Cuidados críticos en el paciente perioperatorio

CRITICAL CARE & EMERGENGY MEDICINE VOL. 6

Critical Care in the Perioperative Patient

Enviar Artículo

www.doi.org/10.58281/ccem.v6i2.12

Fernando Rodriguez-Solana 1 .

1 Unidad de Cuidados Intensivos. Hospital General Regional 180 Instituto Mexicano del Seguro Social. Jalisco. México.

Abstract

Abstract: The perioperative critically ill patient represents a complex clinical challenge that begins at the first point of medical contact, whether in the prehospital or in-hospital setting. Management requires a comprehensive strategy aimed at hemodynamic, ventilatory, metabolic, and multiorgan optimization, with special emphasis on safety during transport and transition to the intensive care unit (ICU). This review describes current principles in the comprehensive management of the perioperative critically ill patient, emphasizing monitoring strategies, resuscitation, multiorgan support, and complication prevention. Current evidence supports dynamic clinical monitoring complemented by bedside ultrasonography (FATE, RUSH, and VEXUS protocols), prioritizing individualized perfusion targets. Fluid resuscitation should be physiology-driven, avoiding fluid overload and favoring balanced crystalloid solutions. Rational use of vasopressors—particularly norepinephrine—remains the cornerstone of vasoplegic management. Lung-protective ventilation, appropriate glycemic control, restrictive transfusion strategies, and early identification of acute kidney injury using emerging biomarkers contribute to improved outcomes. Early enteral nutrition, multimodal analgesia, and non-pharmacological interventions for delirium prevention are essential components of comprehensive supportive care. The management of the perioperative critically ill patient must be multidisciplinary, dynamic, and individualized, prioritizing continuous bedside clinical assessment and physiology-based decision-making supported by contemporary evidence, with the aim of reducing morbidity and mortality and improving clinical outcomes.

Resumen:

El paciente crítico perioperatorio representa un desafío clínico complejo que inicia desde el primer contacto asistencial, ya sea en el ámbito prehospitalario u hospitalario. Su manejo requiere una estrategia integral orientada a la optimización hemodinámica, ventilatoria, metabólica y multiorgánica, con énfasis en la seguridad durante el traslado y la transición a la unidad de cuidados intensivos (UCI). El objetivo de esta revisión es describir los principios actuales del abordaje integral del paciente crítico en el periodo perioperatorio, enfatizando estrategias de monitorización, resucitación, soporte multiorgánico y prevención de complicaciones. La evidencia actual respalda una monitorización clínica dinámica complementada con ultrasonografía a la cabecera del paciente (protocolos FATE, RUSH y VEXUS), priorizando metas de perfusión individualizadas. La reanimación hídrica debe basarse en la fisiopatología, evitando la sobrecarga de volumen y favoreciendo el uso de soluciones balanceadas, mientras que el uso racional de vasopresores —principalmente la norepinefrina— constituye el pilar fundamental del manejo vasoplégico. Asimismo, la ventilación protectora, el control estricto de la glucemia, las estrategias transfusionales restrictivas y la identificación temprana de la lesión renal aguda mediante biomarcadores emergentes optimizan significativamente los resultados clínicos. Complementariamente, la nutrición enteral precoz, la analgesia multimodal y las intervenciones no farmacológicas destinadas a la prevención del delirio forman parte esencial del soporte integral. El abordaje del paciente crítico perioperatorio debe ser multidisciplinario, dinámico e individualizado, priorizando la evaluación clínica continua y la toma de decisiones basada en la fisiopatología y la evidencia contemporánea, con el propósito último de reducir la morbimortalidad y mejorar los desenlaces clínicos.

Critical care, perioperative period, intensive care unit, perioperative care, postoperative complications

Fernando Rodriguez-Solana  
Unidad de Cuidados Intensivos. Hospital General Regional 180 Instituto Mexicano del Seguro Social. Jalisco. México.

  1. Jia L, Wang H, Gao Y, y cols. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter Prospective Study (I-TOUCH). Crit Care. 2023.
  2. American Academy of Orthopaedic Surgeons; American College of Emergency Physicians; University of Maryland, Baltimore County. Critical care transport. 2nd ed. Burlington (MA): Jones & Bartlett Learning; 2017.
  3. Weller GB, Mault J, Ventura ME, Adams J, Campbell FJ, Tremper KK. A retrospective observational study of continuous wireless vital sign monitoring via a medical grade wearable device on hospitalized floor patients. J Clin Med. 2024;13(16):4747. doi:10.3390/jcm13164747.
  4. Tang CHM, Seah JCY, Ahmad HK, Milne MR, Wardman JB, Buchlak QD, y cols. Analysis of line and tube detection performance of a chest X-ray deep learning model to evaluate hidden stratification. Diagnostics (Basel). 2023;13(14):2317. doi:10.3390/diagnostics13142317.
  5. Prateek PS, Seema S, Abhinav AD, Swati SA, Nidhi ND, Kajal K. Impact of preoperative chest imaging on predicting anaesthesia-related pulmonary complications: a systematic review. J Contemp Clin Pract. 2025;11(10):354-357. doi:10.61336/jccp/25-10-52.
  6. Zhang L, Liu ZH, Lv YJ, y cols. Comprehensive improvements in the emergency laboratory test process based on information technology. BMC Med Inform Decis Mak. 2023;23:292. doi:10.1186/s12911-023-02387-x.
  7. Pérez Nieto OR, Guerrero Gutiérrez MA, Morgado Villaseñor LA, Fermín JL, Zamarrón López EI, y cols. Hemodynamic monitoring with the clinic: back to basics. J Emerg Med Crit Care. 2020;6(1):7.
  8. Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol. 2004;21(9):700–707. doi:10.1017/s0265021504009068.
  9. Sloth E, Torp P, Vistisen S. Focus-assessed transthoracic echocardiography (FATE). Eur J Anaesthesiol. 2005;22(8):700–707. doi:10.1017/S0265021504009068.
  10. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically ill. Emerg Med Clin North Am. 2010;28(1):29–vii. doi:10.1016/j.emc.2009.09.010.
  11. Askar H, Misch J, Chen Z, Chadha S, Wang HL. Capnography monitoring in procedural intravenous sedation: a systematic review and meta-analysis. Clin Oral Investig. 2020;24(11):3761-3770. doi:10.1007/s00784-020-03395-1.
  12. Richardson M, Moulton K, Rabb D, Kindopp S, Pishe T, Yan C, y cols. Capnography for monitoring end-tidal CO2 in hospital and pre-hospital settings: a health technology assessment. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016.
  13. Berhanu D, Cardoso Ferreira J, Abegão Pinto L, Aguiar de Sousa D, Lucas Neto L, Tavares Ferreira J. The role of optic nerve sheath ultrasonography in increased intracranial pressure: a systematic review and meta-analysis. J Neurol Sci. 2023;454:120853. doi:10.1016/j.jns.2023.120853.
  14. Qu X, Wang H, Du C, Sun B, y cols. Value of transcranial color-coded duplex sonography-derived middle cerebral artery pulsatility index in intracranial pressure assessment. Sci Rep. 2026. doi:10.1038/s41598-026-44246-5.
  15. Kaye C, Rhodes J, Austin P, Casey M, Gould R, Sira J, Treweek S, y cols. Assessment of depth of sedation using Bispectral Index™ monitoring in patients with severe traumatic brain injury in UK intensive care units. BJA Open. 2024;10:100287. doi:10.1016/j.bjao.2024.100287.
  16. Hernández G, Ospina-Tascón GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J, y cols. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial. JAMA. 2019;321(7):654-664. doi:10.1001/jama.2019.0071.
  17. Malbrain MLNG, Tantakoun K, Zara AT, Ferko NC, Kelly T, Dabrowski W. Urine output is an early and strong predictor of acute kidney injury and associated mortality: A systematic literature review of 50 clinical studies. Ann Intensive Care. 2024;14:110. doi:10.1186/s13613-024-01342-x.
  18. Pereira A, Santos JG, Loureiro MJ, Ferreira F, Almeida AR, Cale R, y cols. Thermodilution vs indirect Fick cardiac output measurement in clinical practice: insights from a tertiary centre. Eur Heart J. 2020;41(Suppl 2):ehaa946.2252. doi:10.1093/ehjci/ehaa946.2252.
  19. Kouz K, Scheeren TWL, de Backer D, Saugel B. Pulse Wave Analysis to Estimate Cardiac Output. Anesthesiology. 2021;134(1):119–126. doi:10.1097/ALN.0000000000003553.
  20. Nieto-Pérez OR, Sánchez-Díaz JS, Solórzano-Guerra A, Márquez-Rosales E, García-Parra OF, Zamarrón-López EI, y cols. Fluidoterapia intravenosa guiada por metas [Intravenous fluid therapy guided by goals]. Med Interna Mex. 2019;35(2):235-250. doi:10.24245/mim.v35i2.2337.
  21. Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, y cols. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370(15):1412-1421. doi:10.1056/NEJMoa1305727.
  22. Sánchez Díaz JS. Manual práctico de ácido-base, líquidos y electrolitos. Ciudad de México: ZarPra; 2021.
  23. Monteiro JN, Goraksha SU. ‘ROSE concept’ of fluid management: Relevance in neuroanaesthesia and neurocritical care. J Neuroanaesthesiol Crit Care. 2017;4(1):10–16. doi:10.4103/2348-0548.197435.
  24. Argaiz ER. VExUS Nexus: Bedside Assessment of Venous Congestion. Adv Chronic Kidney Dis. 2021;28(3):252–261. doi:10.1053/j.ackd.2021.03.004.
  25. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, y cols. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.10007/s00134-021-06506-y.
  26. Morelli A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, y cols. Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study. Crit Care. 2009;13(4):R130. doi:10.1186/cc7990.
  27. Pearson SD, Koyner JL, Patel BK. Management of respiratory failure: Ventilator management 101 and noninvasive ventilation. Clin J Am Soc Nephrol. 2022;17(4):572–580. doi:10.2215/CJN.13091021.
  28. Pérez N Or, Zamarrón LEI, Guerrero GMA, y cols. PEEP: dos lados de la misma moneda. Med Crit. 2021;35(1):34-46. doi:10.35366/99152.
  29. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, y cols. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755. doi:10.1056/NEJMsa1410639.
  30. Mahammedi H, Corrêa TD, Wendon J, y cols. The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure. J Crit Care. 2023;77:154322. doi:10.1016/j.jcrc.2023.154322.
  31. Hernández G, Paredes I, Moran F, Buj M, Colinas L, Rodríguez ML, y cols. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial. Intensive Care Med. 2022;48(12):1751-1759. doi:10.1007/s00134-022-06919-3.
     
  32. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, y cols. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297. doi:10.1056/NEJMoa0810625.
  33. Moghissi E. Hospital management of diabetes: beyond the sliding scale. Cleve Clin J Med. 2004;71(10):801–808. doi:10.3949/ccjm.71.10.801.
  34. Christensen MC, Dziewior F, Kempel A, von Heymann C. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2012;26(1):46-51. doi:10.1053/j.jvca.2011.09.021.
  35. Jensen LR, Possfelt-Møller E, Nielsen AE, Singh UM, Svendsen LB, Penninga L. Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: A retrospective cohort study. Eur J Orthop Surg Traumatol. 2024;34:1479–1486. doi:10.1007/s00590-023-03813-6.
  36. Alghanem H, Liu NCP, Gupta A, Liao C, Wool GD, Rubin DS, y cols. Ratios of calcium to citrate administration in blood transfusion for traumatic hemorrhage: a retrospective cohort study. Transfusion. 2024;64(11):2104-2113. doi:10.1111/trf.17963.
  37. Van den Akker TA, Grimes ZM, Friedman MT. Transfusion-associated circulatory overload and transfusion-related acute lung injury: A review of underreported entities with current updates. Am J Clin Pathol. 2021;156(4):529–539. doi:10.1093/ajcp/aqaa279.
  38. Jiménez Franco DA, Pérez Velásquez CA, Rodríguez Lima DR. Mortality in Critically Ill Patients with Liberal Versus Restrictive Transfusion Thresholds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis. J Clin Med. 2025;14(6):2049. doi:10.3390/jcm14062049.
[1] Rodríguez Solana F. Cuidados críticos en el paciente perioperatorio. CC&EM [Internet]. [citado 26 de agosto de 2026];6(2). Disponible en: https://criticalcareandemergencymedicine.com/OJS/index.php/inicio/article/view/12
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2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

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www.doi.org/10.58281/ccem.v6i2.12

Fernando Rodriguez-Solana 1 .

1 Unidad de Cuidados Intensivos. Hospital General Regional 180 Instituto Mexicano del Seguro Social. Jalisco. México.

Abstract

Abstract: The perioperative critically ill patient represents a complex clinical challenge that begins at the first point of medical contact, whether in the prehospital or in-hospital setting. Management requires a comprehensive strategy aimed at hemodynamic, ventilatory, metabolic, and multiorgan optimization, with special emphasis on safety during transport and transition to the intensive care unit (ICU). This review describes current principles in the comprehensive management of the perioperative critically ill patient, emphasizing monitoring strategies, resuscitation, multiorgan support, and complication prevention. Current evidence supports dynamic clinical monitoring complemented by bedside ultrasonography (FATE, RUSH, and VEXUS protocols), prioritizing individualized perfusion targets. Fluid resuscitation should be physiology-driven, avoiding fluid overload and favoring balanced crystalloid solutions. Rational use of vasopressors—particularly norepinephrine—remains the cornerstone of vasoplegic management. Lung-protective ventilation, appropriate glycemic control, restrictive transfusion strategies, and early identification of acute kidney injury using emerging biomarkers contribute to improved outcomes. Early enteral nutrition, multimodal analgesia, and non-pharmacological interventions for delirium prevention are essential components of comprehensive supportive care. The management of the perioperative critically ill patient must be multidisciplinary, dynamic, and individualized, prioritizing continuous bedside clinical assessment and physiology-based decision-making supported by contemporary evidence, with the aim of reducing morbidity and mortality and improving clinical outcomes.

Resumen:

El paciente crítico perioperatorio representa un desafío clínico complejo que inicia desde el primer contacto asistencial, ya sea en el ámbito prehospitalario u hospitalario. Su manejo requiere una estrategia integral orientada a la optimización hemodinámica, ventilatoria, metabólica y multiorgánica, con énfasis en la seguridad durante el traslado y la transición a la unidad de cuidados intensivos (UCI). El objetivo de esta revisión es describir los principios actuales del abordaje integral del paciente crítico en el periodo perioperatorio, enfatizando estrategias de monitorización, resucitación, soporte multiorgánico y prevención de complicaciones. La evidencia actual respalda una monitorización clínica dinámica complementada con ultrasonografía a la cabecera del paciente (protocolos FATE, RUSH y VEXUS), priorizando metas de perfusión individualizadas. La reanimación hídrica debe basarse en la fisiopatología, evitando la sobrecarga de volumen y favoreciendo el uso de soluciones balanceadas, mientras que el uso racional de vasopresores —principalmente la norepinefrina— constituye el pilar fundamental del manejo vasoplégico. Asimismo, la ventilación protectora, el control estricto de la glucemia, las estrategias transfusionales restrictivas y la identificación temprana de la lesión renal aguda mediante biomarcadores emergentes optimizan significativamente los resultados clínicos. Complementariamente, la nutrición enteral precoz, la analgesia multimodal y las intervenciones no farmacológicas destinadas a la prevención del delirio forman parte esencial del soporte integral. El abordaje del paciente crítico perioperatorio debe ser multidisciplinario, dinámico e individualizado, priorizando la evaluación clínica continua y la toma de decisiones basada en la fisiopatología y la evidencia contemporánea, con el propósito último de reducir la morbimortalidad y mejorar los desenlaces clínicos.

Critical care, perioperative period, intensive care unit, perioperative care, postoperative complications

Fernando Rodriguez-Solana  
Unidad de Cuidados Intensivos. Hospital General Regional 180 Instituto Mexicano del Seguro Social. Jalisco. México.

  1. Jia L, Wang H, Gao Y, y cols. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter Prospective Study (I-TOUCH). Crit Care. 2023.
  2. American Academy of Orthopaedic Surgeons; American College of Emergency Physicians; University of Maryland, Baltimore County. Critical care transport. 2nd ed. Burlington (MA): Jones & Bartlett Learning; 2017.
  3. Weller GB, Mault J, Ventura ME, Adams J, Campbell FJ, Tremper KK. A retrospective observational study of continuous wireless vital sign monitoring via a medical grade wearable device on hospitalized floor patients. J Clin Med. 2024;13(16):4747. doi:10.3390/jcm13164747.
  4. Tang CHM, Seah JCY, Ahmad HK, Milne MR, Wardman JB, Buchlak QD, y cols. Analysis of line and tube detection performance of a chest X-ray deep learning model to evaluate hidden stratification. Diagnostics (Basel). 2023;13(14):2317. doi:10.3390/diagnostics13142317.
  5. Prateek PS, Seema S, Abhinav AD, Swati SA, Nidhi ND, Kajal K. Impact of preoperative chest imaging on predicting anaesthesia-related pulmonary complications: a systematic review. J Contemp Clin Pract. 2025;11(10):354-357. doi:10.61336/jccp/25-10-52.
  6. Zhang L, Liu ZH, Lv YJ, y cols. Comprehensive improvements in the emergency laboratory test process based on information technology. BMC Med Inform Decis Mak. 2023;23:292. doi:10.1186/s12911-023-02387-x.
  7. Pérez Nieto OR, Guerrero Gutiérrez MA, Morgado Villaseñor LA, Fermín JL, Zamarrón López EI, y cols. Hemodynamic monitoring with the clinic: back to basics. J Emerg Med Crit Care. 2020;6(1):7.
  8. Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol. 2004;21(9):700–707. doi:10.1017/s0265021504009068.
  9. Sloth E, Torp P, Vistisen S. Focus-assessed transthoracic echocardiography (FATE). Eur J Anaesthesiol. 2005;22(8):700–707. doi:10.1017/S0265021504009068.
  10. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically ill. Emerg Med Clin North Am. 2010;28(1):29–vii. doi:10.1016/j.emc.2009.09.010.
  11. Askar H, Misch J, Chen Z, Chadha S, Wang HL. Capnography monitoring in procedural intravenous sedation: a systematic review and meta-analysis. Clin Oral Investig. 2020;24(11):3761-3770. doi:10.1007/s00784-020-03395-1.
  12. Richardson M, Moulton K, Rabb D, Kindopp S, Pishe T, Yan C, y cols. Capnography for monitoring end-tidal CO2 in hospital and pre-hospital settings: a health technology assessment. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016.
  13. Berhanu D, Cardoso Ferreira J, Abegão Pinto L, Aguiar de Sousa D, Lucas Neto L, Tavares Ferreira J. The role of optic nerve sheath ultrasonography in increased intracranial pressure: a systematic review and meta-analysis. J Neurol Sci. 2023;454:120853. doi:10.1016/j.jns.2023.120853.
  14. Qu X, Wang H, Du C, Sun B, y cols. Value of transcranial color-coded duplex sonography-derived middle cerebral artery pulsatility index in intracranial pressure assessment. Sci Rep. 2026. doi:10.1038/s41598-026-44246-5.
  15. Kaye C, Rhodes J, Austin P, Casey M, Gould R, Sira J, Treweek S, y cols. Assessment of depth of sedation using Bispectral Index™ monitoring in patients with severe traumatic brain injury in UK intensive care units. BJA Open. 2024;10:100287. doi:10.1016/j.bjao.2024.100287.
  16. Hernández G, Ospina-Tascón GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J, y cols. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial. JAMA. 2019;321(7):654-664. doi:10.1001/jama.2019.0071.
  17. Malbrain MLNG, Tantakoun K, Zara AT, Ferko NC, Kelly T, Dabrowski W. Urine output is an early and strong predictor of acute kidney injury and associated mortality: A systematic literature review of 50 clinical studies. Ann Intensive Care. 2024;14:110. doi:10.1186/s13613-024-01342-x.
  18. Pereira A, Santos JG, Loureiro MJ, Ferreira F, Almeida AR, Cale R, y cols. Thermodilution vs indirect Fick cardiac output measurement in clinical practice: insights from a tertiary centre. Eur Heart J. 2020;41(Suppl 2):ehaa946.2252. doi:10.1093/ehjci/ehaa946.2252.
  19. Kouz K, Scheeren TWL, de Backer D, Saugel B. Pulse Wave Analysis to Estimate Cardiac Output. Anesthesiology. 2021;134(1):119–126. doi:10.1097/ALN.0000000000003553.
  20. Nieto-Pérez OR, Sánchez-Díaz JS, Solórzano-Guerra A, Márquez-Rosales E, García-Parra OF, Zamarrón-López EI, y cols. Fluidoterapia intravenosa guiada por metas [Intravenous fluid therapy guided by goals]. Med Interna Mex. 2019;35(2):235-250. doi:10.24245/mim.v35i2.2337.
  21. Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, y cols. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370(15):1412-1421. doi:10.1056/NEJMoa1305727.
  22. Sánchez Díaz JS. Manual práctico de ácido-base, líquidos y electrolitos. Ciudad de México: ZarPra; 2021.
  23. Monteiro JN, Goraksha SU. ‘ROSE concept’ of fluid management: Relevance in neuroanaesthesia and neurocritical care. J Neuroanaesthesiol Crit Care. 2017;4(1):10–16. doi:10.4103/2348-0548.197435.
  24. Argaiz ER. VExUS Nexus: Bedside Assessment of Venous Congestion. Adv Chronic Kidney Dis. 2021;28(3):252–261. doi:10.1053/j.ackd.2021.03.004.
  25. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, y cols. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.10007/s00134-021-06506-y.
  26. Morelli A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, y cols. Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study. Crit Care. 2009;13(4):R130. doi:10.1186/cc7990.
  27. Pearson SD, Koyner JL, Patel BK. Management of respiratory failure: Ventilator management 101 and noninvasive ventilation. Clin J Am Soc Nephrol. 2022;17(4):572–580. doi:10.2215/CJN.13091021.
  28. Pérez N Or, Zamarrón LEI, Guerrero GMA, y cols. PEEP: dos lados de la misma moneda. Med Crit. 2021;35(1):34-46. doi:10.35366/99152.
  29. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, y cols. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755. doi:10.1056/NEJMsa1410639.
  30. Mahammedi H, Corrêa TD, Wendon J, y cols. The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure. J Crit Care. 2023;77:154322. doi:10.1016/j.jcrc.2023.154322.
  31. Hernández G, Paredes I, Moran F, Buj M, Colinas L, Rodríguez ML, y cols. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial. Intensive Care Med. 2022;48(12):1751-1759. doi:10.1007/s00134-022-06919-3.
     
  32. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, y cols. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297. doi:10.1056/NEJMoa0810625.
  33. Moghissi E. Hospital management of diabetes: beyond the sliding scale. Cleve Clin J Med. 2004;71(10):801–808. doi:10.3949/ccjm.71.10.801.
  34. Christensen MC, Dziewior F, Kempel A, von Heymann C. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2012;26(1):46-51. doi:10.1053/j.jvca.2011.09.021.
  35. Jensen LR, Possfelt-Møller E, Nielsen AE, Singh UM, Svendsen LB, Penninga L. Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: A retrospective cohort study. Eur J Orthop Surg Traumatol. 2024;34:1479–1486. doi:10.1007/s00590-023-03813-6.
  36. Alghanem H, Liu NCP, Gupta A, Liao C, Wool GD, Rubin DS, y cols. Ratios of calcium to citrate administration in blood transfusion for traumatic hemorrhage: a retrospective cohort study. Transfusion. 2024;64(11):2104-2113. doi:10.1111/trf.17963.
  37. Van den Akker TA, Grimes ZM, Friedman MT. Transfusion-associated circulatory overload and transfusion-related acute lung injury: A review of underreported entities with current updates. Am J Clin Pathol. 2021;156(4):529–539. doi:10.1093/ajcp/aqaa279.
  38. Jiménez Franco DA, Pérez Velásquez CA, Rodríguez Lima DR. Mortality in Critically Ill Patients with Liberal Versus Restrictive Transfusion Thresholds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis. J Clin Med. 2025;14(6):2049. doi:10.3390/jcm14062049.
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DOI: 10.3989/ccem

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