Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Association between nutritional risk and ICU mortality","authors":"Micaela Giselle Montenegro Fernandez ,&nbsp;Matías Agustín Atencio ,&nbsp;Nicolas Antonio Grassi ,&nbsp;Denis Ariel Dezurko ,&nbsp;Magdalena Cruz ,&nbsp;Franco Ezequiel Espinoza ,&nbsp;Marina Otamendi ,&nbsp;Florencia Beatriz Vazquez Brignole ,&nbsp;Santiago Tomas Laco ,&nbsp;Lucas Gonzalo Duran","doi":"10.1016/j.acci.2026.100588","DOIUrl":"10.1016/j.acci.2026.100588","url":null,"abstract":"<div><h3>Introduction</h3><div>Critically ill patients are highly vulnerable to malnutrition, which has been associated with adverse outcomes. Nutritional risk assessment tools such as the modified Nutrition Risk in Critically Ill (mNUTRIC) score and the Subjective Global Assessment (SGA) are widely used, although their prognostic role relative to illness severity remains debated.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted in a mixed adult intensive care unit. Adult patients (≥18 years) admitted to the ICU were included. Patients in the immediate postoperative period of scheduled surgery were excluded. Nutritional risk was assessed using mNUTRIC and SGA. The primary outcome was ICU mortality. Associations were evaluated using bivariate and multivariable analyses.</div></div><div><h3>Results</h3><div>A total of 180 patients were analyzed (mean age 51.3<!--> <!-->±<!--> <!-->16.3 years; 60% male). ICU mortality was 30%. High nutritional risk by mNUTRIC was present in 23% of patients with CRP and was associated with higher unadjusted mortality (55% <em>vs.</em> 23%; <em>p</em> <!-->=<!--> <!-->0.0014). Mortality also increased across SGA categories (<em>p</em> <!-->=<!--> <!-->0.0091). In the fully adjusted model, mortality was independently associated with male sex (adjusted OR 2.58; 95% CI 1.13–5.85) and SOFA score (adjusted OR 1.28; 95% CI 1.10–1.49), while the association with high mNUTRIC was attenuated. The model showed acceptable discrimination (AUC 0.766).</div></div><div><h3>Conclusions</h3><div>Nutritional risk was strongly associated with ICU mortality in unadjusted analyses but did not remain an independent predictor after adjustment for organ dysfunction. Nutritional risk appears to function as a marker of vulnerability closely linked to disease severity rather than as a causal determinant of mortality.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100588"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247259","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":"Utilidad del PCR multiplex en el diagnóstico microbiológico temprano y adecuación antimicrobiana en pacientes críticos con bacteriemias","authors":"Nahuel Hernández ,&nbsp;Sofia Mauro ,&nbsp;Santiago Munilla ,&nbsp;Mariela Vieytes ,&nbsp;Antonio Galiana ,&nbsp;Marcelo Barbato ,&nbsp;Federico Verga","doi":"10.1016/j.acci.2026.100595","DOIUrl":"10.1016/j.acci.2026.100595","url":null,"abstract":"<div><h3>Introduction</h3><div>Bacteremia is one of the most frequent infections in critically ill patients. Early and appropriate antimicrobial therapy is a key factor in reducing mortality.</div></div><div><h3>Objectives</h3><div>To evaluate the usefulness of the second-generation BioFire® Blood Culture Identification multiplex PCR panel (BCID2) for microbiological identification and antimicrobial therapy optimization in critically ill patients with bacteremia, compared with conventional microbiology methods.</div></div><div><h3>Methods</h3><div>A descriptive, retrospective, observational study was conducted in the Intensive Care Unit of Hospital Maciel, a tertiary-level center belonging to the State Health Services Administration (ASSE), Montevideo, Uruguay. Patients admitted to the ICU who developed bacteremia and underwent BCID2 testing between January 1 and December 31, 2023, were included. BCID2 results were compared with conventional blood culture results, and positive and negative percent agreement (PPA and NPA) were calculated for microbiological identification and resistance mechanisms.</div></div><div><h3>Results</h3><div>Fifty patients with positive blood cultures who underwent PCR testing were included. BCID2 detected 64 microorganisms and 26 resistance mechanisms. Regarding microbiological identification, BCID2 showed a PPA of 98.3% (95% CI: 91–100) and an NPA of 99.5% (95% CI: 99–100) compared with conventional microbiological methods. Concerning antimicrobial resistance, concordance for the presence or absence of resistance mechanisms was 93%, with a 7% discordance between both methods. Based on BCID2 results, antimicrobial therapy was effectively modified in 50% of cases.</div></div><div><h3>Conclusions</h3><div>In critically ill patients with bacteremia, the use of BCID2 enables rapid and accurate microbiological identification, facilitating early optimization of antimicrobial therapy.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100595"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247313","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":"Caracterización del inicio de la nutrición en pacientes con soporte vasopresor en cuidado intensivo: un estudio retrospectivo de un centro de alta complejidad en la ciudad de Medellín","authors":"Mario Andrés Sfeir Moreno ,&nbsp;Adrián Valverde Legarda ,&nbsp;Bladimir Alejandro Gil Valencia ,&nbsp;Francisco José Molina Saldarriaga ,&nbsp;Juan Carlos Zuluaga Serna ,&nbsp;Néstor Sfeir Moreno","doi":"10.1016/j.acci.2026.100591","DOIUrl":"10.1016/j.acci.2026.100591","url":null,"abstract":"<div><h3>Introduction</h3><div>The initiation of nutritional support in patients with shock represents a challenge in the intensive care unit. Despite the availability of clinical practice guidelines, the available evidence varies and limits precise recommendations regarding the timing, route of administration and initial dose of nutritional support.</div></div><div><h3>Methods</h3><div>An analytical study was conducted from a retrospective cohort of adult patients diagnosed with shock and treated between January 2023 and January 2025 at a high complexity institution in Medellin, Colombia. Characteristics of nutritional support initiation and clinical outcomes were described. Multivariate logistic regression analysis was performed to evaluate associations.</div></div><div><h3>Results</h3><div>Enteral nutrition was administered to 88.6% of patients, and in-hospital mortality was 30.4%. In multivariable analysis, age, use of vasopressin, and parenteral nutrition were associated with higher mortality; in addition, initiation of nutrition at 6-12<!--> <!-->hours or after 24<!--> <!-->hours, as well as a caloric intake of 21-25<!--> <!-->kcal/kg/day, were associated with a higher risk compared with initiation at 13-24<!--> <!-->hours and caloric intake of 11-15<!--> <!-->kcal/kg/day. Nutrition-related complications occurred in 11% of cases.</div></div><div><h3>Conclusion</h3><div>In patients with shock, enteral nutrition can be considered after achieving adequate hemodynamic stability following resuscitation; initiation is safer when avoiding premature initiation or unjustified delays, with progressive caloric prescription according to clinical evolution.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100591"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247246","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":"Pulmonary thromboembolism in liver transplantation: The role of transesophageal echocardiography in early diagnosis and management","authors":"Bruna de Carvalho Oliveira,&nbsp;Arthur Resende Fernandes,&nbsp;Camila Borges Ferreira,&nbsp;Marina Ayres Delgado","doi":"10.1016/j.acci.2025.100583","DOIUrl":"10.1016/j.acci.2025.100583","url":null,"abstract":"<div><div>Pulmonary thromboembolism (PTE) is a serious and potentially fatal complication during liver transplantation (LT), often associated with hemodynamic instability and high mortality rates. Early detection of PTE is essential to prevent severe outcomes, yet diagnosing this condition can be challenging due to its variable presentation and overlap with other perioperative complications. This narrative review was conducted using a structured literature search with predefined inclusion and exclusion criteria to improve transparency, reproducibility, and reduce bias. The review explores the role of transesophageal echocardiography (TEE) in the intraoperative detection and management of PTE in liver transplant recipients. TEE has emerged as a valuable diagnostic tool, providing real-time insights into cardiac function, preload status, and the presence of thromboembolisms. A practical intraoperative management algorithm for PTE during LT is proposed based on the evidence reviewed. Despite its advantages, the application of TEE is limited by safety concerns, particularly in patients with coagulopathies or varices. The review discusses the multifactorial nature of thromboembolic events, emphasizing the need for further research to clarify risk factors, coagulation abnormalities, and PTE. The diagnostic accuracy of TEE is contextualized, and a critical synthesis of evidence is provided.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100583"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247309","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":"Síndrome de distrés respiratorio agudo y fascitis necrotizante fulminante tras infiltración glútea de biopolímeros: reporte de un caso con desenlace fatal","authors":"Luis Alexander Peña-López ,&nbsp;Giovanna Maritza Cortes Bolaños ,&nbsp;David Ballesteros ,&nbsp;Luisa Alejandra Maya Caicedo ,&nbsp;Nelly Patricia Martínez ,&nbsp;Luis Eduardo Ramírez Bejarano ,&nbsp;Henry Mauricio Parada-Gereda","doi":"10.1016/j.acci.2026.100589","DOIUrl":"10.1016/j.acci.2026.100589","url":null,"abstract":"<div><div>Systemic reactions induced by biopolymers represent a growing challenge in intensive care medicine due to their ability to trigger uncontrolled inflammatory responses and multiorgan damage. We report the case of a 30-year-old woman who, following gluteal infiltration with biopolymers, developed a rapidly progressive clinical picture characterised by severe acute respiratory distress syndrome (ARDS), septic shock, and bilateral necrotising fasciitis. During her stay in the intensive care unit, the patient presented with refractory hypoxaemia, mixed acidosis, right ventricular dysfunction, acute kidney injury, and hepatocellular necrosis, despite advanced management with protective mechanical ventilation, combined vasopressor support, corticosteroids, and passive immunotherapy. Imaging studies revealed diffuse alveolar damage with a ground-glass pattern, while local findings confirmed rapidly progressing necrosis of the skin and subcutaneous tissue. The fatal outcome reflected the aggressiveness of the systemic inflammatory process induced by these substances. This case highlights the importance of early recognition, multidisciplinary response, and timely critical decision-making within the intensive care environment. It also underscores the need to strengthen preventive strategies and public health education regarding the use of unauthorised aesthetic materials.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100589"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247308","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":"Síndrome de realimentación en el paciente críticamente enfermo","authors":"Santiago Adolfo Párraga Garabi ,&nbsp;José Miguel Guerrero Carrión ,&nbsp;Fernando José Pereira Paternina ,&nbsp;Willington Aníbal Montenegro Acosta","doi":"10.1016/j.acci.2026.100590","DOIUrl":"10.1016/j.acci.2026.100590","url":null,"abstract":"<div><div>Refeeding syndrome is a potentially severe metabolic complication associated with the reintroduction of energy in patients with significant malnutrition. In intensive care units (ICUs), its recognition is particularly complex due to the high prevalence of multifactorial electrolyte disturbances, frequently fragmented caloric exposure, and overlap with organ dysfunction intrinsic to critical illness.</div><div>To integrate and contextualize the available pathophysiological and clinical evidence on refeeding syndrome in critically ill adults, comparing contemporary diagnostic and preventive frameworks and translating this evidence into practical implications focused on metabolic safety in the ICU. A narrative review of the literature was conducted using PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and LILACS, complemented by international guidelines and consensus statements. Publications from the last 10 years were prioritized, with inclusion of seminal literature when relevant. The synthesis was based on informed clinical interpretation, considering methodological quality, consistency of findings, and relevance to ICU practice.</div><div>Early hypophosphatemia after initiation of nutrition is common in the ICU but lacks diagnostic specificity as an isolated marker of refeeding syndrome. Recent consensus statements converge on emphasizing prevention, cautious caloric advancement, proactive electrolyte and thiamine supplementation, and intensive monitoring during the initial days of refeeding.</div><div>In critically ill patients, refeeding syndrome should be approached as a metabolic safety issue rather than a rigid diagnostic entity. A preventive, contextualized, and dynamic approach to nutritional support is essential to minimize avoidable complications during refeeding in the ICU.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247275","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":"Desempeño de MEWS, NEWS2 y qSOFA en activaciones de equipos de respuesta rápida en dos sedes de una institución colombiana de alta complejidad: estudio observacional","authors":"Albert José Peñaloza Morales ,&nbsp;Jorge Mario González Correa ,&nbsp;Gustavo Antonio Pulgarín Grajales ,&nbsp;Sara Valentina Echeverri Vargas ,&nbsp;María Manuela Osorio Trujillo ,&nbsp;Diana Maryory Gómez Gallego ,&nbsp;Juan C. Hernandez","doi":"10.1016/j.acci.2026.100610","DOIUrl":"10.1016/j.acci.2026.100610","url":null,"abstract":"<div><h3>Background</h3><div>Rapid response teams (RRTs) aim to prevent adverse outcomes in general ward patients. The performance of early warning scores such as MEWS, NEWS2, and qSOFA in this setting remains uncertain.</div></div><div><h3>Methods</h3><div>Observational, retrospective study conducted at two campuses of a tertiary care institution in Medellín, Colombia. Adult patients (≥<!--> <!-->18<!--> <!-->years) with RRT activations from January to December 2024 were included. The primary outcome was a composite event (in-hospital cardiac arrest, in-hospital mortality, or unplanned ICU admission). Discrimination (AUROC), calibration, clinical cutoffs, decision curve analysis, subgroup analyses, and sensitivity analysis were assessed.</div></div><div><h3>Results</h3><div>A total of 167 activations were analyzed. Median age was 69<!--> <!-->years (IQR 49-80); 59.3% were women. The composite outcome occurred in 46.1%. AUROC values were modest: MEWS 0.632 (95%<!--> <!-->CI: 0.545-0.718), NEWS2 0.627 (95%<!--> <!-->CI: 0.541-0.711), and qSOFA 0.570 (95%<!--> <!-->CI: 0.492-0.648). At common thresholds, MEWS showed higher sensitivity (63.6%) and NEWS2 higher specificity (63.1%). qSOFA displayed the lowest discrimination. Calibration revealed risk overestimation at higher deciles. In decision curve analysis, NEWS2 and MEWS provided similar net benefit, outperforming qSOFA. Findings were consistent across subgroups and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>In RRT activations, MEWS and NEWS2 showed modest but comparable performance, while qSOFA was inferior. MEWS, based solely on simple clinical variables, may be particularly valuable in resource-limited settings, and automated MEWS/NEWS2 implementation could enhance early detection of clinical deterioration.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100610"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247317","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-flow nasal cannula versus non-invasive mechanical ventilation to prevent extubation failure: Overview and de novo meta-analysis","authors":"Matías Agustín Atencio ,&nbsp;Marina Otamendi ,&nbsp;Oliva Roxana ,&nbsp;Iñaki Manuel Dopazo Danieli ,&nbsp;Franco Ezequiel Espinoza ,&nbsp;Joel Agustin Schernenco ,&nbsp;Lucas Gonzalo Duran","doi":"10.1016/j.acci.2026.100596","DOIUrl":"10.1016/j.acci.2026.100596","url":null,"abstract":"<div><div>Extubation failure in the intensive care unit (ICU) is associated with increased mortality and prolonged hospital stay. Noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) are commonly used strategies to prevent reintubation, although their comparative effectiveness remains uncertain. We conducted an overview of systematic reviews with a de novo meta-analysis to compare HFNC and NIV in adult patients extubated in the ICU. Comprehensive searches were performed in May 2024 in PubMed, Epistemonikos, and the Virtual Health Library. Methodological quality was assessed using AMSTAR II, and the certainty of evidence was rated with GRADE. Fifteen systematic reviews met the inclusion criteria. The de novo meta-analysis found no significant difference between HFNC and NIV in preventing reintubation (RR 1.07; 95% CI 0.91–1.27; <em>p</em> <!-->=<!--> <!-->0.41; low certainty) or ICU mortality (RR 1.01; 95% CI 0.72–1.42; <em>p</em> <!-->=<!--> <!-->0.94; low certainty). The length of ICU stay was also similar between both interventions (MD −0.42 days; 95% CI −1.11 to 0.27; <em>p</em> <!-->=<!--> <!-->0.23), although heterogeneity was high (<em>I</em>² <!-->=<!--> <!-->75%; very low certainty). In summary, HFNC and NIV appear to have comparable efficacy in preventing extubation failure among critically ill patients. Given the low certainty of the current evidence, the choice between these two strategies should be guided by clinical context and resource availability, while further high-quality clinical trials are needed to strengthen these findings.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100596"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247314","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 del desempeño muscular periférico en adultos en Unidad de Cuidado Intensivo: una revisión de alcance","authors":"Andrés Gonzalo Bravo Diaz ,&nbsp;Johan Steven Sánchez Morales ,&nbsp;Luis Alexander Peña Lopez ,&nbsp;Henry Mauricio Parada Gereda ,&nbsp;Marcela Libreros Arciniegas","doi":"10.1016/j.acci.2025.100585","DOIUrl":"10.1016/j.acci.2025.100585","url":null,"abstract":"<div><div>Acquired weakness in the intensive care unit (ICU-AW) is a frequent and multifactorial complication in critically ill adults, characterized by accelerated loss of muscle mass, type II fiber atrophy, and decreased functional performance. This condition limits independence, worsens quality of life, and may generate persistent sequelae after hospital discharge. With the aim of synthesizing the available evidence on methods and measures for evaluating peripheral muscle performance (PMP), a scoping review was conducted using the databases PubMed, ScienceDirect, Scopus, Web of Science, Virtual Health Library (VHL), and Google Scholar. Search terms included “adult,” “intensive care units,” “muscle skeletal,” “muscle weakness,” and “muscular atrophy.” The search yielded 356 articles, and according to the selection criteria, 40 studies were included. The most commonly used tests were the MRC-sum score (MRC-SS) and handgrip strength, applied mainly during awakening phases and ICU discharge. Ultrasound and computed tomography have become established as objective tools to measure muscle thickness and cross-sectional area, even in sedated patients. Functional mobility and independence assessments—such as the FSS-ICU, IMS, and Barthel Index—are proposed as complementary instruments. Other innovative methods have also been suggested for evaluating PMP. The studies show heterogeneity in evaluation methods and timing, demonstrating the need to validate tests, develop protocols, care guidelines, and continuous training programs, directing efforts toward humanized, high-quality care that supports patients’ functional recovery.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100585"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247310","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":"Optimizing perioperative outcomes: The impact of Surgical Intensive Care Units on critical care management: A narrative review","authors":"Juan Sanjuan ,&nbsp;Wilmer Santiago Ruiz-Gomez ,&nbsp;Gustavo Adolfo Villegas-Gomez ,&nbsp;Antonio Jose Oyola Yepes","doi":"10.1016/j.acci.2026.100586","DOIUrl":"10.1016/j.acci.2026.100586","url":null,"abstract":"<div><div>Surgical Intensive Care Units (SICUs) play a fundamental role in optimizing perioperative management by implementing specialized protocols aimed at improving patient recovery, reducing complications, and enhancing clinical outcomes. Compared to general or mixed ICUs, SICUs employ targeted interventions, including goal-directed hemodynamic therapy, multimodal analgesia, and Enhanced Recovery After Surgery (ERAS) protocols. This narrative review examines the impact of SICUs on mortality, postoperative complications, hospital length of stay, and resource utilization. A narrative literature review was conducted, analyzing studies published between 2000 and 2024 that compared patient outcomes in SICUs versus general or mixed ICUs. Data were extracted from PubMed, Scopus, Web of Science, and Cochrane Library using predefined inclusion criteria. Key variables assessed included mortality rates, length of hospital stay, postoperative complications, ventilatory management strategies, antimicrobial stewardship, and long-term functional outcomes. The quality of included studies was evaluated using the GRADE framework and the Newcastle-Ottawa Scale. Findings indicate that structured perioperative management in SICUs resulted in a 15–20% reduction in mortality and a 1.5–3-day shorter hospital stay compared to general ICUs. SICUs demonstrated superior resource efficiency, reducing unnecessary blood transfusions by 30–40% and reintervention rates by 10–15%. Implementation of goal-directed hemodynamic therapy, early mobilization, and lung-protective ventilation significantly decreased postoperative complications, including a 25–30% reduction in acute kidney injury, sepsis, and ventilator-associated pneumonia. Additionally, antimicrobial stewardship programs within SICUs effectively reduced antibiotic resistance and shortened antimicrobial therapy duration without increasing infection risk. Structured rehabilitation and multidisciplinary collaboration further improved long-term functional outcomes and reduced hospital readmission rates. SICUs offer superior perioperative care, improving patient outcomes through structured management protocols and multidisciplinary coordination. Despite these benefits, challenges remain regarding cost-effectiveness, protocol standardization, and long-term cognitive outcomes. Future research should focus on cost-benefit analyses, the integration of precision medicine, and enhanced interdisciplinary collaboration to further optimize SICU performance.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"26 2","pages":"Article 100586"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247311","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}