Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Rabdomiólisis asociada a fenoverina: reporte de caso","authors":"Felipe Arturo Valenzo Hernández ,&nbsp;Sofía Jiménez Lomas ,&nbsp;Martín Iván Patiño Rosillo ,&nbsp;Dulce Guadalupe Márquez Jiménez","doi":"10.1016/j.acci.2024.07.003","DOIUrl":"10.1016/j.acci.2024.07.003","url":null,"abstract":"<div><div>Rhabdomyolysis is a syndrome characterized by muscle destruction and the release of intracellular contents into the plasma, this being one of the main potential causes of nephrotoxicity. Being a syndrome, its etiology is diverse; however, little has been described about rhabdomyolysis secondary to the consumption of HMG-CoA reductase inhibitor drugs such as Phenoverine.</div><div>The case of a 54-year-old female patient with no significant history is described, with a clinical picture characterized by asthenia, adynamia, muscle pain, arthralgia, and serum creatine kinase (CPK) of 53,032<!--> <!-->IU/L, after the consumption of Phenoverine, complying with diagnostic criteria for rhabdomyolysis secondary to drug use. After the initial evaluation, conservative management was established, based on nephroprotective measures, presenting satisfactory improvement, with resolution of rhabdomyolysis and acute kidney injury.</div><div>The objective of this article is to report the case of rhabdomyolysis secondary to the use of this frequently used antispasmodic agent, and of which this complication is underestimated, which can become so serious and leave permanent kidney damage as a consequence.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 174-177"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610451","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":"Infección por Clostridioides difficile en el adulto","authors":"Fabián Muñoz Ramírez ,&nbsp;Santiago Morón-Serrano","doi":"10.1016/j.acci.2024.08.008","DOIUrl":"10.1016/j.acci.2024.08.008","url":null,"abstract":"<div><h3>Purpose</h3><div>This review aims to provide clear and precise information about <em>Clostridioides difficile</em> infection (CDI), with the goal of enabling physicians to understand it and proceed with timely diagnosis and treatment.</div></div><div><h3>Data Sources and Study Selection</h3><div>Databases such as PubMed, Ovid, SciELO, Embase, and MEDLINE were consulted, along with general web searches and references previously known to the authors. Studies, guidelines, and reviews addressing the epidemiology, diagnosis, treatment, and prevention of CDI were included.</div></div><div><h3>Data Extraction and Synthesis</h3><div>Data were extracted from studies analyzing clinical presentation, diagnostic methods, and therapeutic options. The data synthesis aimed to provide a comprehensive view of best practices based on current evidence.</div></div><div><h3>Conclusions</h3><div>CDI is a significant cause of gastrointestinal disease in healthcare settings, particularly following antibiotic use. Its incidence is increasing, even in young people without risk factors. Diagnosis is based on clinical suspicion and the detection of <em>C. difficile</em> toxins or toxigenic genes using molecular biology techniques or enzyme immunoassays. This review emphasizes the importance of rapid detection and the implementation of effective therapies to reduce associated morbidity.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 91-97"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610549","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":"Monitoreo neurológico multimodal en cuidado intensivo","authors":"Jaime Sarmiento-Calderón ,&nbsp;Diana Borré-Naranjo ,&nbsp;Carmelo Dueñas-Castell","doi":"10.1016/j.acci.2024.10.005","DOIUrl":"10.1016/j.acci.2024.10.005","url":null,"abstract":"<div><div>There are multiple monitoring strategies for the follow-up of patients with brain injuries admitted to the intensive care unit (ICU). These strategies begin with a neurological assessment, include imaging studies, and culminate with the implementation of cutting-edge, high-definition technologies. Clinical outcomes depend on the interpretation of the generated data. Neuromonitoring has received increasing attention in recent years. Current scientific evidence recommends practice standards for the use of neuromonitoring in critically ill patients, emphasizing the need to standardize technologies, efforts, and training necessary to integrate and interpret information from multimodal neuromonitoring (NMM). The future of neuromonitoring is oriented towards the integration and innovation of invasive and non-invasive NMM techniques. In terms of intracranial pressure (ICP), monitoring with an intraventricular catheter remains the reference technique or gold standard. Additionally, technologies for measuring cerebral oxygenation, ultrasonographic evaluations such as transcranial Doppler, optic nerve sheath measurement, and emerging techniques such as automated pupillometry and near-infrared spectroscopy (NIRS), should motivate intensivists to understand their foundation and interpretation, as well as their application to generate treatment strategies, monitor them, and impact better clinical outcomes. This review offers an updated assessment of the status of various neuromonitoring modalities and their use in different scenarios, highlighting the advantages and limitations of each method for implementation, emphasizing their utility in the ICU.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 124-141"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610555","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":"Tormenta tiroidea: abordaje diagnóstico y terapéutico","authors":"José Correa-Guerrero ,&nbsp;Hugo Corrales Santander ,&nbsp;Jorge Yepes Caro ,&nbsp;Jesús Bello Simanca ,&nbsp;Luis Rodríguez Arrieta ,&nbsp;Alejandro Castellanos Pinedo ,&nbsp;Elguis Rodríguez Garizabalo ,&nbsp;Carmelo Dueñas Castell","doi":"10.1016/j.acci.2024.10.010","DOIUrl":"10.1016/j.acci.2024.10.010","url":null,"abstract":"<div><div>Thyroid storm (TT) is a rare but potentially fatal condition if not detected and treated promptly. It is characterized by severe clinical manifestations at the level of the central nervous system, cardiovascular system, and gastrointestinal system, associated with elevated levels of free triiodothyronine (T3) and free thyroxine (T4). Infections and/or treatment discontinuation are the most frequent triggers. Identifying the triggering factor, reducing circulating levels of thyroid hormones, and admission to an intensive care unit become the cornerstone of treatment. In this review, based on a clinical scenario, we will provide information regarding the diagnostic and therapeutic approach to TT.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 159-173"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610558","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":"Meningoencefalitis por reactivación del virus de varicela zóster sin erupción cutánea en paciente inmunocomprometido: reporte de caso y revisión de la literatura","authors":"Hans Altamar Polo ,&nbsp;Izeth Sallas Rodríguez ,&nbsp;Adriana Gamboa Dallos ,&nbsp;Carlos Rebolledo Maldonado","doi":"10.1016/j.acci.2024.10.011","DOIUrl":"10.1016/j.acci.2024.10.011","url":null,"abstract":"<div><div>We present an interesting case of acute meningoencephalitis due to reactivation of the varicella zoster virus in an immunocompromised patient in the absence of dermatomal neuralgia or skin lesions attributable to varicella zoster virus.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 225-230"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610457","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":"Agua extravascular pulmonar como predictor de SDRA y mortalidad en pacientes con choque circulatorio","authors":"Hector Fabio Sanchez G. ,&nbsp;Francisco Naranjo Junoy ,&nbsp;Hector Julio Melendez F.","doi":"10.1016/j.acci.2024.08.012","DOIUrl":"10.1016/j.acci.2024.08.012","url":null,"abstract":"<div><h3>Objective</h3><div>Establish the early association between levels of Extravascular Lung Water indexed to predicted weight (EVLWI), with subsequent development of Acute Respiratory Distress Syndrome (ARDS) and Mortality in patients with circulatory shock.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated the clinical records of 147 adult patients (age 50.5 years<!--> <!-->±<!--> <!-->19.9) in circulatory shock, admitted to Adult Intensive Care Unit of a third-level Hospital. <em>Measurements:</em> Extravascular lung water index, was measured by transpulmonary thermodilution (PiCCO System, Pulsion Medical Systems) from the beginning of the shock state and then every 8<!--> <!-->hours during the first 5 days.</div></div><div><h3>Results</h3><div>Patients who evolved to SDRA had higher levels of EVLWI vs. patients who did not evolve to SDRA. Median EVLWI 14<!--> <!-->ml/kg (RIC: 10<!--> <!-->ml/kg) vs. 8<!--> <!-->ml/kg (RIC: 4<!--> <!-->ml/kg) SDRA vs. no SDRA respectively, (RR: 2.66; 95% CI: 1.68-4.22; <em>P</em> .00). We found no association between EVLWI high on the first day of the state of circulatory shock with respect to mortality at 28 days (RR: 1.17; 95% CI: 0.88-1.56; <em>P</em> .26).</div></div><div><h3>Conclusions</h3><div>The high EVLWI on the first day of the state of shock was associated with evolution to SDRA. We did not find an association of EVLWI high on the first day of the state of shock with mortality on day 28. Prospective studies are required to prove this association.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 8-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610365","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":"Hidroxietil-almidón como líquido de reemplazo en aféresis terapéutica: experiencia en una unidad de cuidados intensivos","authors":"Diana Borré-Naranjo ,&nbsp;Jorge Rico-Fontalvo ,&nbsp;Rodrigo Daza-Arnedo ,&nbsp;David Daguer ,&nbsp;Maria Porto ,&nbsp;Tomas Rodríguez-Yánez ,&nbsp;Miguel Aguilar ,&nbsp;José Rojas-Suarez ,&nbsp;Natalia Ramos Terrades ,&nbsp;María José Soler ,&nbsp;Carmelo Dueñas-Castell","doi":"10.1016/j.acci.2024.09.001","DOIUrl":"10.1016/j.acci.2024.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Therapeutic apheresis (TA) enables the removal of disease-associated molecules from plasma, thereby halting disease progression. The replacement effluent for TA depends on the type of disease. The most used are albumin (4% or 5%) and fresh plasma. However, synthetic plasma expanders such as hydroxyethyl starch (6%) have been utilized in TA.</div></div><div><h3>Objective</h3><div>To describe the experience with the use of hydroxyethyl starch (6%) in the intensive care unit (ICU) as the primary replacement effluent.</div></div><div><h3>Materials and methods</h3><div>A retrospective descriptive study was conducted from October 1, 2014, to December 31, 2020, in an ICU in Cartagena, Colombia, involving patients indicated by a nephrologist to initiate TA according to the guidelines of the American Society for Apheresis (ASFA). Therapeutic apheresis was performed by filtration using the classic multifiltrate technology (Fresenius Medical Care). Plasma volume was calculated using the Kaplan method, and the plasma exchange dose was 1 to 1.5 times the estimated plasma volume, with isovolumetric and iso-oncotic replacement using 6% hydroxyethyl starch, fresh frozen plasma (FFP), and crystalloids.</div></div><div><h3>Results</h3><div>Of the 22 patients included, 18 received 6% hydroxyethyl starch as the main replacement fluid. The median age was 44<!--> <!-->years (32.3-64.5). Patients presented with hypertension (n<!--> <!-->=<!--> <!-->7 [31.8%]) and diabetes mellitus (n<!--> <!-->=<!--> <!-->3 [13.6%]). The main indications for TA were Guillain-Barré syndrome (n<!--> <!-->=<!--> <!-->18 [81.8%]) and myasthenia gravis (n<!--> <!-->=<!--> <!-->18 [81.8%]). Hematological and/or nephrological conditions were recorded as indications for TA in a smaller proportion (n<!--> <!-->=<!--> <!-->4 [18%]). Six percent hydroxyethyl starch was administered to patients with neurological conditions. A total of 101 TA sessions were performed: 87 with 6% hydroxyethyl starch and 14 with fresh frozen plasma (FFP). The safety of TA with 6% hydroxyethyl starch was analyzed using hemoglobin values, platelet count, coagulation profile, and creatinine levels (before and after TA sessions).</div></div><div><h3>Conclusion</h3><div>The use of HES as a replacement fluid for therapeutic apheresis proved to be safe and may be an alternative to the use of 4% or 5% albumin as a substitution fluid.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 20-25"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610366","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":"Evaluación de ítems de escalas qSOFA y SIRS para predicción de choque séptico en urgencias","authors":"Kevin Camilo Gómez-Calderon ,&nbsp;Juan Santiago Serna-Trejos ,&nbsp;Christian Andres Palacios-Martínez ,&nbsp;Dairon Palacios-Moya ,&nbsp;Carmen Elisa Ocampo-Benavides","doi":"10.1016/j.acci.2024.10.012","DOIUrl":"10.1016/j.acci.2024.10.012","url":null,"abstract":"<div><h3>Introduction</h3><div>There is no optimal scale to predict sepsis and septic shock, these have different sensitivities and specificities, this can lead to an unnecessary use of resources.</div></div><div><h3>Objective</h3><div>To evaluate the deterioration times of the variables of the qSOFA and SIRS scales to identify which one changes earlier until presenting septic shock.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted. The qSOFA and SIRS items were assessed in adult patients with suspected infectious process who were admitted to the emergency department.</div></div><div><h3>Results</h3><div>A total of 199 patients, 44.7% (n<!--> <!-->=<!--> <!-->89) developed septic shock. The heart rate criterion, the median time in patients who presented septic shock was 295minutes and those who did not, 354<!--> <!-->minutes (<em>P</em>=.211); For respiratory rate, the median time to criterion change in patients with septic shock was 293<!--> <!-->minutes and without septic shock 311<!--> <!-->minutes (<em>P</em>=.9501); For temperature, no differences were found in the medians of the times. In Glasgow, it was not possible to compare the median times for the change in the criteria. For the patients who presented septic shock, 50% changed the criteria in 313<!--> <!-->minutes; For systolic blood pressure, it is evident that in those who did present septic shock, the median was 180 minutes.</div></div><div><h3>Conclusion</h3><div>No differences were found regarding the change over time of the qSOFA and SIRS variables with a view to predicting septic shock, but we did show delay in antibiotic administration in the septic shock group.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 61-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610371","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":"High lethality suicide attempts in indigenous populations: A holistic approach combining psychiatric and critical care perspectives. Case analysis and scoping review","authors":"Mateo Aguirre Flórez ,&nbsp;José Fernando Gómez González ,&nbsp;Valeria López Pulgarín ,&nbsp;Daniel Millán Morales ,&nbsp;Mateo Moreno Gómez ,&nbsp;Juanita Moreno Gómez ,&nbsp;Laura Alejandra Jiménez Osorio ,&nbsp;Laura Cardozo Ríos ,&nbsp;Carolina Jaramillo Toro ,&nbsp;Germán Alberto Moreno Gómez","doi":"10.1016/j.acci.2024.10.007","DOIUrl":"10.1016/j.acci.2024.10.007","url":null,"abstract":"<div><div>The Embera, an indigenous group in Colombia, particularly in regions like Risaralda, face significant challenges including poverty, displacement, and high rates of preventable diseases. In recent years, there has been a concerning rise in suicide rates within this community. This study presents a case series of 6 Embera patients who attempted suicide with high lethality and were treated in an ICU in Pereira, Risaralda, during 2023. Additionally, a systematic literature review following PRISMA guidelines was conducted to identify studies on suicide among the Embera population, using databases such as PubMed, EMBASE, Web of Science, and Google Scholar, covering articles published between 2000 and 2023. The case series revealed predominant methods of suicide attempts involving substances like Paraquat and the challenges in managing these cases in the ICU. The literature review identified a limited number of studies addressing suicide among the Embera, revealing gaps in understanding the cultural, socioeconomic, and healthcare system factors contributing to these behaviors. The findings underscore the need for comprehensive research and culturally sensitive interventions to address the complex interplay of sociocultural determinants influencing suicide. It is concluded that collaborative efforts involving healthcare professionals, policymakers, and community leaders are essential to develop effective strategies that mitigate suicide risks and promote comprehensive well-being in indigenous communities.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 150-158"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610557","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":"Manejo rápido y escalonado en la tormenta arrítmica: reporte de un caso","authors":"Alvaro Andrés Montenegro Apraez ,&nbsp;Marcela Rivera Portilla ,&nbsp;Alejandro Bejarano Zuleta ,&nbsp;Eduardo Echeverry ,&nbsp;Juan Pablo Garaicoa Garzon","doi":"10.1016/j.acci.2024.04.001","DOIUrl":"10.1016/j.acci.2024.04.001","url":null,"abstract":"<div><div>Arrhythmic storm is usually defined as the presentation of 3 or more episodes of ventricular arrhythmias within 24<!--> <!-->hours. It is widely accepted that this entity is a medical emergency due to the potential for adverse events such as death in up to 54% of cases, probably because the reduction in cardiac chamber filling time significantly reduces cardiac output, leading to cardiogenic shock, multiple organ failure, and death.</div><div>The present case describes a patient with arrhythmic storm secondary to viral myocarditis, due to the recurrence of arrhythmic events despite initial management with antiarrhythmic drugs required a stepwise therapeutic approach guided by a multidisciplinary team and early use of extracorporeal membrane oxygenation (ECMO), which allowed maintaining adequate systemic perfusion while implementing therapeutic measures to control arrhythmic events; The patient was discharged early at 14 days, with no recurrence of arrhythmic events. At 6 months outpatient follow-up, the patient did not require cardiac transplantation, with no recurrence of arrhythmic events, with adequate NYHA functional class I and no left ventricular systolic dysfunction; clinical outcomes are attributed to timely decision making, guided by a multidisciplinary team and early use of early mechanical circulatory support, preventing hypoperfusion, multiple organ failure, and death.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 4","pages":"Pages 432-436"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659104","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}