Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Actualización en rehabilitación cardiaca en el paciente crítico cardiovascular: una revisión de tema","authors":"Juan Santiago Serna-Trejos ,&nbsp;Carlos Andrés Castro-Galvis ,&nbsp;Stefanya Geraldine Bermúdez-Moyano ,&nbsp;Laura Catalina Rodríguez-Fonseca ,&nbsp;Álvaro Andrés Montenegro-Apraez ,&nbsp;Jorge Fernando Miño-Bernal ,&nbsp;Lina María Salazar-Rodríguez ,&nbsp;Valentina Bravo-Echeverry","doi":"10.1016/j.acci.2025.01.004","DOIUrl":"10.1016/j.acci.2025.01.004","url":null,"abstract":"<div><div>Cardiac rehabilitation is a comprehensive, multidisciplinary strategy that has demonstrated significant benefits in critically ill cardiovascular patients, particularly those with ischemic disease, heart failure, and post-surgical interventions. This article reviews recent literature on the impact of cardiac rehabilitation in critically ill patients, highlighting its ability to improve functional capacity, quality of life, and reduce mortality and hospitalizations. Programs include tailored interventions encompassing supervised exercise, risk factor education, and psychosocial support. Important barriers are identified, such as low participation in rehabilitation programs, especially in vulnerable populations, due to economic limitations, geographic access and lack of knowledge on the part of both patients and health professionals. Emerging strategies, such as telemedicine-based rehabilitation and home-based programs, which seek to improve adherence and accessibility, are also discussed. Although the data are promising, more robust evidence is needed to assess efficacy in specific subgroups of critically ill patients and in resource-limited settings.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 350-360"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254074","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":"Esteroides, sepsis y shock séptico: de la plausibilidad biológica a la evidencia actual. Revisión narrativa","authors":"Jorge Luis Vélez-Páez ,&nbsp;Daniel Torres-Carpio ,&nbsp;Manuel Luis Avellanas-Chavala","doi":"10.1016/j.acci.2025.01.007","DOIUrl":"10.1016/j.acci.2025.01.007","url":null,"abstract":"<div><div>The discovery of steroids marked a medical milestone, both physiologically, by understanding adrenal function; and therapeutically, by finding an anti-inflammatory and immunosuppressive hormone that changed the natural history of autoimmune diseases.</div><div>Sepsis is systemic inflammation secondary to an infection, therefore, the use of steroids is biologically plausible. However, history provides negative data on their use at high doses (immunosuppression). Low doses activate non-genomic mechanisms with immunomodulatory and neuroendocrine responses that restore adrenergic sensitivity and improve the hemodynamic context in patients with septic shock and have opened a path towards a reasonable and supported therapeutic indication.</div><div>The objective of this review is to trace the historical path of steroids from their discovery to their current indication in septic shock.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 361-370"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254075","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":"Validación facial y de contenido del instrumento «Awareness, Attitudes, Prevention and Perceptions of COVID-19 Outbreak among Nurses»","authors":"Diana Isabel Cáceres Rivera ,&nbsp;Moisés Alfonso Bravo Gómez ,&nbsp;Raquel Rivera Carvajal ,&nbsp;Claudia Consuelo Torres Contreras","doi":"10.1016/j.acci.2024.11.002","DOIUrl":"10.1016/j.acci.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The care of patients with COVID-19 has generated the need to identify levels of awareness, prevention, attitudes and perception of nursing professionals in intensive care units. The objective of this work was to perform the face and content validation of an instrument of knowledge, attitudes and practices regarding COVID-19.</div></div><div><h3>Methodology</h3><div>Facial validation study of the instrument «Awareness, Attitudes, prevention and perceptions of COVID-19 Outbreak among Nurses» which has 62 questions in four dimensions: knowledge, prevention, attitude and opinion. The Fehring model was used and evaluated taking into account the content validity index (CVI).</div></div><div><h3>Results</h3><div>Eleven experts with postgraduate training and more than 10<!--> <!-->years of clinical experience participated. The CVI (&lt;<!--> <!-->0.80) and the experts’ comments made it possible to identify 8 items that required revision and 4 were deleted. The validated instrument was made up of 58 items, with 36 in knowledge, 13 in prevention, 5 in attitude and 4 in opinion, and with 4 items requiring reversal for the analysis of the instrument.</div></div><div><h3>Conclusions</h3><div>The instrument showed adequate face and content validity so it can be used for the identification of knowledge, attitudes and practices regarding COVID-19.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 243-251"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254078","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 «No hacer» en el tratamiento de los pacientes críticos de los Comités Científicos de la Sociedad Colombiana de Medicina Crítica y Cuidados Intensivos (AMCI)","authors":"Victor Hugo Nieto Estrada ,&nbsp;Bladimir Alejandro Gil Valencia ,&nbsp;Manuel Garay-Fernandez ,&nbsp;Francisco José Molina Saldarriaga ,&nbsp;Rubén Dario Camargo Rubio ,&nbsp;Carmelo Dueñas Castell ,&nbsp;Camilo Pizarro Gómez ,&nbsp;Fernando José Pereira Paternina ,&nbsp;Peter Vergara Ramírez ,&nbsp;Jorge Armando Carrizosa González ,&nbsp;Daniel Leonardo Molano Franco ,&nbsp;Ever Leonardo Rojas Díaz ,&nbsp;Diana Patricia Borre Naranjo ,&nbsp;Liliana Paola Correa Pérez ,&nbsp;Carmen Lorena Gómez Vanegas ,&nbsp;Martha Liliana Sánchez Lozano ,&nbsp;Camilo Andrés Bello Muñoz ,&nbsp;Erick Alexander Borja Large ,&nbsp;Sandra Ximena Olaya Garay ,&nbsp;Juan David Uribe Molano ,&nbsp;Angelica Lizarazo","doi":"10.1016/j.acci.2024.12.001","DOIUrl":"10.1016/j.acci.2024.12.001","url":null,"abstract":"<div><div>The Colombian Association of Critical Medicine and Intensive Care (AMCI) has initiated a project to identify and reduce unnecessary interventions in Intensive Care Units (ICU) to optimize resource use, minimize patient risks, and improve clinical outcomes. Led by AMCI, scientific committee leaders reviewed updated scientific evidence and best clinical practices to develop a series of “Do Not Do” recommendations. These recommendations were based on formal consensus using the Delphi technique to avoid routine procedures and behaviors that provide no value or could harm critically ill patients. The recommendations were developed with specific PICO questions by each committee and underwent a systematic literature review. A digital questionnaire was created, allowing anonymous voting, and a consensus of over 75% was achieved for all recommendations. The five most voted recommendations from the Patient Safety, Sepsis, MEGAN, Interdisciplinary Rehabilitation and Mental Health, and Critical Pneumology committees were selected to be part of the national Choosing Wisely strategy, aiming to promote resource optimization and improve the quality of care in Colombian ICUs. These recommendations are key to reducing unnecessary interventions and improving ICU care standards.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 420-450"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255091","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":"TEP de alto riesgo: abordaje intervencionista que salva vidas. Reporte de caso y revisión de literatura","authors":"Hernan Yair Florez de Moya ,&nbsp;Luis Alfonso Bustamante-Cristancho ,&nbsp;Adalberto de Jesus Caro","doi":"10.1016/j.acci.2025.02.002","DOIUrl":"10.1016/j.acci.2025.02.002","url":null,"abstract":"<div><div>We report the case of a young patient admitted to our institution after suffering cardiac arrest (asystole) and being resuscitated for 15<!--> <!-->minutes, under invasive mechanical ventilation, with hemodynamic lability and atrial fibrillation rhythm with rapid ventricular response upon admission. Among the potential causes of cardiac arrest, pulmonary thromboembolism and drug abuse were suspected (due to not knowing the exact history of the referral site), POCUS was performed with evidence of significant right ventricular involvement and negative CUS at that time for DVT, so cardiac involvement was confirmed with formal transthoracic echocardiogram and urgent chest angiotomography, which showed bilateral involvement of lobar and segmental branches. In this context, massive PTE is considered with indication for thrombolytic management according to current management guidelines, however, given the availability in the institution of invasive procedure, partial thrombectomy is performed by aspiration reducing the thrombotic load and intra-arterial infusion thrombolysis is left (Seattle Protocol), through a catheter in the trunk of the pulmonary artery, in addition to infusion of unfractionated heparin. The clinical evolution of the patient was favorable, with initial stay in ICU for 3<!--> <!-->days and subsequent discharge to general hospitalization where oral anticoagulation with DOAC was defined in view of the negative profile for SAF. In this way we demonstrate a form of intensive management of an increasingly frequent and potentially fatal pathology, mitigating the risks associated with systemic thrombolysis such as intracerebral bleeding, which can occur in up to 10% of cases.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 371-377"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254076","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":"Prevalencia e impacto del síndrome de burnout en trabajadores sanitarios de España y Latinoamérica","authors":"Lennin Jose Tolentino Hinojosa ,&nbsp;Laura Pardo ,&nbsp;Guillermo Suarez-Santamaría Silván ,&nbsp;Alberto Rubio López ,&nbsp;Amílcar Tinoco Solorzano ,&nbsp;Rosario Espinoza Flores ,&nbsp;Jose M. Gómez García ,&nbsp;Pablo Cardinal-Fernández","doi":"10.1016/j.acci.2025.02.004","DOIUrl":"10.1016/j.acci.2025.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to estimate the prevalence of burnout syndrome (BS) in healthcare workers from Spain and Latin America, as well as to assess its impact on their perception of work.</div></div><div><h3>Design</h3><div>Observational, international, multicenter study conducted between February 1st and April 30th, 2023.</div></div><div><h3>Participants</h3><div>Participants were healthcare workers over 18<!--> <!-->years of age who completed an online survey and had maintained the same job position for at least two years prior to completing the questionnaire. Additionally, they had to reside in Spain or Latin America and understand the Spanish language.</div></div><div><h3>Main measurements</h3><div>BS was diagnosed using the Maslach Burnout Inventory (MBI). Demographic and work-related data were also collected, and the perception of work was analyzed through dichotomous questions related to regret about working in healthcare, the desire to leave the profession, and the intention to change job positions.</div></div><div><h3>Results</h3><div>A total of 646 participants were included, with a mean age of 43<!--> <!-->years (IQR 35-51). Of the participants, 367 (57%) were women, and the professions included 515 (80%) doctors, 58 (9%) nurses, 53 (8%) physiotherapists, and 20 (3%) from other professions. No significant differences were observed in BS prevalence between Spain (21%) and Latin America (24%). BS was diagnosed in 153 (24%) participants, who were younger and had fewer years of work experience compared to the rest. No differences were found based on the healthcare worker's job position.</div><div>BS showed a significant impact on the perception of work, with a higher proportion of participants regretting working in healthcare, considering leaving the profession, or wanting to change job positions, particularly in Latin America.</div></div><div><h3>Conclusions</h3><div>The prevalence of SB is high and does not depend on the geographical location where the healthcare worker practices their profession. The impact on the perception of work is considerable, highlighting the importance of implementing strategies to prevent and mitigate this syndrome, thereby improving the quality of care.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 295-300"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254015","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":"Índice musculoesquelético torácico como potencial predictor de mortalidad en los pacientes críticamente enfermos con obesidad: estudio piloto","authors":"Romina del Carmen Gutiérrez-Góngora ,&nbsp;Jessica Garduño-López ,&nbsp;Marcos Antonio Amezcua-Gutiérrez ,&nbsp;Agustín Rodríguez Blas ,&nbsp;Luis Gerardo Duque Florez ,&nbsp;Manuel Armando Molina Castañeda","doi":"10.1016/j.acci.2024.11.001","DOIUrl":"10.1016/j.acci.2024.11.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Sarcopenic obesity is characterized by decreased strength and low muscle mass and has been associated with increased disability and morbidity-mortality. This study aimed to evaluate low muscle mass as a potential independent predictor of mortality in critically ill patients. Measurement of muscle mass at the T12 level using the thoracic skeletal muscle index (SMI) was proposed as a diagnostic method. The objective was to determine the association between low SMI and mortality in critically ill obese patients in the intensive care unit (ICU).</div></div><div><h3>Materials and methods</h3><div>This was a pilot study involving obese adult patients admitted to the ICU over a five-month period. A specialist in imaging performed muscle area measurements at the T12 level using thoracic computed tomography to determine SMI, utilizing Carestream PACS software. Each patient's SMI was evaluated against various outcomes, including mortality, using the chi-square test and SPSS software.</div></div><div><h3>Results</h3><div>Thirteen patients were included, with a mean BMI of 34<!--> <!-->kg/m². All patients had low muscle mass, with an average SMI of 22<!--> <!-->cm²/m². Of these, 38.4% died during their ICU stay; however, no statistically significant relationship was found between mortality and low muscle mass.</div></div><div><h3>Conclusions</h3><div>Low muscle mass was observed in all obese patients admitted to the ICU. However, low SMI was found to have no relationship with mortality, ICU length of stay, duration of mechanical ventilation, kidney injury, or the need to renal replacement therapy. The frequency of sarcopenia was significantly higher in women. Due to the uniformity in low muscle mass identified in all patients, it was not possible to make comparisons between groups.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 235-242"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254077","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":"Efectos de la oración de intercesión en pacientes críticos y terminales: revisión sistemática de la literatura","authors":"Diana Carolina Tovar Artunduaga ,&nbsp;Ledmar Jovanny Vargas Rodríguez ,&nbsp;Airam Luna Peña Castellanos ,&nbsp;Gustavo Ramos Sepulveda","doi":"10.1016/j.acci.2025.01.005","DOIUrl":"10.1016/j.acci.2025.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Intercessory prayer is understood has been shown to help through various psychological and biological changes that are actually or potentially associated with better health.</div></div><div><h3>Objective</h3><div>The objective of the study is to identify the effects of intercessory prayer in critical and terminal patients.</div></div><div><h3>Methodology</h3><div>A systematic review of the literature was carried out. The search for articles by 2<!--> <!-->researchers belonging to the project in the main databases. It was restricted to literature on humans, over 18 years of age, published in the last 15 (fifteen) years in Spanish and English. No breed or country restrictions were made.</div></div><div><h3>Results</h3><div>The 5<!--> <!-->studies were evaluated with PEDro, where the score varied between 8 to 10 points, thus indicating a score that determined them as high-quality studies. The studies included patients over 18 years of age with critical illnesses (in the intensive care unit) and terminal illnesses (oncology in radiotherapy or chemotherapy), finding that patients who received adjuvant management with this measure had better results in mortality, prognosis, requirement of mechanical ventilation and a lower rate of multiple organ dysfunction.</div></div><div><h3>Conclusions</h3><div>Intercessory prayer has different effects that favor the recovery of patients and improve the prognosis, which is why it can be recommended as an adjuvant therapy for patients with terminal illnesses or critically ill patients.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 270-276"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254959","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":"Donación en asistolia controlada con el uso de perfusión regional normotérmica en membrana de circulación extracorpórea: experiencia en Colombia","authors":"Liz Maristella Niño Ramírez ,&nbsp;Julián Orlando Casallas Barrera ,&nbsp;Estefanía Giraldo Bejarano ,&nbsp;Iván Martín ,&nbsp;Mario Andrés Mercado Díaz ,&nbsp;Juan Fernando Parra Correa ,&nbsp;Claudia Marcela Poveda Henao","doi":"10.1016/j.acci.2024.12.003","DOIUrl":"10.1016/j.acci.2024.12.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Controlled donation after circulatory death (cDCD) is a strategy for the procurement and preservation of organs in patients with catastrophic and irreversible conditions that do not progress to brain death. Normothermic regional perfusion (NRP) using ExtraCorporeal Membrane Oxygenation (ECMO) has demonstrated improved functionality of transplanted organs, especially in the context of normothermic abdominal perfusion (NAP-ECMO) and normothermic thoracoabdominal perfusion (NTAP-ECMO), as reported in North America and Europe. However, this technique had not been previously implemented in Colombia.</div></div><div><h3>Objective</h3><div>To describe one patient managed with NAP-ECMO and another with NTAP-ECMO as part of the initial experience with the implementation of the cDCD protocol in Colombia.</div></div><div><h3>Materials and methods</h3><div>A retrospective descriptive case report of two patients meeting the criteria for death by type III circulatory arrest (asystole) according to the Maastricht classification. In both cases, the diagnosis of a catastrophic and irreversible condition justified the application of end-of-life care (EOLC), followed by the investigational implementation of cDCD using NAP-ECMO for abdominal organ perfusion and NTA-ECMO for thoracoabdominal organ perfusion.</div></div><div><h3>Results</h3><div>Two donor patients were included: a 77-year-old man for the cDCD protocol with NAP-ECMO and a 79-year-old woman for the NTAP-ECMO protocol. In both cases, the cause of death was catastrophic stroke with poor functional and vital prognosis. Total ischemia time and functional ischemia time were 66<!--> <!-->minutes and 56<!--> <!-->minutes for NAP-ECMO and 24<!--> <!-->minutes and 22<!--> <!-->minutes for NTAP-ECMO, respectively. Preservation time was 173<!--> <!-->minutes in NAP-ECMO and 60<!--> <!-->minutes in NTAP-ECMO. In both cases, laboratory tests for organ function were optimal, and intraoperative visualization during organ procurement and biopsies confirmed adequate viability of the organs.</div></div><div><h3>Conclusions</h3><div>This report of two cases confirms that implementing cDCD is both feasible and viable in Colombia. A unified multidisciplinary protocol and an integrative approach combining legal, educational, and cultural aspects are essential to ensure dignified, humane, and high-quality care for donors, recipients, and their families.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 384-394"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254968","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":"Terapia ventilatoria guiada con catéter esofágico en una cohorte de SDRA asociado a covid en pacientes con obesidad","authors":"David Yepes Gómez,&nbsp;Ana María Acosta Murcia,&nbsp;Jaisan Jesue Granados Glenn","doi":"10.1016/j.acci.2025.03.001","DOIUrl":"10.1016/j.acci.2025.03.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of acute respiratory distress syndrome (ARDS) has evolved with the adoption of lung-protective strategies. However, accurate PEEP titration remains a challenge, particularly in patients with obesity. Measuring transpulmonary pressure through an esophageal catheter allows for a more individualized and objective PEEP adjustment. The aim of this study was to describe the clinical and ventilatory characteristics of a cohort of obese patients with covid-19-associated ARDS managed with mechanical ventilation guided by an esophageal catheter.</div></div><div><h3>Materials and methods</h3><div>A retrospective observational cohort study was conducted at a tertiary care ICU in Medellín (Colombia) during the SARS-CoV-2 pandemic. Patients included had a diagnosis of ARDS based on the Berlin criteria, a body mass index (BMI) greater than 30, required invasive mechanical ventilation, and received esophageal catheter placement to guide PEEP titration. Patients without confirmed ARDS or who did not require the catheter were excluded. A univariate analysis of clinical, ventilatory, and outcome variables was performed.</div></div><div><h3>Results</h3><div>Eleven patients with severe ARDS and obesity (mean BMI 34.2) were analyzed. The average PEEP was 15.5<!--> <!-->cm H₂O, with sustained positive expiratory transpulmonary pressures. Mortality was 36.4%, lower than previously reported in similar series. All patients required neuromuscular blockade and prone positioning.</div></div><div><h3>Conclusion</h3><div>This study shows that the use of an esophageal catheter in obese patients with covid-19-associated ARDS may improve PEEP titration, potentially reducing mortality. Despite the limitations due to the small cohort size, these findings suggest that the esophageal catheter is a valuable tool for optimizing mechanical ventilation in patients with pulmonary alterations. Further studies with larger sample sizes are recommended to confirm these results and to explore the impact of this technique more thoroughly in clinical practice.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 301-306"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254016","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}