Acta Colombiana de Cuidado Intensivo最新文献

{"title":"Innovation and challenges in the implementation of artificial intelligence in critical care","authors":"Ever Leonardo Rojas-Díaz , Mónica Rojas , Juan Sebastian Osorio-Valencia , Natalia Acevedo Guerrero , Leo Anthony Celi , Margoth Cristina Pinilla-Forero","doi":"10.1016/j.acci.2025.04.007","DOIUrl":"10.1016/j.acci.2025.04.007","url":null,"abstract":"","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 451-452"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842391","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":"Efecto tóxico por herbicida metahemoglobinizante en cuidado crítico: intoxicación por propanil, un reporte de caso","authors":"José J. Hidalgo-Heredia ,&nbsp;Víctor Hugo Nieto Estrada ,&nbsp;Emiro José Noguera García ,&nbsp;María Paula Rojas Leal","doi":"10.1016/j.acci.2025.04.008","DOIUrl":"10.1016/j.acci.2025.04.008","url":null,"abstract":"<div><div>Propanil poisoning, a methemoglobinemia-inducing herbicide pesticide, causes a wide range of signs and symptoms, from mild manifestations such as fatigue to severe complications including cyanosis, arrhythmias, neurological deficits, ventilatory failure, and even death, depending on the degree of exposure to the toxin. In low- to medium-complexity healthcare institutions that lack the ability to identify the toxin or quantify the degree of intoxication, diagnosing and managing such cases presents a significant challenge. The lethal dose of propanil exposure is approximately 10<!--> <!-->ml of the undiluted compound or 200<!--> <!-->ml in its diluted form. Therefore, clinical manifestations and score NEWS2 become a crucial tool in guiding diagnosis and treatment, improving morbidity and mortality rates. Various experimental treatments exist, but there is insufficient scientific evidence to effectively manage this type of poisoning and prevent acute outcomes such as hepatopathy or fatal complications like haemolysis. However, methylene blue has emerged as the antidote of choice for moderate to severe methemoglobinemia. Few patients require exchange transfusion to mitigate the high risk of mortality. Public health policies have demonstrated a reduction in the incidence of morbidity and mortality associated with propanil poisoning.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 571-577"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842202","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":"Asociación de los grados de quemosis con el balance de líquidos en pacientes críticos","authors":"Marcos Vidals-Sánchez ,&nbsp;Nancy Verónica Alva-Arroyo ,&nbsp;Karen Harumi López-Rodríguez ,&nbsp;Jesús Enrique Castrejón-Sánchez ,&nbsp;Marcos Antonio Amezcua-Gutiérrez ,&nbsp;José Carlos Gasca-Aldama","doi":"10.1016/j.acci.2025.04.005","DOIUrl":"10.1016/j.acci.2025.04.005","url":null,"abstract":"<div><h3>Objectives</h3><div>In the intensive care unit (ICU) patients are exposed to ocular complications such as chemosis, which may be linked to fluid overload. The study evaluated the potential utility of chemosis as an objective sign for the early detection of this condition, analyzing its relationship with cumulative fluid balance and its connection to the Godet sign.</div></div><div><h3>Design</h3><div>A prospective cohort study conducted over one year in the ICU of two hospital centers included 251 patients over 18<!--> <!-->years with fluid overload.</div></div><div><h3>Results</h3><div>76.8% of patients developed grade<!--> <!-->3 chemosis, detected on average on day 3.5 (±<!--> <!-->0.4). Patients with grade<!--> <!-->2 chemosis had a 2.3-fold increased risk of exceeding a fluid balance of 8000<!--> <!-->ml (95%<!--> <!-->CI: 1.07-5.12, <em>P</em> <!-->=<!--> <!-->.032), while those with grade<!--> <!-->3 chemosis had a 3.7-fold increased risk (95%<!--> <!-->CI: 1.7-8.09, <em>P</em> <!-->=<!--> <!-->.009). Patients with Godet +++ and ++++ had 2.5 (95%<!--> <!-->CI: 4.67-5.78, <em>P</em> <!-->=<!--> <!-->.016) and 4.4 (95%<!--> <!-->CI: 3.23-7.09, <em>P</em> <!-->=<!--> <!-->.020) times higher probabilities of developing grade<!--> <!-->2 and grade<!--> <!-->3 chemosis, respectively. In the adjusted analysis, a fluid balance greater than 8001<!--> <!-->mL was associated with a 5.6-fold higher probability of developing chemosis (95%<!--> <!-->CI: 1.98-4.21, <em>P</em> <!-->=<!--> <!-->.010).</div></div><div><h3>Conclusions</h3><div>A strong correlation was found between chemosis, fluid overload, and the Godet sign, suggesting that chemosis could be a relevant clinical marker of tissue congestion in critically ill patients, even before being detected by ultrasonography.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 462-467"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842393","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":"Catecolaminas y bacterias: una interacción poco conocida pero clínicamente relevante, revisión integrativa de la bibliografía","authors":"Jorge Luis Vélez-Páez ,&nbsp;Erick Tutín-Miniguano","doi":"10.1016/j.acci.2025.05.001","DOIUrl":"10.1016/j.acci.2025.05.001","url":null,"abstract":"<div><div>Catecholamines, historically known for their role in cardiovascular regulation and stress response, have poorly understood direct biological interactions with pathogenic bacteria, modulating key infectious disease variables such as pathogen growth, virulence, and antibiotic resistance.</div><div>The objective of this review is to uncover the current scientific evidence on this relationship, highlighting mechanisms such as the induction of iron uptake systems (siderophores), the activation of bacterial sensors, and the promotion of biofilms. We emphatically analyze key pathogens in human pathology such as <em>Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus</em>, and <em>Enterococcus faecalis</em>, whose response to catecholamines can exacerbate infections in critically ill patients. In addition, clinical implications are discussed, such as a new therapeutic dilemma in septic shock (catecholaminergic vasopressor support vs. exacerbation of infection) and new therapeutic strategies that derive from the understanding of the complex bacteria-catecholamine interaction, such as the early initiation of non-catecholaminergic vasopressors, virulence inhibitors, iron chelators and combination therapies.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 541-547"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842260","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":"Correlations of optic nerve sheath diameter with intracranial pressure, positive end-expiratory pressure and patient positioning in patients with severe traumatic brain injury on a mechanical ventilator in the ICU","authors":"Shalendra Singh ,&nbsp;Priya Taank ,&nbsp;Diwakar Thapa ,&nbsp;Mayank Dhiman ,&nbsp;Munish Sood","doi":"10.1016/j.acci.2025.02.005","DOIUrl":"10.1016/j.acci.2025.02.005","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to assess the effect of different PEEP levels and patient positioning on optic nerve sheath diameter (ONSD) as a surrogate marker for intracranial pressure (ICP) in patients with severe TBI on mechanical ventilation.</div></div><div><h3>Design</h3><div><span>A prospective interventional study assessing the effects of PEEP and patient positioning on </span>ONSD in ventilated TBI patients.</div></div><div><h3>Setting</h3><div>The aim of this study was to explore how alterations in the PEEP and patient position influence the optic nerve sheath diameter (ONSD), which is a marker of the ICP. Eighty patients on ventilators with TBIs were placed in three different positions with the bed's head end at 0°, 30°, and 45° angles.</div></div><div><h3>Interventions</h3><div>The ONSD was assessed using an ultrasound probe at PEEP of 0, 3, and 5<!--> <!-->cm H₂O in all three positions.</div></div><div><h3>Variables of interest</h3><div>ONSD, ICP and PEEP.</div></div><div><h3>Results</h3><div>The study findings indicate that no statistically significant alteration in the ONSD observed at different PEEP levels or various patient positions. Although there was an increase in the ONSD when the PEEP was increased from 0 to 5<!--> <!-->cm H₂O, this increase did not reach statistical significance. Notably, the most notable changes in ONSD were observed at the 30-degree patient position when the PEEP increased from 0 to 5<!--> <!-->cm H₂O (6.12<!--> <!-->±<!--> <!-->0.38 vs. 6.23<!--> <!-->±<!--> <!-->0.40), with a <em>p</em> value of 0.07, indicating a trend toward significance.</div></div><div><h3>Conclusion</h3><div>The study results suggest that the application of PEEP up to 5<!--> <!-->cm H₂O did not lead to significant changes in the ONSD, suggesting a degree of safety in its application for patients with TBI.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 453-461"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Índice de choque y capacidad para predecir el uso de transfusión masiva en una población con trauma grave en región toracoabdominal","authors":"Daniel Escobar Macías ,&nbsp;Wesley Cardona Castro ,&nbsp;Juan D. Jimenez ,&nbsp;Samuel Correa ,&nbsp;Carlos E. Vallejo","doi":"10.1016/j.acci.2025.01.002","DOIUrl":"10.1016/j.acci.2025.01.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Bleeding is one of the main causes of death associated with trauma. Massive transfusion (MT) is one of the mainstays of treatment, with decreased mortality demonstrated with early initiation of administration. There are multiple tools to activate MT protocols, among which is the shock index (CI), however, the cut-off point to define its activation is not clear. The objective of this study was to determine the diagnostic performance of IC to determine the need for MT in patients with severe trauma to the chest and/or abdomen.</div></div><div><h3>Methodology</h3><div>Cross sectional study. Patients with severe trauma were evaluated between the years 2017 to 2022. The incidence of MT was estimated and the CI of each patient with the first medical contact was calculated. Discrimination was assessed using AUC-ROC for receiving a MT.</div></div><div><h3>Results</h3><div>The cumulative MT incidence was 30.79% (n<!--> <!-->=<!--> <!-->97); In patients who required MT the median CI was 1.2 (IQR: 0.6-1.8), while in patients who did not require MT it was 1 (IQR: 0.5-1.5). The cut-off point of 1.1 in the CI presented the best performance with an AUC-ROC 0.63 to predict the need for MT.</div></div><div><h3>Conclusion</h3><div>In the sample analyzed, the CI has a poor performance in predicting the need for MT, although it was observed that a higher CI is related to greater administration of MT, with an optimal cut-off point of 1.1 for our population.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 261-269"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254958","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":"Comunicar malas noticias en cuidados intensivos: Algoritmo CRISIS 123","authors":"Liliana Correa-Pérez ,&nbsp;John Camilo García Uribe","doi":"10.1016/j.acci.2025.01.001","DOIUrl":"10.1016/j.acci.2025.01.001","url":null,"abstract":"<div><div>In intensive care, it is common to have to provide unfavorable information to patients and families in poor recovery scenarios. The empathic and appropriate delivery of bad news provides confidence, acceptance and grief for the patient and family, while inappropriate communication can generate negative emotional reactions. Through a literature review of current concepts for delivering bad news in serious or critical conditions, a novel proposal is generated: the CRISIS 123 algorithm: a mnemonic for delivering bad news, consisting of three domains: the first promotes techniques for delivering CRISIS 1 information: Communication, Summary/Reasons, Information, Event, Unexpected, Simulation. The CRISIS 2 domain includes key aspects of the news itself: Content, Risks, Impact, Serenity, Introduce and Silence. CRISIS 3 domain explains the emotions that can be experienced by both the giver and the receiver of the news: Compassion/Empathy and Respect, Sensitivity, Irreparable and Sense. An educational and methodical strategy that allows to give greater depth to the values and emotions involved in the communication of bad news in intensive care, and in other settings such as the obstetric ICU, emergency services and palliative care.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 325-335"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recomendaciones de consenso para el abordaje integral y manejo del sangrado en escenarios críticos","authors":"Manuel Garay-Fernández ,&nbsp;Fredy Ariza ,&nbsp;Diego Zuluaga ,&nbsp;Sandra Olaya ,&nbsp;Liliana Correa ,&nbsp;Arturo Cardona ,&nbsp;Gloria Ramos ,&nbsp;Hans García ,&nbsp;Isabel Cristina Arias ,&nbsp;Aura Milena Reina ,&nbsp;Manuel Quintana Diaz","doi":"10.1016/j.acci.2024.11.003","DOIUrl":"10.1016/j.acci.2024.11.003","url":null,"abstract":"<div><div>Hemostatic alterations in massive bleeding manifest in various ways, significantly increasing the risk of complications and mortality. The management of critical bleeding requires multidisciplinary teams and standardized approaches to enable rapid assessment, identification of root causes, precise interventions, and ongoing decision-making. Situations such as major surgery, trauma, and childbirth often involve multiple factors that contribute to hemorrhagic shock, characterized by tissue ischemia and endothelial dysfunction, hypofibrinogenemia and dysfibrinolysis. Acute reductions in erythrocyte mass couple with persistent hypotension further compromise hemostasis and oxygen delivery. This consensus document provides evidence-based recommendations the assessment and management of critical bleeding in three key areas: postpartum hemorrhage, trauma, and cardiovascular surgery. The primary objective is to deliver accessible guidance that prioritizes effective bleeding management in critical scenarios, wheter or not coagulopathy is present. This document also serves as a practical tool to support the implementation and optimization of «Patient Blood Management,» a framework endorsed by the World Health Organization to enhance patient outcomes through evidence-based clinical care.</div><div>The GRADE-based recommendations for managing critical bleeding are organized into four key areas: 1.<!--> <em>Evaluation of coagulation in critical bleeding.</em> Early and sequential assessment of hemostasis is recommended, incorporating viscoelastic or conventional tests. Special enphasis is placed on fibrinogen quantification and platelet function, with the integration of these tests into institutional protocols. 2.<!--> <em>Management of postpartum bleeding.</em> Recommendations highlight the importance of early bleeding identification, the use of uterotonics, tranexamic acid, fibrinogen replacement, comprehensive monitoring, and mechanical bleeding control. 3.<!--> <em>Traumatic bleeding</em> key mesures include administering tranexamic acid and implementing transfusion therapy tailored to individual needs. Massive transfusion protocols, is emphasized, alongside early coagulation assessment using conventional or viscoelastic tests to guide treatment. 4.<!--> <em>Cardiovascular surgery.</em> Recommendations focus on preoperative identification and correction of anemia and risk factors. The use of tranexamic acid, along with perioperative coagulation assessment guided by viscoelastic test-based algorithms, is adviced to minimize transfusions. Strategies also enphasize restrictive transfusion thresholds and targeted bleeding management during prolonged bypass procedures.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 395-419"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255090","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":"Actualización en rehabilitación cardiaca en el paciente crítico cardiovascular: una revisión de tema","authors":"Juan Santiago Serna-Trejos ,&nbsp;Carlos Andrés Castro-Galvis ,&nbsp;Stefanya Geraldine Bermúdez-Moyano ,&nbsp;Laura Catalina Rodríguez-Fonseca ,&nbsp;Álvaro Andrés Montenegro-Apraez ,&nbsp;Jorge Fernando Miño-Bernal ,&nbsp;Lina María Salazar-Rodríguez ,&nbsp;Valentina Bravo-Echeverry","doi":"10.1016/j.acci.2025.01.004","DOIUrl":"10.1016/j.acci.2025.01.004","url":null,"abstract":"<div><div>Cardiac rehabilitation is a comprehensive, multidisciplinary strategy that has demonstrated significant benefits in critically ill cardiovascular patients, particularly those with ischemic disease, heart failure, and post-surgical interventions. This article reviews recent literature on the impact of cardiac rehabilitation in critically ill patients, highlighting its ability to improve functional capacity, quality of life, and reduce mortality and hospitalizations. Programs include tailored interventions encompassing supervised exercise, risk factor education, and psychosocial support. Important barriers are identified, such as low participation in rehabilitation programs, especially in vulnerable populations, due to economic limitations, geographic access and lack of knowledge on the part of both patients and health professionals. Emerging strategies, such as telemedicine-based rehabilitation and home-based programs, which seek to improve adherence and accessibility, are also discussed. Although the data are promising, more robust evidence is needed to assess efficacy in specific subgroups of critically ill patients and in resource-limited settings.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 350-360"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esteroides, sepsis y shock séptico: de la plausibilidad biológica a la evidencia actual. Revisión narrativa","authors":"Jorge Luis Vélez-Páez ,&nbsp;Daniel Torres-Carpio ,&nbsp;Manuel Luis Avellanas-Chavala","doi":"10.1016/j.acci.2025.01.007","DOIUrl":"10.1016/j.acci.2025.01.007","url":null,"abstract":"<div><div>The discovery of steroids marked a medical milestone, both physiologically, by understanding adrenal function; and therapeutically, by finding an anti-inflammatory and immunosuppressive hormone that changed the natural history of autoimmune diseases.</div><div>Sepsis is systemic inflammation secondary to an infection, therefore, the use of steroids is biologically plausible. However, history provides negative data on their use at high doses (immunosuppression). Low doses activate non-genomic mechanisms with immunomodulatory and neuroendocrine responses that restore adrenergic sensitivity and improve the hemodynamic context in patients with septic shock and have opened a path towards a reasonable and supported therapeutic indication.</div><div>The objective of this review is to trace the historical path of steroids from their discovery to their current indication in septic shock.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 361-370"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}