Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Asociación de la disminución de la fracción de engrosamiento diafragmático con resultados adversos en pacientes bajo ventilación mecánica invasiva","authors":"José Patricio Novelo-Pérez ,&nbsp;Gisel Ivonne Aceves-Franco ,&nbsp;Rubén Gerardo García-Gutiérrez ,&nbsp;Guillermo García-de la Cruz ,&nbsp;Arturo Pérez-Cortés","doi":"10.1016/j.acci.2023.12.004","DOIUrl":"10.1016/j.acci.2023.12.004","url":null,"abstract":"<div><h3>Background</h3><p>Diaphragmatic dysfunction is a severity marker for patients under mechanical ventilation and is associated with higher mortality rates. The diaphragmatic thickening fraction, an ultrasound measurement, has been employed as a mechanical ventilation weaning predictor; its impact on adverse outcomes, such as tracheostomy and mortality rates, are still undetermined.</p></div><div><h3>Objective</h3><p>To evaluate the association of diaphragmatic thickening fraction decrease with adverse outcomes in patients under invasive mechanical ventilation.</p></div><div><h3>Material and methods</h3><p>Prospective cohort study. The diaphragmatic thickening fraction was measured by ultrasound on the third day of enrollment, with a follow-up observation on day 14. A ROC curve was computed in search of an optimal cut-off point for sensitivity and specificity. Relative risk was calculated for adverse outcomes with 95% confidence interval.</p></div><div><h3>Results</h3><p>One hundred and eleven patients were analyzed. Sixty-seven patients (74.37%) had a normal diaphragmatic thickening fraction, and forty-four patients (25.63%) had a low diaphragmatic thickening fraction. In the low diaphragmatic thickening fraction group, 37 deaths were documented at day 14 (82.2%), and four cases sustained tracheostomy (14.8%); the incidence of adverse effects was 56.2% (relative risk, 1.79; 95% CI, 1.3–2.45; <em>p</em> <!-->&gt;<!--> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>The diaphragmatic thickening fraction is a novel parameter for clinical monitorization and surveillance for patients under mechanical ventilation, as well as a promising tracheostomy and mortality predictor.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 2","pages":"Pages 92-97"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139634727","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":"Concordancia de la evaluación ecocardiográfica básica funcional del ventrículo izquierdo entre médicos no expertos y cardiólogos especialistas en ecocardiografía","authors":"José Carbonó-Camargo ,&nbsp;José Antonio Rojas Gambasica ,&nbsp;Álvaro Tito Jiménez ,&nbsp;Sofia Muñoz Medina ,&nbsp;Victor Nieto Estrada","doi":"10.1016/j.acci.2023.08.002","DOIUrl":"10.1016/j.acci.2023.08.002","url":null,"abstract":"<div><h3>Introduction</h3><p>The clinical decisions of patients in the intensive care unit are based on the integration of the clinical history and complementary tests. The echocardiographic evaluation can reveal decisive information in the interventions and in the prognosis of the patients.</p></div><div><h3>Objective</h3><p>To determine the concordance in the analysis of left ventricular systolic function performed by physicians with basic training in echocardiography compared with the assessment by expert cardiologists.</p></div><div><h3>Methodology</h3><p>Cross-sectional study of diagnostic concordance with prospective recruitment. Patients hospitalized in the intensive care unit during 2023 in a university clinic with a high level of complexity were included. The concordance between the trained physician and the expert was analyzed using the Kappa index (κ) for the qualitative variables, and the intraclass correlation coefficient for the quantitative ones.</p></div><div><h3>Results</h3><p>131 patients were included, with a mean age of 62 years. The concordance of the echocardiographic assessment was determined, finding very good concordance for left ventricular contractility (κ: 0.97), pericardial effusion (κ: 0.82) and its location (κ: 0.85), contractility disorders (κ: 0.84) and in the quantitative measurement of the ejection fraction (intraclass correlation coefficient: 0.91).</p></div><div><h3>Conclusions</h3><p>There is agreement in the evaluation of left ventricular systolic function in patients hospitalized in the intensive care unit by non-expert medical personnel with training and expert cardiologists. The results should be interpreted as part of a comprehensive assessment at the patient's bedside and not as an isolated diagnosis, always under quality standards and with the necessary verification.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 2","pages":"Pages 79-85"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134934922","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":"Paraquat fulminant poisoning: Case report","authors":"Marcos Antonio Amezcua-Gutiérrez,&nbsp;Jorge Alberto Castañón-González,&nbsp;Nikolett Iren Medveczky-Ordóñez,&nbsp;José Carlos Gasca-Aldama,&nbsp;Jessica Garduño-López","doi":"10.1016/j.acci.2023.08.006","DOIUrl":"10.1016/j.acci.2023.08.006","url":null,"abstract":"<div><p><span>Paraquat is one of the most widely used non-selective herbicides in the world, however, it is prohibited in many countries due to its high toxicity and mortality rate. Herein, we present a case of fulminant PQ poisoning in a 21 years-old woman with a six weeks pregnancy, and a history of sexual abuse and rape; computed tomography showed disseminated micronodular alveolar infiltrates and septal thickening. It rapidly progressed to severe acute respiratory distress syndrome, requiring endotracheal intubation; however, paraquat is known to generate reactive oxygen species that cause cell damage through lipid peroxidation, mitochondrial activation, and </span>apoptosis following oxygen exposure. Therefore, in these cases, the line between the risk and benefit of oxygen therapy is very thin. Despite receiving timely treatment, the serious hemodynamic and respiratory deterioration evolved into multiple organ failure and later the death of the patient. Paraquat poisoning severe intoxication has a dim prognosis, although early diagnosis results in therapeutic challenge due to severe respiratory compromise. We also present a brief review of the literature, as well as a discussion of the treatment for paraquat fulminant poisoning.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 2","pages":"Pages 173-176"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135348626","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 inflamatorio multisistémico pediátrico en paciente con oxigenación por membrana extracorpórea, reporte de un caso","authors":"Mauricio Valencia Garcia ,&nbsp;Yolima Porto Jaramillo ,&nbsp;Jhojan Sebastian Herrera Vargas ,&nbsp;Alfredo Hernández Ruiz ,&nbsp;Roberto Gaitan Luque ,&nbsp;Neil Miguel Daza Alaracon","doi":"10.1016/j.acci.2023.08.004","DOIUrl":"10.1016/j.acci.2023.08.004","url":null,"abstract":"<div><p>Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 is a rare presentation of SARS-CoV-2 infection. Its most common manifestation is cardiogenic shock, with a high percentage of patients requiring vasoactive and inotropic support.</p><p>Occasionally, the myocardial dysfunction can be severe enough to result in death. Therapies such as extracorporeal membrane oxygenation (ECMO) provide a transient support option for recovery; however, it is an underutilized tool.</p><p>In this article, we present the case of an adolescent who initially presented with gastrointestinal symptoms and fever, who subsequently developed refractory cardiogenic shock attributed to a systemic inflammatory syndrome associated with COVID-19. The presence of SARS-CoV-2 was identified through tracheal aspirate, and due to hemodynamic instability, the patient received ECMO therapy along with steroid medications, immunomodulators, and inotropes. After one week, the patient recovered ventricular function with a favorable outcome.</p><p><em>In conclusion</em>, ECMO therapy in pediatric patients with systemic inflammatory syndrome associated with COVID-19 may contribute to improved survival. However, the low utilization of this therapy and limited reporting in the literature lead to deficiencies in the evidence supporting its implementation.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 2","pages":"Pages 165-172"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388046","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":"Asincronía paciente-ventilador: abordaje clínico práctico","authors":"Fabio Varón-Vega ,&nbsp;Susana Moreano ,&nbsp;Eduardo Tuta-Quintero ,&nbsp;Conny Muñoz ,&nbsp;Jonathan Palacios ,&nbsp;Stephanie Crevoisier ,&nbsp;Carmelo Dueñas","doi":"10.1016/j.acci.2024.03.003","DOIUrl":"10.1016/j.acci.2024.03.003","url":null,"abstract":"<div><p>Asynchronies, characterized by the lack of synchronization between the moments when the patient performs neural inspirations and those programmed in the ventilator, are common in patients requiring ventilatory support. Although esophageal monitoring is considered the most accurate method for detection, diagnosis, and intervention, it proves impractical in the clinical evaluation context. Monitoring through various curves and loops, however, facilitates the identification of asynchronies and allows for the assessment of the response to established interventions. This review focuses on differentiating stimuli to the respiratory center and mechanical responses, thereby easing the diagnosis and interventions necessary for their control.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 2","pages":"Pages 152-164"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772699","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":"Predictores de mortalidad en pacientes críticos con neumonía grave por coronavirus 2019 (COVID-19): un estudio observacional multicéntrico en Colombia","authors":"Francisco José Molina ,&nbsp;Luz Elena Botero ,&nbsp;Juan Pablo Isaza ,&nbsp;Lucelly López ,&nbsp;Marco Antonio González ,&nbsp;Bladimir Alejandro Gil ,&nbsp;Juan Luis Echeverri ,&nbsp;Juan David Uribe ,&nbsp;Victoria E. Ángel ,&nbsp;Nelson Javier Fonseca ,&nbsp;Sindy Sitton ,&nbsp;Aurelio González ,&nbsp;Juan Miguel Arias ,&nbsp;Francisco Luis Zapata ,&nbsp;Jhon Alexander Gallego ,&nbsp;Ana Sofía Cortés ,&nbsp;Daniel Giraldo ,&nbsp;Andrea Mazo ,&nbsp;Catalina Aguilar ,&nbsp;Valentina Ruiz ,&nbsp;Antoni Torres","doi":"10.1016/j.acci.2023.12.010","DOIUrl":"10.1016/j.acci.2023.12.010","url":null,"abstract":"<div><h3>Introduction</h3><p>Patients on invasive mechanical ventilation (IMV) with COVID-19 have a high mortality. There is a lack of information on the factors associated with mortality in these patients with a hospital stay of less than 48<!--> <!-->hours, which reflects the severity of the disease.</p></div><div><h3>Objective</h3><p>To identify the variables associated with mortality in patients admitted to the intensive care unit (ICU) in IMV with severe pneumonia due to COVID-19.</p></div><div><h3>Materials and methods</h3><p>Prospective study conducted from March 1 to July 30, 2021, in nine ICUs in the city of Medellín, Colombia. Adult patients who required IMV upon admission to the ICU, with a hospital stay of less than 48<!--> <!-->hours, were included. The following variables were studied: personal history, laboratory tests, complications during the stay, and medical treatment. A multivariate analysis was performed in a Poisson regression model with robust errors.</p></div><div><h3>Results</h3><p>Of the 148 patients admitted to the study, 35.8% died. The risk factors related to mortality in the multivariate analysis were: older than 65 years [RR 2.15 (1.36 - 3.41)], continuing with IMV on day 7 of stay [RR 3.13 (1, 13 – 8.69)], and a history of chronic kidney disease [RR 2.09 (1.2 - 3.64)]. Patients with a C-reactive protein value greater than 10<!--> <!-->mg/dL had lower mortality [RR 0.65 (0.44 – 0.95)].</p></div><div><h3>Conclusions</h3><p>Continuing IMV on day 7, being over 65 years of age, or chronic kidney disease were the risk factors associated with mortality.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 2","pages":"Pages 114-123"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139537178","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 externa y actualización de un modelo predictivo de lesión renal aguda en pacientes adultos hospitalizados en cuidados intensivos","authors":"Sandra Piedad Rincón-Castellanos ,&nbsp;Jorge Luis Barrios-Meza ,&nbsp;Diego Fernando Rojas-Gualdrón","doi":"10.1016/j.acci.2023.07.008","DOIUrl":"10.1016/j.acci.2023.07.008","url":null,"abstract":"<div><h3>Aim</h3><p>To analyze the predictive performance of the risk model for acute kidney injury (AKI) by Malhotra et al., in adults hospitalized in the intensive care unit (ICU) of Clínica Somer (Colombia), 2017 and 2021.</p></div><div><h3>Methods</h3><p>Retrospective follow-up study of a cohort based on medical records. Critically ill patients over 18 years of age admitted to the ICU were included. Patients with end-stage chronic kidney disease or on renal replacement therapy, AKI at admission were excluded. AKI in the first week in the ICU was defined as the outcome variable, and those of the Malhotra model and additional clinical variables as predictor variables. The predictive performance was analyzed for the original (m₀), calibrated (m₁–m₂) and updated (m₃–m₆) models using the C statistic, the Hosmer–Lemeshow (HL) test, and calibration maps.</p></div><div><h3>Results</h3><p>A total of 1235 patients were included, median age 60 years (IQR 45–60), 39.9% women. The incidence of AKI was 30.6%. The original model (m0) showed fit problems (p-HL value &lt;0.05) overestimating the risk of AKI and obtained a C statistic of 0.68 (95% CI: 0.65–0.71). Calibration using intercept and global factor (m₂) solved the adjustment problem. The update with ten additional variables (m₆) only increased the C statistic to 0.72 (95% CI: 0.69–0.75).</p></div><div><h3>Conclusion</h3><p>The performance of the original model in the external validation cohort is not perfect due to differences in the epidemiology of AKI in the ICU. The model updated improves the fit but not the discrimination, yet it still holds some degree of utility in clinical practice.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 1","pages":"Pages 1-9"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90419665","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":"Uso del catéter de arteria pulmonar en las primeras horas posoperatorias de cirugía cardiovascular de alto riesgo","authors":"Viviana Yiset López Ramírez ,&nbsp;Oscar Mauricio Muñoz ,&nbsp;Williams Cervera","doi":"10.1016/j.acci.2023.10.003","DOIUrl":"10.1016/j.acci.2023.10.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Information on physiological phenomena in the postoperative period of cardiac surgery, pulmonary artery catheter (PAC) use, and medical behaviors derived from its measurement, is limited.</p></div><div><h3>Objective</h3><p>To describe the patterns of PAC use and therapeutic behaviors derived from it in the first postoperative hours of high-risk cardiovascular surgery.</p></div><div><h3>Materials and methods</h3><p>Retrospective cohort study of high-risk cardiovascular surgery patients, managed with PAC in the intensive care unit of the Hospital Universitario San Ignacio in Bogotá D.C. (Colombia). The therapeutic interventions derived from the hemodynamic evaluation with this catheter were evaluated, taking into account the patterns of use and therapeutic behaviors according to the postoperative moment.</p></div><div><h3>Results</h3><p>Forty-two patients were included. Median age 65 years, 59.5% men, 57.1% with EuroSCORE<span>≥</span>6. Median time of PAC use was 63 h (RIC 45–80). The number of PAC measurements per 12 h decreased from 2.16<!--> <!-->±<!--> <!-->0.53 in the first 12 h to 1.30<!--> <!-->±<!--> <!-->0.82 after 48 h (<em>p</em>: 0.0003). The number of behaviors taken from each measurement decreased from 1.48<!--> <!-->±<!--> <!-->0.45 to 0.71<!--> <!-->±<!--> <!-->0.51 (<em>p</em>: 0.0001) in the same period. There was significant reduction in number of behaviors associated with fluid, vasoactive, and vasodilator administration over time.</p></div><div><h3>Conclusions</h3><p>Our data suggest that with the passage of hours the number of PAC measurements is decreasing, as well as the number of behaviors taken based on these measurements. These data suggest that many of the patients who maintained the pulmonary artery catheter for up to 48–72 h no longer required it. Further studies will be needed to clarify which patients benefit from pulmonary artery catheterization beyond 48 h.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 1","pages":"Pages 27-35"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138619540","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":"Programa de detección y control de la infección y colonización de enterobacterias productoras de carbapenemasas en una Unidad de Cuidados Intensivos Pediátricos en Colombia","authors":"Carolina Bonilla González ,&nbsp;Nathalie Gualdron Barreto ,&nbsp;Pedro Alexander Barrera López ,&nbsp;Camila Uribe ,&nbsp;Ricardo Elías Núñez Rocha ,&nbsp;Aura Lucia Leal Castro ,&nbsp;Gonzalo Andrés Montaño Rozo","doi":"10.1016/j.acci.2023.09.002","DOIUrl":"10.1016/j.acci.2023.09.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Carbapenemase-producing Enterobacteriaceae (CPEs) are one of the multidrug-resistant microorganisms of greatest public health concern because they are a major cause of nosocomial infections, leading to higher costs, hospital stays, and increased mortality. This problem is increasingly frequent in the pediatric population with mortality rates due to associated infections of up to 50%. With this paper we would like to present and describe our experience in the implementation of a CLD detection and control program in our PICU.</p></div><div><h3>Methods</h3><p>A system of detection and screening through a search policy that defines the groups at risk and detects patients at risk of colonization by CLD, makes timely isolation of patients colonized with positive CLD and patients considered at risk of colonization pending the results of the culture, finally the control and monitoring of patients colonized by CLD.</p></div><div><h3>Results</h3><p>During the period from 2017 - 2020, 1548 patients were admitted to the PICU of the Hospital Universitario Fundación Santa Fe de Bogotá and it was determined that 6.1% of these met at least one risk factor for colonization by CLD; consequently, 95 screenings were performed in 4 years. At the end of the period studied, a cumulative incidence of CLD colonization of 18.94% was obtained among patients with risk factors.</p></div><div><h3>Conclusions</h3><p>We cannot analyze the factors associated with survival or find a significantly lower or higher survival rate by age; but at the end of follow-up we can affirm that this active surveillance strategy favors the rapid stratification of patient risk and the timely initiation of adequate antimicrobial therapy in early stages of infection. Also, timely and targeted treatment has been shown to improve clinical outcomes in high-risk patient populations, including patients with hematologic pathologies, and allows the development of personalized sepsis care plans.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 1","pages":"Pages 10-18"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135654238","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":"Embolismo paradójico secundario a trombosis del septo interauricular en paciente con asistencia ventricular mecánica: una entidad raramente diagnosticada","authors":"Juan Pedro Martínez García-Rodrigo,&nbsp;Juan Pablo Avilés Parra,&nbsp;Irene Jiménez del Río,&nbsp;Eva María Sánchez Sánchez,&nbsp;Jose Suarez Saiz,&nbsp;Ricardo Díaz Abad","doi":"10.1016/j.acci.2023.07.009","DOIUrl":"10.1016/j.acci.2023.07.009","url":null,"abstract":"<div><p>A 59-year-old woman admitted to the ICU due to STEACS. Coronary angiography was performed that revealed total stenosis of the proximal anterior descending artery, and primary angioplasty was performed. During the procedure, hemodynamic instability warranting placement of an Impella device and later a VA ECMO device. Progressive improvement until both devices were decannulated on the tenth day of admission. Twenty-four hours after decannulation, motor focus was observed in the left upper limb. A transthoracic echocardiography was performed, appreciating a dense image with anarchic movement occupying the thickness of the interatrial septum. The transesophageal study confirmed the presence of a thrombus in a patent foramen ovale and an aneurysmal area of the interatrial septum which, in a situation of cardiogenic shock and atrial ectasia, entails an increased risk of paradoxical embolisms.</p></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"24 1","pages":"Pages 74-77"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78323257","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}