Pub Date : 2025-10-01DOI: 10.1016/j.acci.2025.08.006
Esteban Armando Ochoa Robles , Carla Alexandra Luzón Durán
Septic shock, particularly when it exhibits catecholamine resistance, continues to pose a significant challenge in critical care medicine, associated with high mortality rates and complexities in clinical management. This chapter delves deeply into the pathophysiological mechanisms and innovative therapeutic strategies to address this condition. Catecholamine resistance is characterized by a diminished vascular response, influenced by factors such as endothelial dysfunction, alterations in adrenergic receptor signaling, and systemic inflammatory changes. Furthermore, emerging biomarkers that allow for more precise diagnosis and better risk stratification are discussed. Alternative therapies are evaluated, including the use of non-catecholamine vasopressors such as vasopressin and angiotensin II, along with the potential of corticosteroids and new modalities such as hemoadsorption, plasma exchange therapy and plasma transfusion. This analysis provides a critical perspective on therapeutic options that can enhance the management of septic shock resistant to catecholamines, highlighting the need for a more personalized and evidence-based approach in critical care.
{"title":"Resistencia a catecolaminas en el shock séptico: fisiopatología, biomarcadores y estrategias terapéuticas. Revisión crítica de la literatura","authors":"Esteban Armando Ochoa Robles , Carla Alexandra Luzón Durán","doi":"10.1016/j.acci.2025.08.006","DOIUrl":"10.1016/j.acci.2025.08.006","url":null,"abstract":"<div><div>Septic shock, particularly when it exhibits catecholamine resistance, continues to pose a significant challenge in critical care medicine, associated with high mortality rates and complexities in clinical management. This chapter delves deeply into the pathophysiological mechanisms and innovative therapeutic strategies to address this condition. Catecholamine resistance is characterized by a diminished vascular response, influenced by factors such as endothelial dysfunction, alterations in adrenergic receptor signaling, and systemic inflammatory changes. Furthermore, emerging biomarkers that allow for more precise diagnosis and better risk stratification are discussed. Alternative therapies are evaluated, including the use of non-catecholamine vasopressors such as vasopressin and angiotensin<!--> <!-->II, along with the potential of corticosteroids and new modalities such as hemoadsorption, plasma exchange therapy and plasma transfusion. This analysis provides a critical perspective on therapeutic options that can enhance the management of septic shock resistant to catecholamines, highlighting the need for a more personalized and evidence-based approach in critical care.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 704-717"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493059","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}
Pub Date : 2025-10-01DOI: 10.1016/j.acci.2025.06.001
Pedro Grille , Antonella Di Maggio , Hugo Peluffo , Andrés Cawen , Daniela Alí , Ingrid Kasek , Matías Negrotto
Introduction
Traumatic brain injury (TBI) is a heterogeneous entity. Better characterization of trajectories is needed to provide individualized treatment.
Objectives
Identify clinical and paraclinical variables that might describe trajectory and long-term neurological prognosis of patients with moderate and severe TBI (msTBI).
Methods
Prospective study of all patients admitted with msTBI to the intensive care unit. Neurological follow-up was performed at 12 months using the Glasgow Outcome Scale-Extended (GOSE) and the Disability Rating Scale (DRS). Clinical characteristics upon admission, physiological parameters, imaging, invasive and non-invasive neuromonitoring information, as well as blood determination of 4 brain biomarkers were identified: NFL, UCH-L1, GFAP and Tau.
Results
Seventy-five patients were studied (81% severe and 19% moderate). A functional and cognitive improvement was evident during rehabilitation, with good evolution (GOSE: 5-8) in 73.4% and partial or no disability (DRS: 0-11) in 53% of the patients. The presence of shock and brain herniation were statistically associated with a worse prognosis. The finding of a small tentorial notch morphology was significantly associated with the development of neuroworsening. Baseline levels of GFAP, UCH-L1 and NFL were significantly higher in patients with msTBI compared to healthy and traumatized controls without TBI. UCH-L1 levels at admission were statistically significantly associated with outcome. Patients with predominant diffuse axonal injury presented higher NFL values in relation to other injury patterns.
Conclusions
The first study in our environment comparing functional neurological prognosis and brain biomarkers in patients with msTBI is presented. These biomarkers could contribute to describe their trajectories.
{"title":"Traumatismo encefalocraneano moderado y grave en la Unidad de Cuidados Intensivos: trayectoria y factores pronósticos","authors":"Pedro Grille , Antonella Di Maggio , Hugo Peluffo , Andrés Cawen , Daniela Alí , Ingrid Kasek , Matías Negrotto","doi":"10.1016/j.acci.2025.06.001","DOIUrl":"10.1016/j.acci.2025.06.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injury (TBI) is a heterogeneous entity. Better characterization of trajectories is needed to provide individualized treatment.</div></div><div><h3>Objectives</h3><div>Identify clinical and paraclinical variables that might describe trajectory and long-term neurological prognosis of patients with moderate and severe TBI (msTBI).</div></div><div><h3>Methods</h3><div>Prospective study of all patients admitted with msTBI to the intensive care unit. Neurological follow-up was performed at 12 months using the Glasgow Outcome Scale-Extended (GOSE) and the Disability Rating Scale (DRS). Clinical characteristics upon admission, physiological parameters, imaging, invasive and non-invasive neuromonitoring information, as well as blood determination of 4 brain biomarkers were identified: NFL, UCH-L1, GFAP and Tau.</div></div><div><h3>Results</h3><div>Seventy-five patients were studied (81% severe and 19% moderate). A functional and cognitive improvement was evident during rehabilitation, with good evolution (GOSE: 5-8) in 73.4% and partial or no disability (DRS: 0-11) in 53% of the patients. The presence of shock and brain herniation were statistically associated with a worse prognosis. The finding of a small tentorial notch morphology was significantly associated with the development of neuroworsening. Baseline levels of GFAP, UCH-L1 and NFL were significantly higher in patients with msTBI compared to healthy and traumatized controls without TBI. UCH-L1 levels at admission were statistically significantly associated with outcome. Patients with predominant diffuse axonal injury presented higher NFL values in relation to other injury patterns.</div></div><div><h3>Conclusions</h3><div>The first study in our environment comparing functional neurological prognosis and brain biomarkers in patients with msTBI is presented. These biomarkers could contribute to describe their trajectories.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 586-594"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493024","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}
Sepsis continues to be one of the leading causes of death in ICUs worldwide. Treatment approaches are constantly evolving, with the choice of antibiotics playing a crucial role in determining patient outcomes.
Objective
This study aims to compare how safe and effective cefoperazone–sulbactam and piperacillin–tazobactam are when used to treat sepsis patients in the Medical Intensive Care Unit (MICU).
Methodology
We conducted a randomized, prospective and retrospective study involving 100 patients diagnosed with sepsis (with or without other health conditions) who were receiving treatment in the MICU. Patients were randomly assigned to one of two groups: Group-I received cefoperazone–sulbactam (50 patients) and Group-II received piperacillin–tazobactam (50 patients). We monitored clinical measurements including body temperature, heart rate, breathing rate, and white blood cell counts.
Results
We analyzed our data using Two-way ANOVA statistical methods. Our findings revealed that piperacillin–tazobactam produced better clinical outcomes than cefoperazone–sulbactam across several measurements. Patients in Group-II showed faster return to normal vital signs and inflammatory markers. The treatment satisfaction score significantly favored the piperacillin–tazobactam group (p < 0.05).
Conclusion
Piperacillin–tazobactam appears to be more effective for treating sepsis in MICU settings. This finding has important implications for antibiotic stewardship programs and clinical protocols in sepsis management.
{"title":"A comparative study on safety and efficacy of cefoperazone–sulbactam versus piperacillin–tazobactam in sepsis in medical intensive care unit","authors":"Kiranmai Mandava , Eeshitha Chinthoju , Rajini Kolure , Suhasini Boddu , Nabeela Fatima","doi":"10.1016/j.acci.2025.07.003","DOIUrl":"10.1016/j.acci.2025.07.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Sepsis continues to be one of the leading causes of death in ICUs worldwide. Treatment approaches are constantly evolving, with the choice of antibiotics playing a crucial role in determining patient outcomes.</div></div><div><h3>Objective</h3><div>This study aims to compare how safe and effective cefoperazone–sulbactam and piperacillin–tazobactam are when used to treat sepsis patients in the Medical Intensive Care Unit (MICU).</div></div><div><h3>Methodology</h3><div>We conducted a randomized, prospective and retrospective study involving 100 patients diagnosed with sepsis (with or without other health conditions) who were receiving treatment in the MICU. Patients were randomly assigned to one of two groups: Group-I received cefoperazone–sulbactam (50 patients) and Group-II received piperacillin–tazobactam (50 patients). We monitored clinical measurements including body temperature, heart rate, breathing rate, and white blood cell counts.</div></div><div><h3>Results</h3><div>We analyzed our data using Two-way ANOVA statistical methods. Our findings revealed that piperacillin–tazobactam produced better clinical outcomes than cefoperazone–sulbactam across several measurements. Patients in Group-II showed faster return to normal vital signs and inflammatory markers. The treatment satisfaction score significantly favored the piperacillin–tazobactam group (<em>p</em> <!--><<!--> <!-->0.05).</div></div><div><h3>Conclusion</h3><div>Piperacillin–tazobactam appears to be more effective for treating sepsis in MICU settings. This finding has important implications for antibiotic stewardship programs and clinical protocols in sepsis management.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 605-614"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493027","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}
Pub Date : 2025-10-01DOI: 10.1016/j.acci.2025.07.006
Simón Restrepo Arismendy , Juan Sebastián Penagos Sánchez , Alejandro Ospina González , Libia María Rodríguez Padilla , Carlos Jaime Velásquez Franco , Francisco José Molina Saldarriaga
Background
Autoimmune diseases can lead to severe complications requiring admission to the ICU. Previous studies have shown variations in mortality and associated risk factors.
Objectives
To determine the factors associated with mortality in patients with autoimmune diseases admitted to the ICU in a high complexity institution in Medellin, Colombia.
Methodology
A retrospective cohort study was conducted with patients admitted to the ICU between 2014 and 2023. Patients older than 18 years with a diagnosis of autoimmune disease were included. Sociodemographic and clinical variables and clinical outcomes were analyzed.
Results
A total of 104 patients were included, most of them women (n = 93, 89.4%). Infections were the main cause of admission to the ICU (n = 68, 65.4%), especially in patients with rheumatoid arthritis (75%). Pulmonary (n = 60, 57.7%), and renal (n = 34, 32.7%) dysfunction were the most frequent. In-hospital mortality was 18.3%. Risk factors associated with higher mortality were age ≥ 45 years, use of vasopressors, organ dysfunction and history of cancer.
Conclusions
Age, pulmonary dysfunction, history of cancer and the need for vasopressors are key factors in the mortality of patients with autoimmune diseases in ICU. Multidisciplinary management and close follow-up are crucial to improve clinical outcomes.
{"title":"Factores asociados a mortalidad en pacientes con enfermedades autoinmunes admitidos a una unidad de cuidados intensivos entre 2014 y 2023","authors":"Simón Restrepo Arismendy , Juan Sebastián Penagos Sánchez , Alejandro Ospina González , Libia María Rodríguez Padilla , Carlos Jaime Velásquez Franco , Francisco José Molina Saldarriaga","doi":"10.1016/j.acci.2025.07.006","DOIUrl":"10.1016/j.acci.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Autoimmune diseases can lead to severe complications requiring admission to the ICU. Previous studies have shown variations in mortality and associated risk factors.</div></div><div><h3>Objectives</h3><div>To determine the factors associated with mortality in patients with autoimmune diseases admitted to the ICU in a high complexity institution in Medellin, Colombia.</div></div><div><h3>Methodology</h3><div>A retrospective cohort study was conducted with patients admitted to the ICU between 2014 and 2023. Patients older than 18 years with a diagnosis of autoimmune disease were included. Sociodemographic and clinical variables and clinical outcomes were analyzed.</div></div><div><h3>Results</h3><div>A total of 104 patients were included, most of them women (n<!--> <!-->=<!--> <!-->93, 89.4%). Infections were the main cause of admission to the ICU (n<!--> <!-->=<!--> <!-->68, 65.4%), especially in patients with rheumatoid arthritis (75%). Pulmonary (n<!--> <!-->=<!--> <!-->60, 57.7%), and renal (n<!--> <!-->=<!--> <!-->34, 32.7%) dysfunction were the most frequent. In-hospital mortality was 18.3%. Risk factors associated with higher mortality were age ≥ 45 years, use of vasopressors, organ dysfunction and history of cancer.</div></div><div><h3>Conclusions</h3><div>Age, pulmonary dysfunction, history of cancer and the need for vasopressors are key factors in the mortality of patients with autoimmune diseases in ICU. Multidisciplinary management and close follow-up are crucial to improve clinical outcomes.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 620-630"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493029","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}
Pub Date : 2025-10-01DOI: 10.1016/j.acci.2025.07.005
Melissa Castillo-Bustamante , Susan L. Whitney , Juan Sebastián Penagos , Cristhian Cubides , Johanna Vanegas-Munera , Marco González
Objectives
To explore the technical feasibility and potential clinical value of implementing the Video Head Impulse Test (vHIT) and Suppression Head Impulse Paradigm (SHIMP) protocols in non-intubated critically ill patients.
Design
A cross-sectional study was conducted in Medellin, Colombia between January and June 2024, using the vHIT and the Suppression Head Impulse Paradigm (SHIMP) to assess vestibular function.
Setting
Patients aged 18 and older non-intubated, diagnosed with sepsis, respiratory insufficiency, acute kidney disease, heart failure, or cerebrovascular disease were included.
Intervention
The tests were performed bedside with vHIT and Shimp (EyeSeeCam system).
Variables of interest
VOR gain for each canal and gain asymmetry.
Results
Sixteen patients were included, five of had septic shock with single organ involvement, four had multi-organ involvement, one had cerebrovascular disease, three had heart failure, and three had acute kidney injury. Reduced vHIT gains were noted primarily in patients with renal involvement and sepsis (0.6–0.62). Patients with multi-organ septic shock had lower vHIT gains compared to those with fewer organ involvements (0.35–0.62 vs 0.45–0.58). No reductions in vHIT gains were observed in patients with cerebrovascular disease or heart failure. The SHIMP protocol identified reduced gains in patients with multi-organ septic shock (0.30–0.59).
Conclusion
Specific comorbidities may differentially impact vestibular function in ICU patients. These preliminary findings highlight the feasibility of bedside vestibular testing and suggest that integrating vHIT and SHIMP into routine assessments could enhance diagnostic accuracy and inform individualized care strategies in critically ill patients.
目的探讨视频头部脉冲测试（vHIT）和抑制头部脉冲范式（SHIMP）方案在非插管危重患者中的技术可行性和潜在临床价值。DesignA横断面研究于2024年1月至6月在哥伦比亚麦德林进行，使用vHIT和抑制头部脉冲范式（SHIMP）评估前庭功能。研究对象包括年龄在18岁及以上的非插管、诊断为败血症、呼吸功能不全、急性肾病、心力衰竭或脑血管疾病的患者。干预试验在床边使用vHIT和Shimp （EyeSeeCam系统）进行。感兴趣的变量为每根管的vor增益和增益不对称。结果16例患者中，感染性休克单脏器受累5例，多脏器受累4例，脑血管病1例，心力衰竭3例，急性肾损伤3例。vHIT获益降低主要发生在肾脏受累和败血症患者（0.6-0.62）。与器官受累较少的患者相比，多器官感染性休克患者的vHIT获益较低（0.35-0.62 vs 0.45-0.58）。在脑血管疾病或心力衰竭患者中未观察到vHIT增益的减少。SHIMP方案确定多器官感染性休克患者的获益降低（0.30-0.59）。结论特定合并症对ICU患者前庭功能的影响可能存在差异。这些初步研究结果强调了床边前庭测试的可行性，并表明将vHIT和SHIMP纳入常规评估可以提高诊断准确性，并为危重患者提供个性化护理策略。
{"title":"Feasibility of bedside vestibular assessment using vHIT and SHIMP in critically ill ICU patients: An exploratory study","authors":"Melissa Castillo-Bustamante , Susan L. Whitney , Juan Sebastián Penagos , Cristhian Cubides , Johanna Vanegas-Munera , Marco González","doi":"10.1016/j.acci.2025.07.005","DOIUrl":"10.1016/j.acci.2025.07.005","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore the technical feasibility and potential clinical value of implementing the Video Head Impulse Test (vHIT) and Suppression Head Impulse Paradigm (SHIMP) protocols in non-intubated critically ill patients.</div></div><div><h3>Design</h3><div>A cross-sectional study was conducted in Medellin, Colombia between January and June 2024, using the vHIT and the Suppression Head Impulse Paradigm (SHIMP) to assess vestibular function.</div></div><div><h3>Setting</h3><div>Patients aged 18 and older non-intubated, diagnosed with sepsis, respiratory insufficiency, acute kidney disease, heart failure, or cerebrovascular disease were included.</div></div><div><h3>Intervention</h3><div>The tests were performed bedside with vHIT and Shimp (EyeSeeCam system).</div></div><div><h3>Variables of interest</h3><div>VOR gain for each canal and gain asymmetry.</div></div><div><h3>Results</h3><div>Sixteen patients were included, five of had septic shock with single organ involvement, four had multi-organ involvement, one had cerebrovascular disease, three had heart failure, and three had acute kidney injury. Reduced vHIT gains were noted primarily in patients with renal involvement and sepsis (0.6–0.62). Patients with multi-organ septic shock had lower vHIT gains compared to those with fewer organ involvements (0.35–0.62 vs 0.45–0.58). No reductions in vHIT gains were observed in patients with cerebrovascular disease or heart failure. The SHIMP protocol identified reduced gains in patients with multi-organ septic shock (0.30–0.59).</div></div><div><h3>Conclusion</h3><div>Specific comorbidities may differentially impact vestibular function in ICU patients. These preliminary findings highlight the feasibility of bedside vestibular testing and suggest that integrating vHIT and SHIMP into routine assessments could enhance diagnostic accuracy and inform individualized care strategies in critically ill patients.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 615-619"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493028","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}
Pub Date : 2025-10-01DOI: 10.1016/j.acci.2025.08.007
Jorge Ignacio Balaguera Vila , Luis Carlos Triana , Gabriel Oviedo
Introduction
Burnout syndrome is a common clinical entity in the modern era, significantly affecting the quality of life of those who suffer from it. Its role in the quality of life of healthcare providers has been recognized, and various populations have been characterized. However, there are few studies focused on intensivists and critical care residents, which motivated the conduction of this study to describe the prevalence and identify risk factors for burnout syndrome in this population.
Methodology
Cross-sectional study conducted through a self-administered survey, analytical in nature, with multivariate analysis using logistic regression. Burnout syndrome was characterized using the Maslach Burnout Inventory. The prevalence of burnout syndrome was determined in the analyzed sample. Sociodemographic factors associated with burnout-related engagement were evaluated.
Results
Data from 194 participants were analyzed, including medical specialists and residents in first or second specialty training in intensive care and critical care medicine. The prevalence of Burnout Syndrome in the population was 6.7%, but 69.59% showed some degree of involvement in domains related to Burnout Syndrome. The main risk factor significantly associated with involvement in one or more categories of the Maslach Burnout Inventory was age over 50 years (aOR 3.64, 95% CI 1.40–9.43, p-value = 0.008), and being a medical resident was significantly associated with presenting full Burnout Syndrome (aOR 3.67, 95% CI 1.12–12.09, p-value = 0.03). Sleeping 6 or more hours appeared to be a protective factor against involvement in any of the categories described (aOR 0.44, 95% CI 0.22–0.89, p-value = 0.02).
Conclusion
Participants in this study, in the city of Bogotá, expressed a high prevalence of involvement in at least one category related to burnout syndrome, with age, resident status, and sleep duration being representative factors in its occurrence.
职业倦怠综合征是现代常见的临床症状，严重影响患者的生活质量。它在医疗保健提供者的生活质量中的作用已得到承认，并已确定了不同人群的特征。然而，很少有研究关注重症医师和重症监护居民，这促使本研究的开展，以描述这一人群的患病率和确定倦怠综合征的危险因素。方法：通过自我管理的调查进行横断面研究，本质上是分析性的，使用逻辑回归进行多变量分析。使用Maslach倦怠量表对倦怠综合征进行表征。在分析样本中确定倦怠综合征的患病率。对与职业倦怠相关的社会人口因素进行评估。结果分析194名参与者的数据，包括接受重症监护和危重医学一、二级专科培训的医学专家和住院医师。人群中倦怠综合征的患病率为6.7%，但有69.59%的人有一定程度的倦怠综合征相关领域。与Maslach职业倦怠量表的一个或多个类别显著相关的主要危险因素是年龄超过50岁（aOR 3.64, 95% CI 1.40-9.43， p值= 0.008），而住院医师与出现完全职业倦怠综合征显著相关（aOR 3.67, 95% CI 1.12-12.09， p值= 0.03）。睡眠6小时或更长时间似乎是防止上述任何一类疾病发生的保护因素（aOR 0.44, 95% CI 0.22-0.89， p值= 0.02）。结论：波哥大市的参与者表达了至少一种与倦怠综合征相关的类别的高患病率，年龄、居住状态和睡眠时间是其发生的代表性因素。
{"title":"Prevalencia y factores de riesgo del síndrome de burnout en profesionales de cuidado intensivo en Bogotá en el año 2024","authors":"Jorge Ignacio Balaguera Vila , Luis Carlos Triana , Gabriel Oviedo","doi":"10.1016/j.acci.2025.08.007","DOIUrl":"10.1016/j.acci.2025.08.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Burnout syndrome is a common clinical entity in the modern era, significantly affecting the quality of life of those who suffer from it. Its role in the quality of life of healthcare providers has been recognized, and various populations have been characterized. However, there are few studies focused on intensivists and critical care residents, which motivated the conduction of this study to describe the prevalence and identify risk factors for burnout syndrome in this population.</div></div><div><h3>Methodology</h3><div>Cross-sectional study conducted through a self-administered survey, analytical in nature, with multivariate analysis using logistic regression. Burnout syndrome was characterized using the Maslach Burnout Inventory. The prevalence of burnout syndrome was determined in the analyzed sample. Sociodemographic factors associated with burnout-related engagement were evaluated.</div></div><div><h3>Results</h3><div>Data from 194 participants were analyzed, including medical specialists and residents in first or second specialty training in intensive care and critical care medicine. The prevalence of Burnout Syndrome in the population was 6.7%, but 69.59% showed some degree of involvement in domains related to Burnout Syndrome. The main risk factor significantly associated with involvement in one or more categories of the Maslach Burnout Inventory was age over 50 years (aOR 3.64, 95% CI 1.40–9.43, p-value<!--> <!-->=<!--> <!-->0.008), and being a medical resident was significantly associated with presenting full Burnout Syndrome (aOR 3.67, 95% CI 1.12–12.09, p-value<!--> <!-->=<!--> <!-->0.03). Sleeping 6 or more hours appeared to be a protective factor against involvement in any of the categories described (aOR 0.44, 95% CI 0.22–0.89, p-value<!--> <!-->=<!--> <!-->0.02).</div></div><div><h3>Conclusion</h3><div>Participants in this study, in the city of Bogotá, expressed a high prevalence of involvement in at least one category related to burnout syndrome, with age, resident status, and sleep duration being representative factors in its occurrence.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 663-670"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493055","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}
Case reports of extracorporeal membrane oxygenation (ECMO) support to support respiratory function during high-risk tracheal repair surgery are limited, and reports in the literature on the use of robotic surgery and ECMO are also scarce. Some benefits of robotic surgery have been observed such as less pain, shorter operative time and postoperative complications, despite the possible complications with the simultaneous use of ECMO such as the risk of bleeding, survival in these patients remains high.
We report the case of a 56 years old patient with tracheal stenosis following pseudoaneurysm repair who required complex surgery for tracheal reconstruction by Da Vinci robot assisted surgery and ECMO veno-venous support. After 48 h of support and successful surgery the patient was discharged.
Case reports demonstrate the capacity of ECMO to successfully support critically compromised patients with critical upper airway obstruction, where conventional mechanical ventilation is difficult or even impossible to ensure.
{"title":"Cirugía compleja de vía aérea asistida por robot y soporte de oxigenación por membrana extracorpórea (ECMO) veno-venoso: reporte de caso","authors":"Marisol Malvaez Castillo , Ibzan Jahzeel Salvador Ibarra , Gustavo Lugo Goytia","doi":"10.1016/j.acci.2025.07.001","DOIUrl":"10.1016/j.acci.2025.07.001","url":null,"abstract":"<div><div>Case reports of extracorporeal membrane oxygenation (ECMO) support to support respiratory function during high-risk tracheal repair surgery are limited, and reports in the literature on the use of robotic surgery and ECMO are also scarce. Some benefits of robotic surgery have been observed such as less pain, shorter operative time and postoperative complications, despite the possible complications with the simultaneous use of ECMO such as the risk of bleeding, survival in these patients remains high.</div><div>We report the case of a 56 years old patient with tracheal stenosis following pseudoaneurysm repair who required complex surgery for tracheal reconstruction by Da Vinci robot assisted surgery and ECMO veno-venous support. After 48<!--> <!-->h of support and successful surgery the patient was discharged.</div><div>Case reports demonstrate the capacity of ECMO to successfully support critically compromised patients with critical upper airway obstruction, where conventional mechanical ventilation is difficult or even impossible to ensure.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 742-745"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493063","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}
Pub Date : 2025-10-01DOI: 10.1016/j.acci.2025.05.007
Víctor Hugo Nieto Estrada , Paola Andrea Rojas González , Lina Fernanda Daza Roldán , Mauricio Andrés Prada Romero , José Antonio Pumarejo Villazón , Daniel Andrés Martínez de los Ríos , Albert Alexander Valencia Moreno
Objective
To determine the prevalence of colonization by carbapenemase-producing microorganisms (KPC) in a cardiovascular intensive care unit (ICU), identify the main causative pathogens, compare clinical outcomes between colonized and non-colonized patients, and explore associated risk factors.
Design
Analytical observational retrospective study.
Setting
Cardiovascular ICU of a tertiary university hospital in Bogotá, Colombia.
Patients
Historical cohort of 1,100 adult patients admitted between January 2021 and December 2022. A sample of 102 patients was selected for comparative analysis (51 colonized, 51 controls).
Interventions
None. Rectal swabs were performed at admission to detect colonization, and clinical records were reviewed retrospectively.
Measurements
Data included demographic and clinical characteristics, ICU length of stay, in-hospital mortality, and incidence of nosocomial infections. Bivariate analyses and logistic regression were used to identify risk factors.
Results
Colonization prevalence was 7.7%. Global mortality was 1.7%, occurring exclusively among colonized patients. Median ICU stay was 2 days, with no significant differences between groups. Nosocomial infections developed in 11.7% of colonized versus 7.8% of control patients. Prior ICU hospitalization and recent antibiotic use were significantly associated with colonization. Among antibiotics, prior use of beta-lactams showed a strong association (OR: 8.68; 95% CI: 2.1-34.6). Escherichia coli was the most frequently isolated organism in infection cases. In 42.8% of infections, no etiological agent was identified.
Conclusions
Colonization with KPC-producing organisms in cardiovascular ICU patients was low. Although there was a trend toward increased infections, it was not associated with higher mortality or adverse clinical outcomes.
{"title":"Desenlaces clínicos de los pacientes que ingresan en la UCI cardiovascular colonizados con carbapenemasas","authors":"Víctor Hugo Nieto Estrada , Paola Andrea Rojas González , Lina Fernanda Daza Roldán , Mauricio Andrés Prada Romero , José Antonio Pumarejo Villazón , Daniel Andrés Martínez de los Ríos , Albert Alexander Valencia Moreno","doi":"10.1016/j.acci.2025.05.007","DOIUrl":"10.1016/j.acci.2025.05.007","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence of colonization by carbapenemase-producing microorganisms (KPC) in a cardiovascular intensive care unit (ICU), identify the main causative pathogens, compare clinical outcomes between colonized and non-colonized patients, and explore associated risk factors.</div></div><div><h3>Design</h3><div>Analytical observational retrospective study.</div></div><div><h3>Setting</h3><div>Cardiovascular ICU of a tertiary university hospital in Bogotá, Colombia.</div></div><div><h3>Patients</h3><div>Historical cohort of 1,100 adult patients admitted between January 2021 and December 2022. A sample of 102 patients was selected for comparative analysis (51 colonized, 51 controls).</div></div><div><h3>Interventions</h3><div>None. Rectal swabs were performed at admission to detect colonization, and clinical records were reviewed retrospectively.</div></div><div><h3>Measurements</h3><div>Data included demographic and clinical characteristics, ICU length of stay, in-hospital mortality, and incidence of nosocomial infections. Bivariate analyses and logistic regression were used to identify risk factors.</div></div><div><h3>Results</h3><div>Colonization prevalence was 7.7%. Global mortality was 1.7%, occurring exclusively among colonized patients. Median ICU stay was 2 days, with no significant differences between groups. Nosocomial infections developed in 11.7% of colonized versus 7.8% of control patients. Prior ICU hospitalization and recent antibiotic use were significantly associated with colonization. Among antibiotics, prior use of beta-lactams showed a strong association (OR: 8.68; 95% CI: 2.1-34.6). Escherichia coli was the most frequently isolated organism in infection cases. In 42.8% of infections, no etiological agent was identified.</div></div><div><h3>Conclusions</h3><div>Colonization with KPC-producing organisms in cardiovascular ICU patients was low. Although there was a trend toward increased infections, it was not associated with higher mortality or adverse clinical outcomes.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 579-585"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493023","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}
Pub Date : 2025-10-01DOI: 10.1016/j.acci.2025.08.002
Jessica Garduño-López , Marcos Antonio Amezcua-Gutiérrez , José Carlos Gasca-Aldama , Marco Antonio Juan-Gómez , Fernando Gabriel Delgado-Mejía , Juan Ángel Morales-Ferrer
Introduction
Prone positioning is a key strategy in managing acute respiratory distress syndrome (ARDS); however, few studies have explored its impact on cerebral hemodynamics. This study analyzed cerebral hemodynamic changes using transcranial Doppler ultrasound (TCD) in patients with ARDS after transitioning from the supine to the prone position.
Materials and methods
A longitudinal, prospective, observational study was conducted on a cohort of patients admitted to the Intensive Care Unit (ICU) of a tertiary hospital in Mexico City. Over a period of seven months, patients diagnosed with ARDS who required prone positioning were included. Ventilatory, blood gas, hemodynamic variables, and cerebral blood flow using transcranial Doppler were evaluated at four time points: in the supine position, immediately after the start of the prone maneuver, at one hour, and at 24 hours post-maneuver.
Results
A total of 30 patients diagnosed with ARDS requiring prone positioning were included. A significant increase in the flows of the left and right middle cerebral arteries (MCA) through systolic, diastolic, and mean velocities was observed after the maneuver (p < 0.001), along with a decrease in intracranial pressure (ICP), resistance index (RI), and pulsatility index (PI). ICP decreased to 1.1 mmHg one hour after the maneuver. Notable improvements in oxygenation parameters were observed, with no significant effect of intrathoracic pressure transmission—related to driving pressure and lung compliance—on intracranial hemodynamics.
Conclusions
The hemodynamic and ventilatory changes observed during prone positioning remained within physiological ranges and did not negatively affect cerebral hemodynamics. These findings confirm the safety of using prone positioning and suggest a potential benefit in patients with concomitant brain injury without intracranial hypertension.
{"title":"Cambios hemodinámicos cerebrales durante la ventilación mecánica en posición prono","authors":"Jessica Garduño-López , Marcos Antonio Amezcua-Gutiérrez , José Carlos Gasca-Aldama , Marco Antonio Juan-Gómez , Fernando Gabriel Delgado-Mejía , Juan Ángel Morales-Ferrer","doi":"10.1016/j.acci.2025.08.002","DOIUrl":"10.1016/j.acci.2025.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Prone positioning is a key strategy in managing acute respiratory distress syndrome (ARDS); however, few studies have explored its impact on cerebral hemodynamics. This study analyzed cerebral hemodynamic changes using transcranial Doppler ultrasound (TCD) in patients with ARDS after transitioning from the supine to the prone position.</div></div><div><h3>Materials and methods</h3><div>A longitudinal, prospective, observational study was conducted on a cohort of patients admitted to the Intensive Care Unit (ICU) of a tertiary hospital in Mexico City. Over a period of seven months, patients diagnosed with ARDS who required prone positioning were included. Ventilatory, blood gas, hemodynamic variables, and cerebral blood flow using transcranial Doppler were evaluated at four time points: in the supine position, immediately after the start of the prone maneuver, at one hour, and at 24<!--> <!-->hours post-maneuver.</div></div><div><h3>Results</h3><div>A total of 30 patients diagnosed with ARDS requiring prone positioning were included. A significant increase in the flows of the left and right middle cerebral arteries (MCA) through systolic, diastolic, and mean velocities was observed after the maneuver (p<!--> <!--><<!--> <!-->0.001), along with a decrease in intracranial pressure (ICP), resistance index (RI), and pulsatility index (PI). ICP decreased to 1.1<!--> <!-->mmHg one hour after the maneuver. Notable improvements in oxygenation parameters were observed, with no significant effect of intrathoracic pressure transmission—related to driving pressure and lung <em>compliance</em>—on intracranial hemodynamics.</div></div><div><h3>Conclusions</h3><div>The hemodynamic and ventilatory changes observed during prone positioning remained within physiological ranges and did not negatively affect cerebral hemodynamics. These findings confirm the safety of using prone positioning and suggest a potential benefit in patients with concomitant brain injury without intracranial hypertension.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 648-655"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493053","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}
Ancillary test are often needed when clinical diagnosis of brain death is not possible, or an apnea test cannot be performed, in these situations demonstration of cerebral flow arrest with the use of transcranial Doppler ultrasonography (TCD) is a feasible, repeatable and non expensive way with high diagnostic yield reported in the literature, however there are limitations for this technique, prominently the need for sectorial transducer, specialized knobology and the absence an adequate acoustic window, in this review we aim to review and describe the technique for an alternative technique using central retinal vessels doppler (CRVD) ultrasound for the diagnosis and confirmation of brain death exemplified by the presentation of a case report.
{"title":"Central retinal vessels Doppler assessment of brain death as an alternative to transcranial doppler: Case report and method definition","authors":"Camilo Perez , Edith Elianna Rodríguez , German Eduardo Fonseca Medina , Jorge Carrizosa-Gonzalez","doi":"10.1016/j.acci.2025.05.006","DOIUrl":"10.1016/j.acci.2025.05.006","url":null,"abstract":"<div><div>Ancillary test are often needed when clinical diagnosis of brain death is not possible, or an apnea test cannot be performed, in these situations demonstration of cerebral flow arrest with the use of transcranial Doppler ultrasonography (TCD) is a feasible, repeatable and non expensive way with high diagnostic yield reported in the literature, however there are limitations for this technique, prominently the need for sectorial transducer, specialized knobology and the absence an adequate acoustic window, in this review we aim to review and describe the technique for an alternative technique using central retinal vessels doppler (CRVD) ultrasound for the diagnosis and confirmation of brain death exemplified by the presentation of a case report.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 4","pages":"Pages 729-733"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145493061","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号