Acta Colombiana de Cuidado Intensivo最新文献

{"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":"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":"Sepsis and septic shock associated with tuberculosis “Landouzy's tifobacilosis”: A dark and unpredictable enemy – From pathophysiology to clinical implications","authors":"José Darío Portillo-Miño, José Leonel Zambrano-Urbano, Diego Fernando Taramuel-Gómez, Franco Andrés Montenegro-Coral, Nasly Violedy Ipia Ordoñez, Luis Guillermo Andino-Bucheli, Leopoldo Javier Eraso-García, Hector Fabio Sanchez-Galvez, J. I. Martínez-Díaz","doi":"10.1016/j.acci.2024.06.002","DOIUrl":"https://doi.org/10.1016/j.acci.2024.06.002","url":null,"abstract":"","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"31 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690506","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}

{"title":"Azul de metileno en intoxicación por cianuro: reporte de caso en paciente con infarto cerebeloso secundario","authors":"Johanna Catherine Ruiz Castillo ,&nbsp;Sara Margarita Benedetti Ramírez ,&nbsp;Miguel Antonio Tolosa Rodríguez","doi":"10.1016/j.acci.2024.05.007","DOIUrl":"10.1016/j.acci.2024.05.007","url":null,"abstract":"<div><p>Mortality rates from cyanide poisoning are significantly high due to the devastating effects that this chemical substance can trigger in the body, quickly compromising vital functions. Currently, within the treatment strategies, circulatory and ventilatory support stands out, along with the administration of specific antidotes, which are difficult to access and are not usually available in most hospitals.</p><p>Although methylene blue has long been considered an option to counteract the effects of cyanide poisoning, research on its mechanisms of action and effectiveness has been limited for decades, leaving aside its protective effects and properties. unique redox in mitochondrial complexes and the Krebs cycle. A clinical case is presented of a patient with acute potassium cyanide poisoning who responded to antidotal treatment with methylene blue; However, she developed a cerebellar stroke as a consequence of the poisoning, despite having no apparent clinical manifestations.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 320-325"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141991339","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":"The enigma of hypernatremia: Ampicillin/sulbactam as an unexpected cause—A case report","authors":"","doi":"10.1016/j.acci.2023.12.005","DOIUrl":"10.1016/j.acci.2023.12.005","url":null,"abstract":"<div><p>Pharmacological hypernatremia is a common electrolyte disorder observed in hospital settings. However, its association with antimicrobial agents remains under investigation. To the best of our knowledge, there are no documented cases of hypernatremia resulting from the use of ampicillin/sulbactam. We present the case of a 58-year-old male who developed this electrolyte imbalance during hospitalization, which was refractory to conventional management. The patient only exhibited significant clinical improvement upon modification and discontinuation of the antibiotic, thereby suggesting an unusual etiology for hypernatremia.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 264-267"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635157","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":"Hemodiafiltración y eliminación extracorpórea de CO2 en un paciente con compromiso pulmonar y renal por sepsis: reporte de caso","authors":"","doi":"10.1016/j.acci.2024.01.001","DOIUrl":"10.1016/j.acci.2024.01.001","url":null,"abstract":"<div><p>Acute respiratory distress syndrome (ARDS) is characterized by acute hypoxemic respiratory failure and is associated with unfavorable clinical outcomes. It is closely related to acute kidney injury by different mechanisms, including biotrauma. In patients with sepsis, it is common to find these two entities, so pulmonary and renal support strategies have emerged. Here we present the case of a 54-year-old male patient, postoperative appendectomy who as a complication developed aspiration pneumonia, septic shock, acute kidney injury and ARDS, as support measures required the combination of extracorporeal CO₂ removal and continuous renal replacement therapy, achieving protective ventilation parameters and progressive resolution of multiple organ dysfunction.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 3","pages":"Pages 273-278"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467639","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}