Pub Date : 2025-01-01DOI: 10.1016/j.acci.2024.08.003
Santiago Sierra-Castillo , David Aristizábal-Colorado , Danilo Weir-Restrepo , Alin Abreu-Lomba , Jairo A. Gandara-Ricardo
Thyroid storm is an endocrine emergency that can lead to multiorgan dysfunction and death. Its etiology may vary, but when induced by amiodarone, it poses challenges in both diagnosis and clinical management. The relationship between amiodarone and thyroid function can cause hypothyroidism in up to 25% of cases and hyperthyroidism in up to 10% of cases. The case of a 68-year-old woman who presented with refractory atrial fibrillation to amiodarone treatment, subsequently developing an amiodarone-induced thyroid storm, is described. Despite conventional first-line antiarrhythmic management, she experienced cardiogenic shock and multiorgan failure. Following antithyroid therapy implementation, the patient exhibited a notable clinical improvement and progressive stabilization. The challenges in the diagnosis and management of this patient are discussed.
{"title":"Corazón, amiodarona y glándula tiroides: la tormenta perfecta. A propósito de un caso","authors":"Santiago Sierra-Castillo , David Aristizábal-Colorado , Danilo Weir-Restrepo , Alin Abreu-Lomba , Jairo A. Gandara-Ricardo","doi":"10.1016/j.acci.2024.08.003","DOIUrl":"10.1016/j.acci.2024.08.003","url":null,"abstract":"<div><div>Thyroid storm is an endocrine emergency that can lead to multiorgan dysfunction and death. Its etiology may vary, but when induced by amiodarone, it poses challenges in both diagnosis and clinical management. The relationship between amiodarone and thyroid function can cause hypothyroidism in up to 25% of cases and hyperthyroidism in up to 10% of cases. The case of a 68-year-old woman who presented with refractory atrial fibrillation to amiodarone treatment, subsequently developing an amiodarone-induced thyroid storm, is described. Despite conventional first-line antiarrhythmic management, she experienced cardiogenic shock and multiorgan failure. Following antithyroid therapy implementation, the patient exhibited a notable clinical improvement and progressive stabilization. The challenges in the diagnosis and management of this patient are discussed.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 182-187"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610452","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 : 2025-01-01DOI: 10.1016/j.acci.2024.08.010
Esther Cecilia Wilches-Luna , José Julián Bernal-Sánchez , Jenny Marcela Arias Campo , Andrés Fabricio Caballero-Lozada
A series of 5 cases of patients in the Intensive Care Unit (ICU) undergoing measurements of Maximal Inspiratory Muscle Strength (MIP), Diaphragmatic Excursion (DE), and Diaphragm Thickening Fraction (TFdi) is described. These measurements were taken within the first 24 hours of mechanical ventilation (MV) initiation and at 72 hours of ventilatory support.
Inspiratory Muscle Training (IMT) was applied using the Threshold IMT device (Philips Respironics Threshold IMT, Koninklijke Philips N.V.). IMT was conducted twice daily for 7 days, supervised by specialized physiotherapists, with monitoring of physiological parameters. Clinical outcomes for the 5 cases indicate a positive progression in terms of weaning from MV, improvement in muscular strength, and diaphragmatic amplitude.
Aspects related to IMT, results from ultrasonographic measurements, and MIP are described. An increase in MIP was observed in 3 cases (10.5%-34.6%), while 4 cases exhibited an augmentation in TFdi and DE. These findings suggest that IMT may have positive effects on respiratory function in ICU patients.
{"title":"Ultrasonografía diafragmática y presión inspiratoria máxima (PiMáx) en pacientes ventilados que recibieron entrenamiento muscular inspiratorio (EMI): serie de casos","authors":"Esther Cecilia Wilches-Luna , José Julián Bernal-Sánchez , Jenny Marcela Arias Campo , Andrés Fabricio Caballero-Lozada","doi":"10.1016/j.acci.2024.08.010","DOIUrl":"10.1016/j.acci.2024.08.010","url":null,"abstract":"<div><div>A series of 5 cases of patients in the Intensive Care Unit (ICU) undergoing measurements of Maximal Inspiratory Muscle Strength (MIP), Diaphragmatic Excursion (DE), and Diaphragm Thickening Fraction (TFdi) is described. These measurements were taken within the first 24<!--> <!-->hours of mechanical ventilation (MV) initiation and at 72<!--> <!-->hours of ventilatory support.</div><div>Inspiratory Muscle Training (IMT) was applied using the Threshold IMT device (Philips Respironics Threshold IMT, Koninklijke Philips N.V.). IMT was conducted twice daily for 7 days, supervised by specialized physiotherapists, with monitoring of physiological parameters. Clinical outcomes for the 5 cases indicate a positive progression in terms of weaning from MV, improvement in muscular strength, and diaphragmatic amplitude.</div><div>Aspects related to IMT, results from ultrasonographic measurements, and MIP are described. An increase in MIP was observed in 3 cases (10.5%-34.6%), while 4 cases exhibited an augmentation in TFdi and DE. These findings suggest that IMT may have positive effects on respiratory function in ICU patients.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 194-200"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610454","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 : 2025-01-01DOI: 10.1016/j.acci.2024.09.002
M. Natalia Gómez González , Hugo Eduardo Guerrero-Topete , Francisco Javier Perea-Gallardo , María del Carmen Islas Escalante , Pedro Luis González-Carrillo , Sandra Paola Nolazco-Contreras
Introduction
Aneurysmal subarachnoid hemorrhage (aSAH) has a high mortality and elevated risk of disability among survivors. Certain biomarkers function as predictors of poor prognosis and mortality in these patients. However, in most hospitals in Mexico these specific serum biomarkers are not available. The aim is to find accessible, economic and reproducible serum biomarkers.
Objective
To determine whether serum concentrations of leukocytes, platelets, glucose, phosphorus, potassium and lactate are related to poor prognosis and mortality in patients with aSAH.
Material and methods
Observational, descriptive, retrospective, analytical study, conducted from March 2022 to September 2023 in patients admitted to the Intensive Care Unit with aSAH. By means of a non-probabilistic convenience sampling, levels of leukocytes, platelets, glucose, phosphorus, potassium and lactate were obtained at admission and 24 h later. These parameters were correlated with poor prognosis and mortality.
Results
Of 84 patients registered, 18 died (21.4%), 14 presented cerebral infarction (16.7%), 23 neurological sequelae (27.4%). The rest (n = 29) remained without neurological sequelae (34.5%). Lactate levels > 1.55 mmol/L (AUC 0.698; p = 0.005) presented statistical significance at admission, as well as at 24 h with cutoff point > 1.25 mmol/L (AUC 0.743; p < 0.001), followed by leukocyte levels > 8.7 × 10*3 (AUC 0.674; p = 0.01) and platelets < 158 × 10*3 (AUC 0.657; p = 0.02). No biomarker presented significant correlation with prognosis.
Conclusions
In patients with aSAH, lactate values at admission and 24 h later are recommended to predict mortality.
{"title":"Biomarcadores séricos como predictores de mal pronóstico y mortalidad en pacientes con hemorragia subaracnoidea aneurismática en terapia intensiva","authors":"M. Natalia Gómez González , Hugo Eduardo Guerrero-Topete , Francisco Javier Perea-Gallardo , María del Carmen Islas Escalante , Pedro Luis González-Carrillo , Sandra Paola Nolazco-Contreras","doi":"10.1016/j.acci.2024.09.002","DOIUrl":"10.1016/j.acci.2024.09.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) has a high mortality and elevated risk of disability among survivors. Certain biomarkers function as predictors of poor prognosis and mortality in these patients. However, in most hospitals in Mexico these specific serum biomarkers are not available. The aim is to find accessible, economic and reproducible serum biomarkers.</div></div><div><h3>Objective</h3><div>To determine whether serum concentrations of leukocytes, platelets, glucose, phosphorus, potassium and lactate are related to poor prognosis and mortality in patients with aSAH.</div></div><div><h3>Material and methods</h3><div>Observational, descriptive, retrospective, analytical study, conducted from March 2022 to September 2023 in patients admitted to the Intensive Care Unit with aSAH. By means of a non-probabilistic convenience sampling, levels of leukocytes, platelets, glucose, phosphorus, potassium and lactate were obtained at admission and 24<!--> <!-->h later. These parameters were correlated with poor prognosis and mortality.</div></div><div><h3>Results</h3><div>Of 84 patients registered, 18 died (21.4%), 14 presented cerebral infarction (16.7%), 23 neurological sequelae (27.4%). The rest (n<!--> <!-->=<!--> <!-->29) remained without neurological sequelae (34.5%). Lactate levels<!--> <!-->><!--> <!-->1.55<!--> <!-->mmol/L (AUC 0.698; p<!--> <!-->=<!--> <!-->0.005) presented statistical significance at admission, as well as at 24<!--> <!-->h with cutoff point<!--> <!-->><!--> <!-->1.25<!--> <!-->mmol/L (AUC 0.743; p<!--> <!--><<!--> <!-->0.001), followed by leukocyte levels<!--> <!-->><!--> <!-->8.7<!--> <!-->×<!--> <!-->10*3 (AUC 0.674; p<!--> <!-->=<!--> <!-->0.01) and platelets<!--> <!--><<!--> <!-->158<!--> <!-->×<!--> <!-->10*3 (AUC 0.657; p<!--> <!-->=<!--> <!-->0.02). No biomarker presented significant correlation with prognosis.</div></div><div><h3>Conclusions</h3><div>In patients with aSAH, lactate values at admission and 24<!--> <!-->h later are recommended to predict mortality.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 26-34"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610367","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 : 2025-01-01DOI: 10.1016/j.acci.2024.08.007
Angélica María Mendoza Caballero , Ricardo Andrés Sánchez Algarín
Acute disseminated encephalomyelitis (ADEM), belongs to a group of disorders characterized by the acute or subacute appearance of neurological deficits with evidence of inflammatory demyelination of the central nervous system (CNS), is a rare pathology that mainly affects children and young adults., it is considered that 50-80% of cases occur after involvement of the lower respiratory tract, gastrointestinal system or exanthematous disease; The associated infectious agents are viruses. Diagnostic evaluation includes cerebrospinal fluid and neuroimaging studies to evaluate the multifocal brain lesions characteristic of ADEM; Treatment consists of intravenous corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin. This is a 2-year-old male preschooler, who initially presents with respiratory and gastrointestinal symptoms, later with neurological deterioration, presenting seizures characterized by tonic posture that progresses to bilateral clonic movements, poor pupillary response, comatose state, and no response to nociceptive stimuli. and truncal hypotonia, performed brain MRI where extensive lesions involving the supra- and infratentorial white matter were observed, compatible with ADEM. Fortunately, it is a disease with a good prognosis and clinical evolution; however, this case shows that not all patients have a good response to the management established, which leads to the need to establish markers specific to this pathology that allow a diagnosis directed from the moment of suspected diagnosis in order to prevent possible complications and associated neurological sequelae.
{"title":"Encefalomielitis aguda diseminada fulminante en un paciente pediátrico: reporte de caso y revisión de la literatura","authors":"Angélica María Mendoza Caballero , Ricardo Andrés Sánchez Algarín","doi":"10.1016/j.acci.2024.08.007","DOIUrl":"10.1016/j.acci.2024.08.007","url":null,"abstract":"<div><div>Acute disseminated encephalomyelitis (ADEM), belongs to a group of disorders characterized by the acute or subacute appearance of neurological deficits with evidence of inflammatory demyelination of the central nervous system (CNS), is a rare pathology that mainly affects children and young adults., it is considered that 50-80% of cases occur after involvement of the lower respiratory tract, gastrointestinal system or exanthematous disease; The associated infectious agents are viruses. Diagnostic evaluation includes cerebrospinal fluid and neuroimaging studies to evaluate the multifocal brain lesions characteristic of ADEM; Treatment consists of intravenous corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin. This is a 2-year-old male preschooler, who initially presents with respiratory and gastrointestinal symptoms, later with neurological deterioration, presenting seizures characterized by tonic posture that progresses to bilateral clonic movements, poor pupillary response, comatose state, and no response to nociceptive stimuli. and truncal hypotonia, performed brain MRI where extensive lesions involving the supra- and infratentorial white matter were observed, compatible with ADEM. Fortunately, it is a disease with a good prognosis and clinical evolution; however, this case shows that not all patients have a good response to the management established, which leads to the need to establish markers specific to this pathology that allow a diagnosis directed from the moment of suspected diagnosis in order to prevent possible complications and associated neurological sequelae.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 188-193"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610453","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 : 2025-01-01DOI: 10.1016/j.acci.2024.09.003
David Aristizábal-Colorado , Juan Manuel Montoya-Ospina , Alejandro Bejarano-Zuleta , Leopoldo Garces-Villabón , Martin Ocampo-Posada
Dengue is a common entity in Colombia; proof of this is that between the years 2023 and 2024 an increase in cases was reported, these being the years with the highest number of reports to date. Among the atypical manifestations of dengue, myocarditis has been recorded. However, for its definitive diagnosis, in many cases the stability of the patient is required, an aspect that in some cases is difficult to obtain because their conditions may be critical. This work reports the history of a patient who debuted with an acute myocardial infarction with ST segment elevation and presented fulminant myocarditis due to dengue. The main diagnostic methods are summarized with important details to prevent the diagnosis from going unnoticed.
{"title":"Lado oculto del dengue: la amenaza silenciosa de la miocarditis. Revisión corta a propósito de un caso","authors":"David Aristizábal-Colorado , Juan Manuel Montoya-Ospina , Alejandro Bejarano-Zuleta , Leopoldo Garces-Villabón , Martin Ocampo-Posada","doi":"10.1016/j.acci.2024.09.003","DOIUrl":"10.1016/j.acci.2024.09.003","url":null,"abstract":"<div><div>Dengue is a common entity in Colombia; proof of this is that between the years 2023 and 2024 an increase in cases was reported, these being the years with the highest number of reports to date. Among the atypical manifestations of dengue, myocarditis has been recorded. However, for its definitive diagnosis, in many cases the stability of the patient is required, an aspect that in some cases is difficult to obtain because their conditions may be critical. This work reports the history of a patient who debuted with an acute myocardial infarction with ST segment elevation and presented fulminant myocarditis due to dengue. The main diagnostic methods are summarized with important details to prevent the diagnosis from going unnoticed.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 201-206"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610455","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 : 2025-01-01DOI: 10.1016/j.acci.2024.08.009
Jose Correa Guerrero , Jorge Rico Fontalvo , Carmelo Dueñas Castell
In critically ill patients with lung-induced kidney injury or ventilator-induced kidney injury, several factors are described that may contribute to their development. The inflammatory response generated from an injured lung with hypoxemia and hypercapnia producing hemodynamic changes at the renal level with the subsequent drop in glomerular filtration. During mechanical ventilation the above phenomena are usually magnified, the positive intrathoracic pressure and intra-abdominal pressure generated by mechanical ventilation can affect renal hemodynamics, and thus reduce blood flow and glomerular filtration. In addition, a greater inflammatory response triggered by mechanical ventilation, with elevated levels of proinflammatory cytokines, influences acute kidney injury (AKI). Among ventilatory parameters, studies suggest that increases in positive end-expiratory pressure (PEEP) and tidal volume (Vc) and a reduction in compliance of the respiratory system are related to the development of ventilator-induced kidney injury, although there are discrepancies in some findings. As a result of the above, management guidelines have been generated for lung-kidney interaction in critically ill patients with ventilator-induced kidney injury, such as compliance with the KDIGO guidelines; conservative fluid management, monitoring of clinical variables such as serum creatinine, urinary output, ventilatory monitoring with the aim of protective ventilation, and treating complications such as hypotension, venous congestion, right heart failure and intra-abdominal hypertension, as they may contribute to greater kidney dysfunction. The importance of understanding and addressing the interaction between the lungs and kidneys in critically ill patients may improve clinical outcomes.
{"title":"Interacción entre el sistema respiratorio y renal durante la ventilación mecánica","authors":"Jose Correa Guerrero , Jorge Rico Fontalvo , Carmelo Dueñas Castell","doi":"10.1016/j.acci.2024.08.009","DOIUrl":"10.1016/j.acci.2024.08.009","url":null,"abstract":"<div><div>In critically ill patients with lung-induced kidney injury or ventilator-induced kidney injury, several factors are described that may contribute to their development. The inflammatory response generated from an injured lung with hypoxemia and hypercapnia producing hemodynamic changes at the renal level with the subsequent drop in glomerular filtration. During mechanical ventilation the above phenomena are usually magnified, the positive intrathoracic pressure and intra-abdominal pressure generated by mechanical ventilation can affect renal hemodynamics, and thus reduce blood flow and glomerular filtration. In addition, a greater inflammatory response triggered by mechanical ventilation, with elevated levels of proinflammatory cytokines, influences acute kidney injury (AKI). Among ventilatory parameters, studies suggest that increases in positive end-expiratory pressure (PEEP) and tidal volume (Vc) and a reduction in compliance of the respiratory system are related to the development of ventilator-induced kidney injury, although there are discrepancies in some findings. As a result of the above, management guidelines have been generated for lung-kidney interaction in critically ill patients with ventilator-induced kidney injury, such as compliance with the KDIGO guidelines; conservative fluid management, monitoring of clinical variables such as serum creatinine, urinary output, ventilatory monitoring with the aim of protective ventilation, and treating complications such as hypotension, venous congestion, right heart failure and intra-abdominal hypertension, as they may contribute to greater kidney dysfunction. The importance of understanding and addressing the interaction between the lungs and kidneys in critically ill patients may improve clinical outcomes.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 98-105"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610550","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 : 2025-01-01DOI: 10.1016/j.acci.2024.10.006
José Lucas Daza , Omar Eduardo Zapata
Septic shock is a syndrome characterized by tissue hypoperfusion and persistent hypotension that does not respond to fluid supply, and this is secondary to an uncontrolled infection. It is a frequent cause of admission to the intensive care unit and its mortality risk is variable.
The origin of septic shock can have various etiologies and different responsible microorganisms such as bacteria, viruses or fungi, with variable complications depending on the affected parenchyma.
Tissue hypoperfusion is present in patients with septic shock due to several mechanisms that include systemic vasodilation, relative hypovolemia, macro and microcirculatory endothelial dysfunction and low blood pressure with altered global perfusion pressure. Classically, septic shock has been described as a hyperdynamic state, with increased cardiac output and decreased systemic vascular resistance, which makes arterial hypotension in many cases refractory to management with fluids alone. When myocardial depression occurs, which many authors have called septic heart disease, the state of hypoperfusion worsens and increases mortality. From the renal point of view, it generates acute kidney injury, which is one of the main complications associated with septic shock, increasing the risk of mortality, and between 30 and 40% will require renal replacement therapy.
Hemodynamic treatment of septic shock is aimed at maintaining oxygen supply above a critical threshold, while maintaining a mean arterial pressure at a level that allows adequate organ perfusion.
{"title":"Efecto de los vasopresores sobre la función renal y cardíaca en pacientes con shock séptico","authors":"José Lucas Daza , Omar Eduardo Zapata","doi":"10.1016/j.acci.2024.10.006","DOIUrl":"10.1016/j.acci.2024.10.006","url":null,"abstract":"<div><div>Septic shock is a syndrome characterized by tissue hypoperfusion and persistent hypotension that does not respond to fluid supply, and this is secondary to an uncontrolled infection. It is a frequent cause of admission to the intensive care unit and its mortality risk is variable.</div><div>The origin of septic shock can have various etiologies and different responsible microorganisms such as bacteria, viruses or fungi, with variable complications depending on the affected parenchyma.</div><div>Tissue hypoperfusion is present in patients with septic shock due to several mechanisms that include systemic vasodilation, relative hypovolemia, macro and microcirculatory endothelial dysfunction and low blood pressure with altered global perfusion pressure. Classically, septic shock has been described as a hyperdynamic state, with increased cardiac output and decreased systemic vascular resistance, which makes arterial hypotension in many cases refractory to management with fluids alone. When myocardial depression occurs, which many authors have called septic heart disease, the state of hypoperfusion worsens and increases mortality. From the renal point of view, it generates acute kidney injury, which is one of the main complications associated with septic shock, increasing the risk of mortality, and between 30 and 40% will require renal replacement therapy.</div><div>Hemodynamic treatment of septic shock is aimed at maintaining oxygen supply above a critical threshold, while maintaining a mean arterial pressure at a level that allows adequate organ perfusion.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 142-149"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610556","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 : 2025-01-01DOI: 10.1016/j.acci.2024.10.008
Fernanda Ordóñez-Hernández, Jessica Garduño-López, Marcos Antonio Amezcua-Gutiérrez
Introduction
Right ventricular ultrasonography is indicated in patients with chest pain, dyspnea, hypotension, tachycardia, hypoxemia, shock, or respiratory failure. An increasing number of acute and chronic conditions have been associated with RV diastolic dysfunction, including pressure and volume overload pathologies, primary lung disease, ischemic heart disease, congenital heart disease, cardiomyopathies, left ventricular dysfunction (when ventricular interdependence exists), systemic diseases, and the physiological aging process. Other critical situations such as shock, cardiac arrest, mechanical ventilation, and CO2 are also associated with this dysfunction. Echocardiographic variables such as tricuspid annular plane systolic excursion (TAPSE), pulsed Doppler S wave (S′), and fractional area change (FAC) are indicators of RV systolic dysfunction.
Material and methodology
A 6-month observational, descriptive, longitudinal, and prospective study was conducted in the Intensive Care Unit (ICU) of a tertiary care hospital in Mexico City. The RV function of 100 patients was evaluated via echocardiography at ICU admission and 24 hours later, analyzing variables such as TAPSE, S′, FAC, pulmonary artery systolic pressure (PASP), pulmonary mesosystolic notch, and tricuspid regurgitation (TR).
Results
The main admission diagnoses were septic shock (24%), pneumonia and acute respiratory distress syndrome (ARDS) (21%), hypovolemic shock (14%), and congestive heart failure (CHF) (8%). A total of 77% of patients required invasive mechanical ventilation, with 29% presenting RV failure at admission and 28% after 24 hours. Significant associations were found between RV failure and PASP > 40 mmHg, mesosystolic notch, ARDS secondary to community-acquired pneumonia (CAP), CHF, septic shock, hypovolemic shock, PaCO2, and PaO2/FiO2.
Conclusion
One-third of ICU patients exhibit signs of RV failure, and a similar proportion continue to show this diagnosis 24 hours later. ARDS secondary to CAP, CHF, septic shock, hypovolemic shock, PASP > 40 mmHg, mesosystolic notch, PaCO2 > 48 mmHg, and PaO2/FiO2 < 150 mmHg are associated with RV failure. Echocardiographic evaluation from ICU admission is crucial for detecting and preventing severe complications.
{"title":"Descripción ecocardiográfica de la función del ventrículo derecho en los pacientes críticamente enfermos. Revisión de una cohorte","authors":"Fernanda Ordóñez-Hernández, Jessica Garduño-López, Marcos Antonio Amezcua-Gutiérrez","doi":"10.1016/j.acci.2024.10.008","DOIUrl":"10.1016/j.acci.2024.10.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Right ventricular ultrasonography is indicated in patients with chest pain, dyspnea, hypotension, tachycardia, hypoxemia, shock, or respiratory failure. An increasing number of acute and chronic conditions have been associated with RV diastolic dysfunction, including pressure and volume overload pathologies, primary lung disease, ischemic heart disease, congenital heart disease, cardiomyopathies, left ventricular dysfunction (when ventricular interdependence exists), systemic diseases, and the physiological aging process. Other critical situations such as shock, cardiac arrest, mechanical ventilation, and CO2 are also associated with this dysfunction. Echocardiographic variables such as tricuspid annular plane systolic excursion (TAPSE), pulsed Doppler S wave (S′), and fractional area change (FAC) are indicators of RV systolic dysfunction.</div></div><div><h3>Material and methodology</h3><div>A 6-month observational, descriptive, longitudinal, and prospective study was conducted in the Intensive Care Unit (ICU) of a tertiary care hospital in Mexico City. The RV function of 100 patients was evaluated via echocardiography at ICU admission and 24<!--> <!-->hours later, analyzing variables such as TAPSE, S′, FAC, pulmonary artery systolic pressure (PASP), pulmonary mesosystolic notch, and tricuspid regurgitation (TR).</div></div><div><h3>Results</h3><div>The main admission diagnoses were septic shock (24%), pneumonia and acute respiratory distress syndrome (ARDS) (21%), hypovolemic shock (14%), and congestive heart failure (CHF) (8%). A total of 77% of patients required invasive mechanical ventilation, with 29% presenting RV failure at admission and 28% after 24<!--> <!-->hours. Significant associations were found between RV failure and PASP<!--> <!-->> 40<!--> <!-->mmHg, mesosystolic notch, ARDS secondary to community-acquired pneumonia (CAP), CHF, septic shock, hypovolemic shock, PaCO2, and PaO2/FiO2.</div></div><div><h3>Conclusion</h3><div>One-third of ICU patients exhibit signs of RV failure, and a similar proportion continue to show this diagnosis 24<!--> <!-->hours later. ARDS secondary to CAP, CHF, septic shock, hypovolemic shock, PASP<!--> <!-->> 40<!--> <!-->mmHg, mesosystolic notch, PaCO2<!--> <!-->> 48<!--> <!-->mmHg, and PaO2/FiO2 <<!--> <!-->150<!--> <!-->mmHg are associated with RV failure. Echocardiographic evaluation from ICU admission is crucial for detecting and preventing severe complications.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 52-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610370","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 : 2025-01-01DOI: 10.1016/j.acci.2024.10.002
Leonardo Arzayus Patiño , Diego Fernando Muñoz Escudero , Diego Fernando Scarpetta , Henry Mauricio Parada Gereda
Residual pneumothorax after chest surgery is common. Once it has been verified that the chest tube is working correctly, treatment consists of performing respiratory physiotherapy to achieve complete lung expansion. The objective of this study is to demonstrate the use of ultrasonography as an accurate and real-time tool to monitor lung re-expansion and resolve the pleural space in patients with residual pneumothorax after thoracic surgery. Two cases of post-surgical residual pneumothorax are reported, monitored by serial lung ultrasounds before and after respiratory physiotherapy interventions.
Case 1: A 68-year-old female patient developed a right pneumothorax and posterior empyema after the placement of a nasojejunal tube, requiring chest surgery. Ultrasound-guided respiratory physiotherapy was performed, resulting in complete post-surgical lung re-expansion.
Case 2: A 49-year-old male patient, a cyclist, sustained multiple rib and clavicle fractures, leading to a left pneumothorax. Postoperative ultrasound-guided physiotherapy interventions were conducted, resulting in full lung re-expansion.
Ultrasound effectively identified residual pneumothorax and guided respiratory physiotherapy intervention, achieving complete lung re-expansion in both cases. This approach reduced the need for additional radiographs and minimized radiation exposure.
{"title":"Diagnóstico, seguimiento y tratamiento guiado por ultrasonografía del neumotórax residual posquirúrgico. Reporte de caso","authors":"Leonardo Arzayus Patiño , Diego Fernando Muñoz Escudero , Diego Fernando Scarpetta , Henry Mauricio Parada Gereda","doi":"10.1016/j.acci.2024.10.002","DOIUrl":"10.1016/j.acci.2024.10.002","url":null,"abstract":"<div><div>Residual pneumothorax after chest surgery is common. Once it has been verified that the chest tube is working correctly, treatment consists of performing respiratory physiotherapy to achieve complete lung expansion. The objective of this study is to demonstrate the use of ultrasonography as an accurate and real-time tool to monitor lung re-expansion and resolve the pleural space in patients with residual pneumothorax after thoracic surgery. Two cases of post-surgical residual pneumothorax are reported, monitored by serial lung ultrasounds before and after respiratory physiotherapy interventions.</div><div>Case 1: A 68-year-old female patient developed a right pneumothorax and posterior empyema after the placement of a nasojejunal tube, requiring chest surgery. Ultrasound-guided respiratory physiotherapy was performed, resulting in complete post-surgical lung re-expansion.</div><div>Case 2: A 49-year-old male patient, a cyclist, sustained multiple rib and clavicle fractures, leading to a left pneumothorax. Postoperative ultrasound-guided physiotherapy interventions were conducted, resulting in full lung re-expansion.</div><div>Ultrasound effectively identified residual pneumothorax and guided respiratory physiotherapy intervention, achieving complete lung re-expansion in both cases. This approach reduced the need for additional radiographs and minimized radiation exposure.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 207-213"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610636","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 : 2025-01-01DOI: 10.1016/j.acci.2024.09.005
Germán D. Londoño Ruíz, Luis Carlos Triana
Objective
The literature highlights the need to improve education in critical care medicine; Currently in Colombia there is no data that characterizes the personnel who are receiving training in intensive care.
Design
A descriptive study was carried out where the characteristics of intensive care training programs in Colombia were reviewed.
Setting
Colombian medical postgraduate educational system.
Participants
People in intensive care training in Colombia.
Interventions
A survey was applied, and a review of intensive care training programs was carried out.
Main variables of interest
Number of intensive care programs, first and second specialty programs, geographic distribution, base specialties of second specialty programs.
Results
A total of 20 intensive care training programs were found, 55% offered as a second specialty and 45% as first specialty programs. A total of 78 surveys were carried out, obtaining responses from 8 of the 9 cities where programs are offered; The base programs that are doing second specialty training in intensive care were: 38% internal medicine, 29% emergency medicine; Most respondents have access to wellness areas and there was a tendency for second specialty respondents to have more paid work compared to first specialty respondents.
Conclusions
There is a wide range of intensive care programs in the country, with different characteristics among them.
{"title":"Formación del cuidado intensivo en Colombia: la gran encuesta","authors":"Germán D. Londoño Ruíz, Luis Carlos Triana","doi":"10.1016/j.acci.2024.09.005","DOIUrl":"10.1016/j.acci.2024.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>The literature highlights the need to improve education in critical care medicine; Currently in Colombia there is no data that characterizes the personnel who are receiving training in intensive care.</div></div><div><h3>Design</h3><div>A descriptive study was carried out where the characteristics of intensive care training programs in Colombia were reviewed.</div></div><div><h3>Setting</h3><div>Colombian medical postgraduate educational system.</div></div><div><h3>Participants</h3><div>People in intensive care training in Colombia.</div></div><div><h3>Interventions</h3><div>A survey was applied, and a review of intensive care training programs was carried out.</div></div><div><h3>Main variables of interest</h3><div>Number of intensive care programs, first and second specialty programs, geographic distribution, base specialties of second specialty programs.</div></div><div><h3>Results</h3><div>A total of 20 intensive care training programs were found, 55% offered as a second specialty and 45% as first specialty programs. A total of 78 surveys were carried out, obtaining responses from 8 of the 9 cities where programs are offered; The base programs that are doing second specialty training in intensive care were: 38% internal medicine, 29% emergency medicine; Most respondents have access to wellness areas and there was a tendency for second specialty respondents to have more paid work compared to first specialty respondents.</div></div><div><h3>Conclusions</h3><div>There is a wide range of intensive care programs in the country, with different characteristics among them.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 1","pages":"Pages 35-44"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610368","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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