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Department of Critical Care Hospital San Juan del Río
From ANDROMEDA-SHOCK 1 to ANDROMEDA-SHOCK 2, capillary refill time evolved from a bedside sign to a personalised, physiology-based resuscitation target with direct implications for clinical practice and ICU organisation. Introduction The evolution of haemodynamic resuscitation in septic shock reflects the identity of critical care as a field that balances protocolised pathways wi1
READ MORENutritional support is vital in critical care, yet optimal timing, dose, and composition are debated. Guidelines often conflict with recent trials showing that even lower early goals versus aggressive or early escalating dose may be harmful or not relevant. This review synthesises current evidence, highlighting guideline–trial discrepancies and proposing phase-specific strategies for ICU manage1
READ MORETraumatic rhabdomyolysis is a clinical and biochemical syndrome frequently encountered in the intensive care unit, characterised by skeletal muscle necrosis and the release of intracellular components such as myoglobin, creatine kinase, and electrolytes into the bloodstream. Trauma-induced muscle injury may result from crush injuries, compartment syndrome, prolonged immobilisation, or severe bu1
READ MOREThe management of acute respiratory distress syndrome (ARDS) in traumatic brain injury (TBI) patients presents unique challenges due to the need for lung-protective ventilation while maintaining cerebral perfusion. This article examines optimal ventilation strategies, oxygenation targets, fluid management, and adjunctive therapies to balance pulmonary and neurological outcomes in critically ill1
READ MORENon-invasive ventilation is extensively employed in the management of acute hypoxaemic and hypercapnic respiratory failure, offering a potential means to circumvent intubation in carefully selected patients under vigilant supervision. Non-Invasive Ventilation Non-invasive ventilation (NIV) represents a respiratory support strategy designed to alleviate respiratory distress
READ MOREThis article will address current and controversial topics regarding early mobilisation and respiratory therapy in critically ill patients in the Intensive Care Unit (ICU). We will explore the implications, challenges, and potential benefits related to these interventions, highlighting the need for ongoing research and discussion in this evolving field. Introduction Holistic
READ MORECorticosteroids are commonly used drugs in multiple diseases and conditions of critically ill patients. In this article, we review the pharmacology of corticosteroids and provide recommendations for their use in the ICU based on the best available evidence. Corticosteroids: Pharmacology and General Aspects Corticosteroids are hormones synthesised in the adrenal cortex from c
READ MOREIn the ICU, providing better care with less is the holy grail. This mnemonic tries to resume a list of the key interventions for human, evidence-based and patient-centred care. Background In 2005, Prof Jean-Louis Vincent introduced the mnemonic "FAST HUG," advocating for a comprehensive approach to patient care encompassing seven key components: Feeding, Analgesia, Sedation,
READ MOREWhile intravenous fluids have traditionally been a routine treatment for most critically ill patients, many severe pathologies now suggest a preference for conservative fluid therapy over liberal fluid administration. Introduction Intravenous fluid resuscitation began in 1832 during the cholera pandemic, improving intravascular volume and electrolyte recovery in patients with sever1
READ MOREKidney Replacement Therapy is a commonly used therapeutic strategy in the intensive care unit for patients who develop Acute Kidney Injury or who already have a diagnosis of chronic kidney disease. ICU staff should know when to use it and which type is most suitable for the circumstances. Epidemiology and Outcomes of AKI Acute kidney injury (AKI) is a common complication in critica1
READ MOREPreeclampsia is a complex syndrome whose complications bear an impact on perinatal morbidity and mortality. Angiogenic biomarkers may significantly impact both the decision to admit patients and risk stratification and may also help guide patient management and level of care. Preeclampsia is one of the main causes of maternal and foetal morbimortality, with a global incidence of 3-5%, and1
READ MOREUltrasonographic assessment of the neck vessels in critically ill patients contributes to rapid and non-invasive management of fluids to evaluate responsiveness and tolerance and blood volume status. Introduction There are multiple ways to evaluate the responsiveness and tolerance to IV fluids, as well as venous congestion, in critically ill patients. For these purposes, 1
READ MORESevere infections by antibiotic resistant gram-negative bacteria are frequent in ICU patients. They are associated with high morbidity and mortality. Introduction Bacterial infections in patients hospitalised in the Intensive Care Unit (ICU) are frequent, and they elicit an increase in morbidity and mortality. The emerging development of antibiotic resistance in gram-negative ba1
READ MOREA Practical Approach for Intensivists A practical approach to analgesia, sedation and neuromuscular blockade of critically ill patients and a discussion on potential benefits, adverse effects and current professional international recommendations. Introduction Patients hospitalised in the Intensive Care Unit (ICU) are naturally prone to experience pain. They may require administration1
READ MOREAn overview of the haemodynamic management of patients in septic shock and strategies for detection of haemodynamic changes and appropriate therapeutic action to improve the prognosis of these patients. Introduction Sepsis is one of the main causes of admission to the Intensive Care Unit (ICU). It is defined as a life-threatening organ dysfunction, caused by dysregulated host response1
READ MOREPulmonary embolism is a reason for admission to the Intensive Care Unit and this complication in hospitalised patients is associated with high morbidity and mortality. The identification and management of pulmonary embolism is a challenge for doctors. Introduction Pulmonary Embolism (PE) is the third c ardiovascular cause of death since its clinical expressions in critical patient1
READ MOREClostridioides difficile (C. difficile) infection is a potentially serious complication in critical patients admitted to the Intensive Care Unit (ICU). It generally occurs because of an alteration of the intestinal microbiota due to antibiotic exposure that must be timely identified and diagnosed to start proper and early management. Clostridioides difficile (C. difficile) i
READ MORECOVID-19 represents a challenge in respiratory therapy. Evidence-guided protective mechanical ventilation is essential to reduce mortality. “Only a set of well-directed strategies can combat a formidable enemy.” Introduction The SARS-CoV-2 virus responsible for the COVID-19 pandemic has a wide variety of clinical presentations. Age is the most important risk factor for critical 1
READ MOREProne position (PP) in awake, non-intubated patients with respiratory failure is a physiology-based ventilatory strategy that improves oxygenation and may decrease the need for intubation and invasive mechanical ventilation (IMV). Introduction During the pandemic caused by the SARS-CoV-2 virus, which produces coronavirus disease 2019 (COVID-19), prone positioning (PP) has been1
READ MOREElderly patients have damaging and serious complications when they acquire SARS-CoV2 infection. It is thus important to consider this particular age group for better management of COVID-19. The gradual reversal of the population pyramid that has developed in recent decades has resulted in older adults being mostly affected in a pandemic situation. Senior people are the defencele1
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