Pub Date : 2025-07-01DOI: 10.1016/j.acci.2025.04.001
Laura Andrea Apráez Henao , Isabel Cristina Zuluaga Aristizabal , Mauricio Fernández Laverde
Diffuse axonal injury is a subtype of brain injury secondary to severe traumatic brain injury; the mechanism that explains the damage is due to rotational forces and rapid acceleration-deceleration that cause cutting and tearing of axonal white matter along with the blood vasculature, leading to cerebral edema and ischemic brain damage. Although most of the brain presents a normal structure, a minority of axons are affected, which is why findings of axonal damage in brain imaging require specialized techniques to visualize the damage. Despite understanding the trauma mechanism and neurological sequelae, there are few studies correlating radiological findings and histopathology, and there is limited data on treatment.
The objective of this study is to recognize the relevance of diffuse axonal injury in pediatrics, emphasizing its impact on functional and neurological prognosis. Despite being a severe injury, children have a significant potential for long-term neurological recovery, highlighting the importance of prolonged follow-up combined with rehabilitation therapies.
{"title":"Daño axonal difuso posterior al trauma craneoencefálico en pediatría: la importancia de reconocerlo","authors":"Laura Andrea Apráez Henao , Isabel Cristina Zuluaga Aristizabal , Mauricio Fernández Laverde","doi":"10.1016/j.acci.2025.04.001","DOIUrl":"10.1016/j.acci.2025.04.001","url":null,"abstract":"<div><div>Diffuse axonal injury is a subtype of brain injury secondary to severe traumatic brain injury; the mechanism that explains the damage is due to rotational forces and rapid acceleration-deceleration that cause cutting and tearing of axonal white matter along with the blood vasculature, leading to cerebral edema and ischemic brain damage. Although most of the brain presents a normal structure, a minority of axons are affected, which is why findings of axonal damage in brain imaging require specialized techniques to visualize the damage. Despite understanding the trauma mechanism and neurological sequelae, there are few studies correlating radiological findings and histopathology, and there is limited data on treatment.</div><div>The objective of this study is to recognize the relevance of diffuse axonal injury in pediatrics, emphasizing its impact on functional and neurological prognosis. Despite being a severe injury, children have a significant potential for long-term neurological recovery, highlighting the importance of prolonged follow-up combined with rehabilitation therapies.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 512-518"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842257","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 : 2025-07-01DOI: 10.1016/j.acci.2025.04.004
Andres Felipe Yepes-Velasco, Lorena Moreno-Araque, Manuel Castaño
Teaching in the intensive care unit (ICU) represents a multifaceted challenge that goes beyond the mere transmission of medical knowledge. This unique environment requires developing both technical and interpersonal competencies in a highly complex context. The critical nature of patients, combined with healthcare demands, creates a scenario where educators must carefully balance educational needs with patient safety. Frequently, this balance tips toward immediate clinical care, which can reduce practical learning opportunities for residents. This review explores the key challenges that clinical teachers encounter while educating in high-workload environments such as the ICU.
{"title":"Enseñando bajo presión: los retos de educar en cuidado intensivo","authors":"Andres Felipe Yepes-Velasco, Lorena Moreno-Araque, Manuel Castaño","doi":"10.1016/j.acci.2025.04.004","DOIUrl":"10.1016/j.acci.2025.04.004","url":null,"abstract":"<div><div>Teaching in the intensive care unit (ICU) represents a multifaceted challenge that goes beyond the mere transmission of medical knowledge. This unique environment requires developing both technical and interpersonal competencies in a highly complex context. The critical nature of patients, combined with healthcare demands, creates a scenario where educators must carefully balance educational needs with patient safety. Frequently, this balance tips toward immediate clinical care, which can reduce practical learning opportunities for residents. This review explores the key challenges that clinical teachers encounter while educating in high-workload environments such as the ICU.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 531-540"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842259","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}
Neurocritical patients require specific management aimed at neuroprotection, therefore it is important to ensure and aggressive respiratory efforts such as coughing should be avoided. Here, we present the case of a 72-year-old patient who was treated with systemic neuroprotective measures such as inhibition of the cough reflex; for this purpose, the artificial airway was made patent with prior instillation of lidocaine. During this intervention, no increase in the optic nerve sheath was observed, as well as inhibiting the spontaneous ventilatory response, achieving ventilatory coupling and a neuroprotective state.
{"title":"Lidocaína como estrategia para minimizar la tos y controlar la presión intracraneal en una paciente neurocrítica: reporte de caso","authors":"Andrés Mauricio Enríquez Popayán, Joismer Alejandro Henao Cruz","doi":"10.1016/j.acci.2025.04.003","DOIUrl":"10.1016/j.acci.2025.04.003","url":null,"abstract":"<div><div>Neurocritical patients require specific management aimed at neuroprotection, therefore it is important to ensure and aggressive respiratory efforts such as coughing should be avoided. Here, we present the case of a 72-year-old patient who was treated with systemic neuroprotective measures such as inhibition of the cough reflex; for this purpose, the artificial airway was made patent with prior instillation of lidocaine. During this intervention, no increase in the optic nerve sheath was observed, as well as inhibiting the spontaneous ventilatory response, achieving ventilatory coupling and a neuroprotective state.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 559-563"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842263","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 : 2025-07-01DOI: 10.1016/j.acci.2025.04.006
Víctor Hugo Nieto Estrada , José Rojas-Suarez , Diana Borré-Naranjo , Jheremy Reyes , Anacaona Martinez del Valle
Introduction
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease with severe clinical manifestations, for which diagnosis and treatment may be limited by medical knowledge and barriers to specialized care access.
Objective
To assess the perception and level of knowledge about PNH among physicians from different specialties in a national context.
Methods
A cross-sectional study was conducted using a structured survey targeting general practitioners, residents, and specialists. The questionnaire assessed six dimensions: signs and symptoms, pathophysiology, diagnosis, treatment, prognosis, and access to diagnosis and treatment. Knowledge perception was evaluated, and objective questions were included to measure the level of knowledge in each dimension. The internal consistency of the instrument was high, with an adequate Cronbach's alpha.
Results
Two hundred eighteen responses were received from a calculated sample of 355. Most surveyed physicians perceived their knowledge of PNH as low. However, objective knowledge assessment suggests a gap between general practitioners and specialists, with an overall knowledge level considered moderate. Hematologists demonstrated a high level of knowledge, but access barriers to specialized care may contribute to delayed diagnoses.
Conclusion
Using a standardized instrument, it is demonstrated that knowledge gaps regarding PNH across different levels of medical training could affect the early recognition of the disease. Therefore, it is recommended to strengthen medical education on PNH and improve strategies for access to specialized care to optimize disease management.
{"title":"Survey on knowledge and perception of paroxysmal nocturnal hemoglobinuria among Colombian physicians: A cross-sectional study","authors":"Víctor Hugo Nieto Estrada , José Rojas-Suarez , Diana Borré-Naranjo , Jheremy Reyes , Anacaona Martinez del Valle","doi":"10.1016/j.acci.2025.04.006","DOIUrl":"10.1016/j.acci.2025.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease with severe clinical manifestations, for which diagnosis and treatment may be limited by medical knowledge and barriers to specialized care access.</div></div><div><h3>Objective</h3><div>To assess the perception and level of knowledge about PNH among physicians from different specialties in a national context.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using a structured survey targeting general practitioners, residents, and specialists. The questionnaire assessed six dimensions: signs and symptoms, pathophysiology, diagnosis, treatment, prognosis, and access to diagnosis and treatment. Knowledge perception was evaluated, and objective questions were included to measure the level of knowledge in each dimension. The internal consistency of the instrument was high, with an adequate Cronbach's alpha.</div></div><div><h3>Results</h3><div>Two hundred eighteen responses were received from a calculated sample of 355. Most surveyed physicians perceived their knowledge of PNH as low. However, objective knowledge assessment suggests a gap between general practitioners and specialists, with an overall knowledge level considered moderate. Hematologists demonstrated a high level of knowledge, but access barriers to specialized care may contribute to delayed diagnoses.</div></div><div><h3>Conclusion</h3><div>Using a standardized instrument, it is demonstrated that knowledge gaps regarding PNH across different levels of medical training could affect the early recognition of the disease. Therefore, it is recommended to strengthen medical education on PNH and improve strategies for access to specialized care to optimize disease management.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 468-475"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842252","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 : 2025-07-01DOI: 10.1016/j.acci.2025.05.002
Andrés Esteban Salazar Molina , Héctor Hernández Garcés , Omar Patricio Bustamante Celleri , Marco Antonio Carangui Urgilés
Objectives
To evaluate the benefits and risks of conservative versus liberal oxygen therapy in in patients with IMV.
Design
Systematic review with meta-analysis and TSA of RCTs published in MEDLINE/PubMed, Web of Science, SciELO, Embase, Scopus, and the Cochrane Central of Register of Clinical trials, through December 2024. No language restrictions.
Population
Patients admitted to ICU with IMV, older than 18 years.
Intervention
Conservative oxygen therapy: SatO2 88–92% and/or PaO2 between 55–80 mmHg; Liberal oxygen therapy: SatO2 ≥ 94% or PaO2 ≥ 90 mmHg.
Measurements
Overall mortality, in-ICU mortality, at 28 and 90 days, length of stay, ventilator-free days, and complications.
Results
We included 10 RCTs (n = 5254), all of which were classified as low risk of bias, except for one. Meta-analysis and TSA showed no differences between conservative and liberal strategies regarding overall mortality (RR 0.98; 95% CI 0.96–1.01; p = 0.29, I2: 0%), ICU (RR 0.99; 95% CI 0.96–1.02; p = 0.41, I2: 7%), 28-day (RR 0.98; 95% CI 0.95–1.02; p = 0.4, I2: 0%), or 90-day (RR 0.97; 95% CI 0.94–1.01; p = 0.17, I2: 0%). We found no differences regarding hospital and ICU stay, ventilator-free days, or complications. Subgroup and sensitivity analysis did not modify the results.
Conclusion
We found no beneficial or harmful effects when comparing a conservative versus a liberal strategy with respect to all-cause mortality in adult IMV patients. Other clinical outcomes of interest were also comparable between the two groups.
目的评价IMV患者保守氧疗与自由氧疗的获益和风险。采用meta分析和TSA对截至2024年12月发表在MEDLINE/PubMed、Web of Science、SciELO、Embase、Scopus和Cochrane Central of Register of Clinical trials上的随机对照试验进行系统评价。没有语言限制。年龄大于18岁的IMV患者入住ICU。保守氧疗：SatO2 88-92%和/或PaO2 55 - 80mmhg；自由氧治疗：SatO2≥94%或PaO2≥90mmhg。总死亡率、28天和90天icu内死亡率、住院时间、无呼吸机天数和并发症。结果纳入10项rct (n = 5254)，除1项外均为低偏倚风险。meta分析和TSA显示保守和自由策略在总死亡率方面没有差异(RR 0.98；95% ci 0.96-1.01；p = 0.29, I2: 0%), ICU (RR 0.99；95% ci 0.96-1.02；p = 0.41, I2: 7%)， 28天(RR 0.98；95% ci 0.95-1.02；p = 0.4, I2: 0%)或90天(RR 0.97；95% ci 0.94-1.01；p = 0.17, I2: 0%)。我们发现在住院和ICU住院时间、无呼吸机天数或并发症方面没有差异。亚组分析和敏感性分析没有改变结果。结论：在成人IMV患者的全因死亡率方面，我们没有发现保守治疗与自由治疗的有益或有害影响。两组之间的其他临床结果也具有可比性。
{"title":"Oxigenoterapia conservadora vs. liberal en pacientes críticos con ventilación mecánica invasiva. Revisión sistemática y metaanálisis","authors":"Andrés Esteban Salazar Molina , Héctor Hernández Garcés , Omar Patricio Bustamante Celleri , Marco Antonio Carangui Urgilés","doi":"10.1016/j.acci.2025.05.002","DOIUrl":"10.1016/j.acci.2025.05.002","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the benefits and risks of conservative versus liberal oxygen therapy in in patients with IMV.</div></div><div><h3>Design</h3><div>Systematic review with meta-analysis and TSA of RCTs published in MEDLINE/PubMed, Web of Science, SciELO, Embase, Scopus, and the Cochrane Central of Register of Clinical trials, through December 2024. No language restrictions.</div></div><div><h3>Population</h3><div>Patients admitted to ICU with IMV, older than 18 years.</div></div><div><h3>Intervention</h3><div>Conservative oxygen therapy: SatO2 88–92% and/or PaO2 between 55–80<!--> <!-->mmHg; Liberal oxygen therapy: SatO2 ≥<!--> <!-->94% or PaO2 ≥<!--> <!-->90<!--> <!-->mmHg.</div></div><div><h3>Measurements</h3><div>Overall mortality, in-ICU mortality, at 28 and 90 days, length of stay, ventilator-free days, and complications.</div></div><div><h3>Results</h3><div>We included 10 RCTs (n<!--> <!-->=<!--> <!-->5254), all of which were classified as low risk of bias, except for one. Meta-analysis and TSA showed no differences between conservative and liberal strategies regarding overall mortality (RR 0.98; 95% CI 0.96–1.01; p<!--> <!-->=<!--> <!-->0.29, I2: 0%), ICU (RR 0.99; 95% CI 0.96–1.02; p<!--> <!-->=<!--> <!-->0.41, I2: 7%), 28-day (RR 0.98; 95% CI 0.95–1.02; p<!--> <!-->=<!--> <!-->0.4, I2: 0%), or 90-day (RR 0.97; 95% CI 0.94–1.01; p<!--> <!-->=<!--> <!-->0.17, I2: 0%). We found no differences regarding hospital and ICU stay, ventilator-free days, or complications. Subgroup and sensitivity analysis did not modify the results.</div></div><div><h3>Conclusion</h3><div>We found no beneficial or harmful effects when comparing a conservative versus a liberal strategy with respect to all-cause mortality in adult IMV patients. Other clinical outcomes of interest were also comparable between the two groups.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 476-485"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842253","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 : 2025-07-01DOI: 10.1016/j.acci.2025.04.002
Matías Agustín Atencio , Joaquín Andrés Luini , Agostina Dana Villa , Romina Ayelén Hegel , Santiago Hiebaum , Agustín Yañez Schmidt , Iñaki Manuel Dopazo Danieli , Lucas Gonzalo Duran
Gastrointestinal bleeding (GIB) has been associated with corticosteroid use, leading to the routine implementation of gastric prophylaxis in critically ill patients. However, the evidence remains contradictory. This systematic review of systematic reviews (SR) and meta-analysis aimed to synthesize the available evidence regarding the risk of GIB in critically ill patients treated with corticosteroids.
Systematic reviews published between 2019 and 2024 were identified, including studies that evaluated patients over 16 years old in critical condition receiving corticosteroids. Out of 365 retrieved studies, 7 met the inclusion criteria. The quality of the evidence was assessed using AMSTAR II. Additionally, a de novo meta-analysis was conducted using RevMan 5.4 to integrate outcomes related to GIB risk, intensive care unit (ICU) mortality, and hospital length of stay.
Regarding GIB, the analysis included 53 randomized controlled trials (RCTs) with a total of 29,701 participants, showing a global relative risk (RR) of 1.13 (95% CI: 0.97-1.33). For mortality, the analysis of 23 RCTs with 4,596 participants indicated an RR of 0.85 (95% CI: 0.79-0.92), with high certainty of evidence. Concerning ICU length of stay, 22 RCTs with 4,635 participants reported a mean difference of −0.66 days (95% CI: −1.69 to 0.37).
This review indicates that corticosteroid use in critically ill patients is not associated with a significant increase in GIB risk. Furthermore, corticosteroids have been shown to reduce ICU mortality, reinforcing their role in the management of critically ill patients.
{"title":"Riesgo de hemorragia gastrointestinal asociado al uso de corticoides en los pacientes críticos: revisión de revisiones sistemáticas y metaanálisis","authors":"Matías Agustín Atencio , Joaquín Andrés Luini , Agostina Dana Villa , Romina Ayelén Hegel , Santiago Hiebaum , Agustín Yañez Schmidt , Iñaki Manuel Dopazo Danieli , Lucas Gonzalo Duran","doi":"10.1016/j.acci.2025.04.002","DOIUrl":"10.1016/j.acci.2025.04.002","url":null,"abstract":"<div><div>Gastrointestinal bleeding (GIB) has been associated with corticosteroid use, leading to the routine implementation of gastric prophylaxis in critically ill patients. However, the evidence remains contradictory. This systematic review of systematic reviews (SR) and meta-analysis aimed to synthesize the available evidence regarding the risk of GIB in critically ill patients treated with corticosteroids.</div><div>Systematic reviews published between 2019 and 2024 were identified, including studies that evaluated patients over 16 years old in critical condition receiving corticosteroids. Out of 365 retrieved studies, 7 met the inclusion criteria. The quality of the evidence was assessed using AMSTAR II. Additionally, a d<em>e novo</em> meta-analysis was conducted using RevMan 5.4 to integrate outcomes related to GIB risk, intensive care unit (ICU) mortality, and hospital length of stay.</div><div>Regarding GIB, the analysis included 53 randomized controlled trials (RCTs) with a total of 29,701 participants, showing a global relative risk (RR) of 1.13 (95% CI: 0.97-1.33). For mortality, the analysis of 23 RCTs with 4,596 participants indicated an RR of 0.85 (95% CI: 0.79-0.92), with high certainty of evidence. Concerning ICU length of stay, 22 RCTs with 4,635 participants reported a mean difference of −0.66 days (95% CI: −1.69 to 0.37).</div><div>This review indicates that corticosteroid use in critically ill patients is not associated with a significant increase in GIB risk. Furthermore, corticosteroids have been shown to reduce ICU mortality, reinforcing their role in the management of critically ill patients.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 519-530"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842258","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 : 2025-07-01DOI: 10.1016/j.acci.2025.03.002
Juan Santiago Serna-Trejos , Stefanya Geraldine Bermúdez-Moyano , Carlos Andrés Castro-Galvis , Maria Alejandra Londoño-Osorio , Laura Catalina Rodríguez-Fonseca , David Altman-Salcedo , Virginia Zarama-Córdoba
The insertion of central vascular access is crucial in 75% of patients in intensive care units for the administration of venotoxic drugs, hemodynamic monitoring, and parenteral nutrition. Common insertion sites include the internal jugular vein, the subclavian or proximal axillary vein, and the femoral vein, each with specific risks of immediate and delayed complications. Real-time ultrasound guidance has been noted for reducing immediate complications during central venous catheter insertion, although its use is limited by equipment availability and the perception of a longer procedure. Direct ultrasound guidance is superior to indirect guidance in reducing mechanical complications, though its impact on infection rates remains debated. Infraclavicular insertion is recommended to minimize delayed complications, though its use is less frequent due to perceived technical difficulty and the risk of pneumothorax. A pre-procedural ultrasound analysis is advised to detect anatomical anomalies and select the optimal site for catheterization. Subsequently, a vascular, cardiac, pleural, and pulmonary ultrasound analysis helps detect and prevent catheter malposition and pleuropulmonary complications. For subclavian vein cannulation, real-time ultrasound guidance has shown higher success rates and fewer complications, although the certainty of the evidence is limited. Two-dimensional ultrasound for the internal jugular vein significantly reduces complications and improves first-attempt success rates. Additionally, ultrasound guidance improves success rates and reduces complications in arterial and peripheral venous cannulation, proving to be safer and more efficient for hemodialysis catheter insertion compared to methods based on anatomical landmarks.
{"title":"Utilidad del uso de la ultrasonografía para los accesos vasculares en los diferentes escenarios de la atención en salud: una revisión de alcance","authors":"Juan Santiago Serna-Trejos , Stefanya Geraldine Bermúdez-Moyano , Carlos Andrés Castro-Galvis , Maria Alejandra Londoño-Osorio , Laura Catalina Rodríguez-Fonseca , David Altman-Salcedo , Virginia Zarama-Córdoba","doi":"10.1016/j.acci.2025.03.002","DOIUrl":"10.1016/j.acci.2025.03.002","url":null,"abstract":"<div><div>The insertion of central vascular access is crucial in 75% of patients in intensive care units for the administration of venotoxic drugs, hemodynamic monitoring, and parenteral nutrition. Common insertion sites include the internal jugular vein, the subclavian or proximal axillary vein, and the femoral vein, each with specific risks of immediate and delayed complications. Real-time ultrasound guidance has been noted for reducing immediate complications during central venous catheter insertion, although its use is limited by equipment availability and the perception of a longer procedure. Direct ultrasound guidance is superior to indirect guidance in reducing mechanical complications, though its impact on infection rates remains debated. Infraclavicular insertion is recommended to minimize delayed complications, though its use is less frequent due to perceived technical difficulty and the risk of pneumothorax. A pre-procedural ultrasound analysis is advised to detect anatomical anomalies and select the optimal site for catheterization. Subsequently, a vascular, cardiac, pleural, and pulmonary ultrasound analysis helps detect and prevent catheter malposition and pleuropulmonary complications. For subclavian vein cannulation, real-time ultrasound guidance has shown higher success rates and fewer complications, although the certainty of the evidence is limited. Two-dimensional ultrasound for the internal jugular vein significantly reduces complications and improves first-attempt success rates. Additionally, ultrasound guidance improves success rates and reduces complications in arterial and peripheral venous cannulation, proving to be safer and more efficient for hemodialysis catheter insertion compared to methods based on anatomical landmarks.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 502-511"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842256","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}
Porphyria is a disease caused by a retrograde accumulation of precursors of the HEM group, which is essential for the hemoglobin funtion; generating organic toxicity. Acute hepatic porphyrias are characterized by neurological involvement, the most frequent is the acute intermittent porphyria. The neurological symptoms are explained by the toxicity induced by the enzyme aminolevulinic acid (ALA) and the critical deficiency of the HEM group. The clinical presentation is varied, as is the neurological onset; hence the complexity in its diagnosis, which must be early and timely.
{"title":"Porfiria neuropática, más allá que un reto diagnóstico. Reporte de caso y revisión de la literatura","authors":"Tatiana Patricia Buitrago-González , Cinthya Katerine Galindo González , Eder Cáceres , Iván Mauricio González Zambrano","doi":"10.1016/j.acci.2025.02.003","DOIUrl":"10.1016/j.acci.2025.02.003","url":null,"abstract":"<div><div>Porphyria is a disease caused by a retrograde accumulation of precursors of the HEM group, which is essential for the hemoglobin funtion; generating organic toxicity. Acute hepatic porphyrias are characterized by neurological involvement, the most frequent is the acute intermittent porphyria. The neurological symptoms are explained by the toxicity induced by the enzyme aminolevulinic acid (ALA) and the critical deficiency of the HEM group. The clinical presentation is varied, as is the neurological onset; hence the complexity in its diagnosis, which must be early and timely.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 564-570"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842261","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 : 2025-07-01DOI: 10.1016/j.acci.2025.05.003
Pablo Mattos Navarro , Rosaura Caron Estrada
Introduction
Invasive mechanical ventilation is essential for children with severe respiratory failure but increases the risk of infections due to exposure to pathogenic microorganisms. There are 2 main humidification technologies: heated humidifiers and heat and moisture exchangers. Although some studies suggest that the latter may reduce respiratory infections, the results are inconclusive, especially in children and infants.
Objective
To evaluate bacterial exposure and antibiotic resistance profile in mechanically ventilated pediatric patients using heated humidifiers and heat and moisture exchangers.
Methods
Descriptive cross-sectional study between 2016 to 2023, of 1920 endotracheal cultures taken after 48 hours of intubation in mechanically ventilated pediatric patients and classified according to the type of humidifier. The frequency and resistance profile of the identified bacteria were determined.
Results
The percentage of positivity and the most frequently identified bacterial species were the same in both groups. The strains from heated humidifiers showed greater antibiotic resistance, 56% of which presented only 1 or 2 therapeutic options, compared to 28% in the group of heat and humidity exchangers. In addition, 50% of the strains in the heat and humidity exchangers had 4 or more therapeutic options, compared to 39% in the heat exchanger group.
Conclusions
No significant differences in bacterial exposure were found between the 2 technologies. However, heated humidifier strains showed higher antibiotic resistance, suggesting a higher potential risk of infections with limited therapeutic options.
{"title":"Resistencia antibiótica y exposición bacteriana de pacientes pediátricos en ventilación mecánica con humidificadores térmicos e intercambiadores de calor y humedad","authors":"Pablo Mattos Navarro , Rosaura Caron Estrada","doi":"10.1016/j.acci.2025.05.003","DOIUrl":"10.1016/j.acci.2025.05.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Invasive mechanical ventilation is essential for children with severe respiratory failure but increases the risk of infections due to exposure to pathogenic microorganisms. There are 2<!--> <!-->main humidification technologies: heated humidifiers and heat and moisture exchangers. Although some studies suggest that the latter may reduce respiratory infections, the results are inconclusive, especially in children and infants.</div></div><div><h3>Objective</h3><div>To evaluate bacterial exposure and antibiotic resistance profile in mechanically ventilated pediatric patients using heated humidifiers and heat and moisture exchangers.</div></div><div><h3>Methods</h3><div>Descriptive cross-sectional study between 2016 to 2023, of 1920 endotracheal cultures taken after 48<!--> <!-->hours of intubation in mechanically ventilated pediatric patients and classified according to the type of humidifier. The frequency and resistance profile of the identified bacteria were determined.</div></div><div><h3>Results</h3><div>The percentage of positivity and the most frequently identified bacterial species were the same in both groups. The strains from heated humidifiers showed greater antibiotic resistance, 56% of which presented only 1 or 2 therapeutic options, compared to 28% in the group of heat and humidity exchangers. In addition, 50% of the strains in the heat and humidity exchangers had 4 or more therapeutic options, compared to 39% in the heat exchanger group.</div></div><div><h3>Conclusions</h3><div>No significant differences in bacterial exposure were found between the 2<!--> <!-->technologies. However, heated humidifier strains showed higher antibiotic resistance, suggesting a higher potential risk of infections with limited therapeutic options.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 486-494"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842254","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 : 2025-07-01DOI: 10.1016/j.acci.2025.05.005
Jairo Andres Renteria-Roa , Ricardo Ernesto Salazar Noguera , Antonio Isac Aparicio Negrete , Alejandra Bedoya Uribe , Danny Steven Pantoja Rojas , Andrés Felipe Palacio Sánchez
Background
Tuberculosis (TB) remains a major contributor to morbidity and mortality, particularly among critically ill patients. Identifying clinical predictors of mortality in the intensive care unit (ICU) may guide early interventions and improve outcomes. This study aimed to assess the association between multiple clinical variables and 30-day mortality in patients with severe TB admitted to the ICU.
Materials and Methods
This was a single-center retrospective cohort study including adult patients with microbiologically confirmed severe TB admitted to the ICU between 2015 and 2022. Patients with COVID-19, unconfirmed TB diagnosis, or incomplete clinical records were excluded by the investigators. A total of 99 participants were included for analysis. Sociodemographic and clinical variables, ICU complications, and 30-day mortality were assessed using descriptive statistics, bivariate comparisons, and multivariable logistic regression. The study protocol was approved by the institutional ethics committee and conducted in accordance with the Declaration of Helsinki.
Results
Among 1,663 TB patients, 15% required ICU admission. Ninety-nine patients met the inclusion criteria, with a 30-day mortality rate of 47%. Compared to survivors, non-survivors had higher rates of comorbidities (85 vs. 60%; P<.01), septic shock (91 vs. 28%; P<.001), mechanical ventilation, renal replacement therapy, acute respiratory distress syndrome (ARDS), elevated APACHE II scores (median 20 vs. 12; P<.01), higher heart rate, and increased lactate levels. In bivariate analysis, all variables except multilobar pneumonia and PaO2/FiO2 ratio were significantly associated with mortality. In the multivariable model, only septic shock (adjusted OR: 18.92; 95% CI: 4.9-72.9), comorbidities (adjusted OR: 4.73; 95% CI: 1.26-17.7), and APACHE II score (adjusted OR: 1.14; 95% CI: 1.03-1.24) remained independent predictors of death.
Conclusion
Severe TB in critically ill patients is associated with high 30-day mortality. Septic shock, the presence of comorbidities, and elevated APACHE II scores were identified as independent risk factors. Early recognition and individualized management of these factors may improve clinical outcomes in this high-risk population.
结核病（TB）仍然是造成发病率和死亡率的主要因素，特别是在危重患者中。确定重症监护病房（ICU）死亡率的临床预测因素可以指导早期干预并改善结果。本研究旨在评估重症监护病房重症结核病患者30天死亡率与多个临床变量之间的关系。材料和方法这是一项单中心回顾性队列研究，纳入了2015年至2022年间ICU住院的微生物学证实的成年重症结核病患者。研究人员排除了COVID-19患者、未确诊的结核病诊断或不完整的临床记录。共纳入99名参与者进行分析。使用描述性统计、双变量比较和多变量逻辑回归评估社会人口统计学和临床变量、ICU并发症和30天死亡率。研究方案由机构伦理委员会批准，并根据赫尔辛基宣言进行。结果1663例结核病患者中，15%的患者需要ICU治疗。99例患者符合纳入标准，30天死亡率为47%。与幸存者相比，非幸存者的合并症发生率更高(85% vs. 60%；P<.01)，感染性休克(91比28%；P<.001)、机械通气、肾脏替代治疗、急性呼吸窘迫综合征（ARDS）、APACHE II评分升高(中位数20 vs. 12；P<.01)，心率加快，乳酸水平升高。在双变量分析中，除多叶性肺炎和PaO2/FiO2比值外，所有变量均与死亡率显著相关。在多变量模型中，只有感染性休克(调整OR: 18.92；95% CI: 4.9-72.9)，合并症(调整OR: 4.73；95% CI: 1.26-17.7)和APACHE II评分(调整OR: 1.14；95% CI: 1.03-1.24)仍然是独立的死亡预测因子。结论重症结核患者30天死亡率较高。脓毒性休克、合并症的存在和APACHE II评分升高被认为是独立的危险因素。这些因素的早期识别和个体化管理可能会改善这一高危人群的临床结果。
{"title":"Características y desenlaces asociados con la mortalidad en la tuberculosis grave en cuidados intensivos: estudio de una cohorte retrospectiva","authors":"Jairo Andres Renteria-Roa , Ricardo Ernesto Salazar Noguera , Antonio Isac Aparicio Negrete , Alejandra Bedoya Uribe , Danny Steven Pantoja Rojas , Andrés Felipe Palacio Sánchez","doi":"10.1016/j.acci.2025.05.005","DOIUrl":"10.1016/j.acci.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a major contributor to morbidity and mortality, particularly among critically ill patients. Identifying clinical predictors of mortality in the intensive care unit (ICU) may guide early interventions and improve outcomes. This study aimed to assess the association between multiple clinical variables and 30-day mortality in patients with severe TB admitted to the ICU.</div></div><div><h3>Materials and Methods</h3><div>This was a single-center retrospective cohort study including adult patients with microbiologically confirmed severe TB admitted to the ICU between 2015 and 2022. Patients with COVID-19, unconfirmed TB diagnosis, or incomplete clinical records were excluded by the investigators. A total of 99 participants were included for analysis. Sociodemographic and clinical variables, ICU complications, and 30-day mortality were assessed using descriptive statistics, bivariate comparisons, and multivariable logistic regression. The study protocol was approved by the institutional ethics committee and conducted in accordance with the Declaration of Helsinki.</div></div><div><h3>Results</h3><div>Among 1,663 TB patients, 15% required ICU admission. Ninety-nine patients met the inclusion criteria, with a 30-day mortality rate of 47%. Compared to survivors, non-survivors had higher rates of comorbidities (85 vs. 60%; <em>P</em><.01), septic shock (91 vs. 28%; <em>P</em><.001), mechanical ventilation, renal replacement therapy, acute respiratory distress syndrome (ARDS), elevated APACHE II scores (median 20 vs. 12; <em>P</em><.01), higher heart rate, and increased lactate levels. In bivariate analysis, all variables except multilobar pneumonia and PaO<sub>2</sub>/FiO<sub>2</sub> ratio were significantly associated with mortality. In the multivariable model, only septic shock (adjusted OR: 18.92; 95% CI: 4.9-72.9), comorbidities (adjusted OR: 4.73; 95% CI: 1.26-17.7), and APACHE II score (adjusted OR: 1.14; 95% CI: 1.03-1.24) remained independent predictors of death.</div></div><div><h3>Conclusion</h3><div>Severe TB in critically ill patients is associated with high 30-day mortality. Septic shock, the presence of comorbidities, and elevated APACHE II scores were identified as independent risk factors. Early recognition and individualized management of these factors may improve clinical outcomes in this high-risk population.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 3","pages":"Pages 548-558"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842262","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}
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