment is a short course of metronidazole.</p><p>We present 3 cases identified in a high complexity institution in the city of Medellin (Colombia), which were characterized by the presence of non-specific respiratory symptoms such as cough, progressive dyspnea and variable evolution time. During the in-hospital evaluation, diagnostic aids were performed that were initially guided to common respiratory pathologies and that subsequently allowed the incidental discovery of the protozoan in all cases and with this, the appropriate treatment was initiated.</p><p>The recognition of this parasitic infection will lead to a better understanding of behavior and interaction with humans, to observe epidemiological characteristics, risk factors and in turn will allow us to know the local incidence and carry out possible measures to prevent the pathology.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 302-309"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781339","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}