Evaluating the Shock Index, Revised Assessment of Bleeding and Transfusion (RABT), Assessment of Blood Consumption (ABC) and novel PTTrauma score to predict critical transfusion threshold (CAT) in penetrating thoracic trauma.

The shock index (SI) has been associated with predicting transfusion needs in trauma patients. However, its utility in penetrating thoracic trauma (PTTrauma) for predicting the Critical Administration Threshold (CAT) has not been well-studied. This study aimed to evaluate the prognostic value of SI in predicting CAT in PTTrauma patients and compare its performance with the Assessment of Blood Consumption (ABC) and Revised Assessment of Bleeding and Transfusion (RABT) scores. We conducted a prognostic type 2, single-center retrospective observational cohort study on patients with PTTrauma and an Injury Severity Score (ISS) > 9. The primary exposure was SI at admission, and the primary outcome was CAT. Logistic regression and decision curve analysis were used to assess the predictive performance of SI and the PTTrauma score, a novel model incorporating clinical variables. Of the 620 participants, 53 (8.5%) had more than one CAT. An SI > 0.9 was associated with CAT (adjusted OR 4.89, 95% CI 1.64-14.60). The PTTrauma score outperformed SI, ABC, and RABT scores in predicting CAT (AUC 0.867, 95% CI 0.826-0.908). SI is a valuable predictor of CAT in PTTrauma patients. The novel PTTrauma score demonstrates superior performance compared to existing scores, highlighting the importance of developing targeted predictive models for specific injury patterns. These findings can guide clinical decision-making and resource allocation in the management of PTTrauma.

Agreement of point of care ultrasound and final clinical diagnosis in patients with acute heart failure, acute coronary syndrome, and shock: POCUS not missing the target.

Point-of-care ultrasound (POCUS) is an important tool for clinical diagnosis and decision-making in critical and non-critical scenarios. Dyspnea, chest pain, and shock are conditions susceptible to evaluation with ultrasound considering diagnostic accuracy and clinical impact already proven. There is scarce evidence in diagnosis agreement using ultrasound as an extension of physical examination. We aimed to evaluate ED patients in whom POCUS was performed, to analyze agreement between clinical initial diagnosis using ultrasound images and final diagnosis. Furthermore, we analyze failed diagnosis, inconclusive POCUS exams, and discuss details. A cross-sectional analytical study was conducted on adults who visited the emergency department with any of these three chief complaints: dyspnea, chest pain, and shock. All were evaluated with ultrasound at admission. Agreement between initial diagnosis using POCUS and final definite diagnosis was calculated. Failed diagnosis and inconclusive exams were analyzed. A total of 209 patients were analyzed. Populations: mostly males, mean age 64 years old, hypertensive. Agreement on patients with dyspnea and suspicion of acute decompensated heart failure was 0.98; agreement on chest pain suspicion of non-ST acute coronary syndrome was 0.96; agreement on type of shock was 0.90. Among the population, 12 patients had an inconclusive POCUS exam, and 16 patients had a failed diagnosis. The use of POCUS in the emergency department shows almost perfect agreement when compared with the final diagnosis in individuals experiencing acutely decompensated heart failure, acute coronary syndrome, and shock. Prospective studies are needed to evaluate the impact of this tool on mortality and prognosis when there are diagnostic errors.

Liposarcoma gigante mediastinal. Cirugía radical con abordaje Clamshell y manejo en la Unidad de Cuidados Críticos / Giant Mediastinal Liposarcoma. Radical Surgery with Clamshell Approach and Management in Critical Care Unit

Se presenta a un paciente con liposarcoma mediastinal gigante con dolor torácico, disnea, cuyos estudios por imágenes revelaban la presencia de una gran tumoración de 42 cm en su diámetro mayor que abarcaba todo el mediastino, comprometía ambas cavidades torácicas, rechazaba los pulmones, corazón y grandes vasos. La biopsia con aguja cortante bajo guía ecográfica fue informada como liposarcoma. El paciente tuvo resección completa del tumor mediante la incisión Clamshell. En el post operatorio inmediato, presentó shock circulatorio más disfunción multiorgánica (DOMS): plaquetopenia, insuficiencia renal aguda con necesidad de soporte dialítico, injuria hepática. El soporte y monitoreo especializado en la Unidad de Cuidados Intensivos (UCI) permitió mejoría clínica y buena evolución. Salió de alta en buenas condiciones.

We present a patient with giant mediastinal liposarcoma with chest pain, dyspnea, whose imaging studies revealed the presence of a large tumor measuring 42 cm in its greatest diameter that covered the entire mediastinum, involved both thoracic cavities, rejected the lungs, heart and big glasses. The sharp needle biopsy under ultrasound guidance was reported as liposarcoma. The patient had complete resection of the tumor through the Clamshell incision. In the immediate postoperative period, he presented circulatory shock plus multiple organ dysfunction (DOMS): plateletopenia, acute renal failure with the need for dialytic support, liver injury. Specialized support and monitoring in the Intensive Care Unit (ICU) allowed clinical improvement and good evolution. He was discharged in good condition.

Complicaciones, clínica y tratamiento de pacientes con hepatocarcinoma, posterior a quimioembolización en dos hospitales de Quito / Complications, symptoms and treatment of patients with hepatocellular carcinoma, after chemoembolization in two hospitals in Quito

INTRODUCCIÓN. La quimioembolización transarterial ha demostrado mejorar la tasa de sobrevida en los pacientes con hepatocarcinoma, se ha descrito como tratamiento paliativo; es útil, efectivo y bien tolerado. Esta terapéutica tiene el objetivo de disminuir el volumen tumoral. OBJETIVO. Determinar las complicaciones que presentan los pacientes con diagnóstico de hepatocarcinoma, posterior a la realización de quimioembolización transarterial del servicio de Gastroenterología del Hospital de Especialidades Carlos Andrade Marín y Hospital de Especialidades Eugenio Espejo, durante el período enero 2015 - enero 2020. MATERIALES Y MÉTODOS. Es un estudio retrospectivo observacional transversal; se diseñó un formulario de recolección de información, utilizando media y desvío estándar para variables cuantitativas; frecuencia y porcentaje para cualitativas; en las variables con distribución no paramétrico se recurrió a la mediana, rango intercuartil y sus intervalos, además se utilizó Chi Cuadrado, Índice de Yates y test de U Mann Whitney. Se trabajó en el paquete estadístico SPSS versión 26. RESULTADOS. Se analizaron 97 pacientes, el 60,8% fue de sexo masculino de los cuales el 56.7% presentó alguna comorbilidad; la mayoría de los pacientes no tuvieron complicaciones, sin embargo, la hipertensión arterial se presentó como manifestación clínica post quimioembolización transarterial (10,3%); el choque, el síndrome ascítico ­ edematoso y el dolor abdominal fueron las complicaciones de mayor frecuencia. Los datos estadísticamente significativos fueron los siguientes: los pacientes con hepatocarcinoma y cirrosis hepática con severidad Child Pugh B, tuvieron un porcentaje mayor de complicaciones valor p = 0,01; un tamaño más grande del tumor sobre el número de lesiones, se relacionó con presentar alguna complicación postquimioembolización transarterial valor p = 0,001, lo que significó un aumento en la estancia hospitalaria valor p = 0,006; los pacientes que presentaron complicaciones mayores y menores tuvieron un tiempo de hospitalización más prolongado valor p < 0,05; la asociación entre la mortalidad y las complicaciones post quimioembolización en hospitalización y en UCI tuvieron una tasa general de 3,2% valor p = 0,001. CONCLUSIÓN. Las complicaciones mayores como el síndrome ascítico edematoso y el estado de choque, se mantuvieron sobre la media general. Con una tasa de mortalidad esperada según la tendencia internacional.

INTRODUCTION: Transarterial chemoembolization has been shown to improve the survival rate in patients with hepatocarcinoma, it has been described as palliative treatment; it is useful, effective and well tolerated. This therapy aims to reduce tumor volume, due to its embolic, vascular and cytotoxic effects. OBJECTIVE: To determine the complications presented by patients diagnosed with hepatocarcinoma, after performing transarterial chemoembolization of the Gastroenterology service of the Carlos Andrade Marín Specialty Hospital and Eugenio Espejo Specialty Hospital, during the period January 2015 - January 2020. METHODOLOGY: This cross-sectional observational study was conducted in patients with hepatocarcinoma who underwent transarterial chemoembolization. A form was designed for the collection of information, through a pseudonymized database, which was analyzed using the statistical package SPSS version 26. RESULTS: 97 patients were analyzed, 60.8% were male, of which 56.7% presented some comorbidity; Most of the patients had no complications, however, arterial hypertension presented as a clinical manifestation after transarterial chemoembolization in 10.3%; shock, ascites edema decompensation and abdominal pain were the most frequent complications. The statistically significant data were the following: patients with hepatocellular carcinoma and liver cirrhosis with Child Pugh B severity had a higher percentage of complications valor p = 0,01; a larger tumor size compared to the number of lesions was related to presenting some post-transarterial chemoembolization complication valor p = 0,001, which meant an increase in hospital stay valor p = 0,006; patients who presented major and minor complications had a longer hospitalization time valor p < 0,05, the association between mortality and post chemoembolization complications in hospitalization and in the ICU had an overall rate of 3.2% valor p = 0,001. CONCLUSION. Major complications, such as edematous ascitic syndrome and shock, remained above the general average. With an expected mortality rate according to the international trend.

[Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City]. / Alteraciones cardiovasculares en el síndrome inflamatorio multisistémico pediátrico asociado a COVID-19 en un hospital pediátrico de tercer nivel de la Ciudad de México.

Objective: The objective is to expose the cardiovascular alterations in patients diagnosed with pediatric inflammatory multisystem syndrome (PIMS) associated with COVID-19 during the SARS-CoV-2 pandemic, in order to understand the disease, its evolution, and optimal management upon diagnosis. Method: Retrospective, observational, cross-sectional analytical study of patients diagnosed with PIMS according to the criteria of the World Health Organization at the National Institute of Pediatrics, from March 2020 to December 2021. Results: During the study period, 77 patients with PIMS were diagnosed. The results showed correlation between the shock state and alteration of laboratory markers (platelets 144217.29 ± 139321.6 µL [p < 0.001], procalcitonin 27.37 ± 38.37 ng/ml [p = 0.05] and ferritin 1937.87 ± 2562.63 [p < 0.001]). The ventricular function in patients with shock was significantly lower compared to those without shock (49.6 ± 9.1% vs. 58.1 ± 8.4 %; t-Student p < 0.001), as well as injury to the left coronary artery (p = 0.02). There is a correlation between NT-proBNP and ventricular dysfunction (Kruskal-Wallis p = 0.007). Statistical significance was found in the association between death, elevation of inflammatory markers and ventricular dysfunction (p < 0.001). Conclusions: The cardiovascular alterations observed, in order of frequency, were pericardial effusion (25.7%), myocarditis (15%), mild ventricular dysfunction (13.5%) and small coronary aneurysm with predominance of the left coronary artery and the anterior descending one.

Objetivo: Exponer las alteraciones cardiovasculares en los pacientes diagnosticados con síndrome inflamatorio multisistémico pediátrico (PIMS) asociado a COVID-19 durante la pandemia por SARS-CoV-2 con el fin de comprender la enfermedad, su evolución y el manejo óptimo al diagnóstico. Método: Estudio retrospectivo, observacional, transversal y analítico de pacientes con diagnóstico de PIMS de acuerdo con los criterios de la Organización Mundial de la Salud en el Instituto Nacional de Pediatría, de marzo de 2020 a diciembre de 2021. Resultados: Durante el periodo de estudio se diagnosticaron 77 pacientes con PIMS. Los resultados demostraron una correlación entre el estado de choque y la alteración de los marcadores de laboratorio (plaquetas 144217.29 ± 139321.6 µl [p < 0.001], procalcitonina 27.37 ± 38.37 ng/ml [p = 0.05] y ferritina 1937.87 ± 2562.63 [p < 0.001]). La función ventricular en los pacientes con choque se registró significativamente menor en comparación con aquellos sin choque (49.6 ± 9.1 % vs. 58.1 ± 8.4 %; t de Student p < 0.001), así como lesión en la arteria coronaria izquierda (p = 0.02). Existe una correlación entre el NT-proBNP y la disfunción ventricular (Kruskal-Wallis p = 0.007). Se encontró significancia estadística en la asociación entre fallecimiento, elevación de los marcadores inflamatorios y disfunción ventricular (p < 0.001). Conclusiones: Las alteraciones cardiovasculares observadas fueron, en orden de frecuencia, derrame pericárdico (25.7%), miocarditis (15%), disfunción ventricular leve (13.5%) y aneurisma pequeño coronario con predominio de la arteria coronaria izquierda y la descendente anterior.

Impacto de la edad, las comorbilidades y las complicaciones en pacientes con COVID-19 con síndrome de dificultad respiratoria aguda en la ventilación mecánica invasiva. Estudio multicéntrico observacional / Impact of Age, Comorbidities and Complications in COVID-19 Patients with Acute Respiratory Distress Syndrome on Invasive Mechanical Ventilation. An Observational Multicenter Study

Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.

Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis

Severe adenovirus infection outbreak in Colombia: Experience from a tertiary pediatric hospital in 2022 / Brote de adenovirus grave en Colombia: experiencia de un hospital pediátrico de tercer nivel en 2022

Introduction. During the SARS-CoV-2 pandemic, many countries experienced decreased respiratory virus circulation, followed by an out-of-season outbreak. In a pediatric hospital in Colombia, we observed a surge in severe adenovirus infections, leading to concerns about the impact of eased public health restrictions and immune debt in children under five years old. Objective. To describe the clinical characteristics of patients with severe adenovirus infection in a pediatric hospital in Colombia. Materials and methods. We reviewed the data of 227 patients with severe adenovirus infection at the Fundación Hospital Pediátrico La Misericordia. Results. A total of 196 patients were included in this study. The median age was two years, and 62% were male. Adenoviruses were isolated from all patients' samples. Ninetyseven percent were admitted to the pediatric intensive care unit, 94% required respiratory support, and the in-hospital lethality rate was 11%. Conclusion. In 2022, there was an outbreak of severe adenovirus infections, affecting mainly children under five years of age, with higher-than-usual mortality.

Introducción. Durante la pandemia por SARS-CoV-2, muchos países evidenciaron una disminución en la circulación de virus respiratorios, seguida por un brote fuera de la temporada esperada. En un hospital de Colombia, se observó un aumento en los casos de infección grave por adenovirus, lo cual generó preocupación sobre el impacto que tuvo la disminución de los cuidados establecidos durante pandemia y la posible deuda inmunológica en niños menores de cinco años. Objetivo. Describir las características clínicas de los pacientes con infección grave por adenovirus en un hospital pediátrico de Colombia. Materiales y métodos. Se revisaron 227 pacientes con infección grave por adenovirus en la Fundación Hospital Pediátrico La Misericordia, desde el 1° de enero hasta el 31 de diciembre de 2022. Resultados. El estudio incluyó 196 casos. La edad media de los pacientes fue de dos años y el 62 % eran de sexo masculino. Los adenovirus se aislaron a partir de las muestras de todos los pacientes. El 97 % de los pacientes ingresó a la unidad de cuidados intensivos, el 94 % requirió soporte ventilatorio y la tasa de mortalidad fue del 11 %. Conclusiones. En el 2022 hubo un brote de adenovirus que afectó principalmente a los niños menores de cinco años, con una mortalidad mayor a lo reportado con anterioridad en Colombia.

Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation.

OBJECTIVE: To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. METHODS: A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. RESULTS: The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). CONCLUSION: Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.

Relationship between peripheral ischemic microvascular reserve, persistent hyperlactatemia, and its temporal dynamics in sepsis: a post hoc study.

OBJECTIVE: To measure the prognostic value of peripheral ischemic microvascular reserve in the context of persistent sepsis-induced hyperlactatemia and measure its influence on the temporal dynamics of lactate and the strength of association between these variables. METHODS: This post hoc analysis of the peripheral perfusion index/postocclusive reactive hyperemia trial, an observational cohort study that enrolled patients with sepsis who persisted with lactate levels ≥ 2mmol/L after fluid resuscitation (with or without shock). Peripheral ischemic microvascular reserve was evaluated using the association of the peripheral perfusion index and postocclusive reactive hyperemia techniques. The cutoff point of ∆ peripheral perfusion index peak values (%) defined the groups with low (≤ 62%) and high peripheral ischemic microvascular reserve (> 62%). RESULTS: A total of 108 consecutive patients with persistent sepsis-induced hyperlactatemia were studied. The high peripheral ischemic microvascular reserve group showed higher 28-day mortality than the low peripheral ischemic microvascular reserve group (p < 0.01). The temporal dynamics of lactate within the first 48 hours showed a rapid decrease in lactate levels in the low peripheral ischemic microvascular reserve group (p < 0.01). However, this result was not reproduced in the linear mixed effects model. A weak correlation between peripheral ischemic microvascular reserve (%) and lactate level (mmol/L) was observed within the first 24 hours (r = 0.23; p < 0.05). CONCLUSION: The prognostic value of high peripheral ischemic microvascular reserve was confirmed in the context of persistent sepsis-induced hyperlactatemia. Although there was a weak positive correlation between peripheral ischemic microvascular reserve value and lactate level within the first 24 hours of sepsis diagnosis, the low peripheral ischemic microvascular reserve group appeared to have a faster decrease in lactate over the 48 hours of follow-up.

Resultados de la estrategia de código rojo en la atención a pacientes con hemorragia posparto / Results of the red code strategy in the care of patients with postpartum hemorrhage

Introducción: La estrategia de código rojo permite la atención inmediata, sistematizada y coordinada de la hemorragia posparto. Es un esquema de trabajo organizado que contribuye a un tratamiento oportuno y pertinente de la hemorragia obstétrica. Con esta herramienta, el equipo asistencial puede seguir los pasos indicados sin desviarse del objetivo, trabajar de manera ordenada y aplicarlo en cada situación específica, para disminuir la morbilidad y mortalidad materna. Objetivo: Caracterizar los resultados de la estrategia de código rojo en la atención a pacientes con hemorragia posparto en Villa Clara. Métodos: Se realizó un estudio de desarrollo, observacional, de corte transversal y retrospectivo de las pacientes con hemorragia posparto en Villa Clara, durante el período de enero 2018 a junio de 2021. La muestra no probabilística quedó conformada por 127 pacientes. Se utilizaron medidas de resumen para la descripción de las variables. En las cuantitativas se emplearon medidas de tendencia central y de dispersión (media y desviación estándar), para las variables cualitativas se mostraron frecuencias absolutas y relativas. Para establecer las relaciones entre variables se aplicó la prueba de independencia basada en la distribución Ji cuadrado. Resultados: En la evaluación del cumplimiento del protocolo de código rojo resultaron incorrectos algunos parámetros como: el diagnóstico de las etapas del choque y el tiempo de accionar. Conclusiones: Cada institución debe contar con protocolos y guías de atención de pacientes obstétricas con bases científicas que se correspondan a las posibilidades de cada país; estos protocolos deben facilitar y perfeccionar las acciones del médico.

Introduction: the red code strategy allows immediate, systematized and coordinated care of postpartum hemorrhage. It is an organized work scheme that contributes to timely and relevant treatment of obstetric hemorrhage. The healthcare team can follow with this tool the indicated steps without deviating from the objective, work in an orderly manner and apply it in each specific situation to reduce maternal morbidity and mortality. Objective: to characterize the results of the red code strategy in the care of patients with postpartum hemorrhage in Villa Clara. Methods: a retrospective, cross-sectional, observational and developmental study was carried out in patients with postpartum hemorrhage in Villa Clara from January 2018 to June 2021. The non-probabilistic sample consisted of 127 patients. Summary measures were used to describe the variables. Measures of central tendency and dispersion (mean and standard deviation) were used in the quantitative variables as well as absolute and relative frequencies were shown for the qualitative ones. The independence test based on the Chi-square distribution was applied to establish the relationships between variables. Results: some parameters were incorrect in the evaluation of compliance with the red code protocol such as the diagnosis of the stages of shock and the time to act. Conclusions: each institution must have protocols and guidelines for the care of obstetric patients with scientific bases that correspond to the possibilities of each country; these protocols should facilitate and improve the doctor's actions.

TNF/iNOS/NO pathway mediates host susceptibility to endothelial-dependent circulatory failure and death induced by betacoronavirus infection.

Poor disease outcomes and lethality are directly related to endothelial dysfunction in betacoronavirus infections. Here, we investigated the mechanisms underlying the vascular dysfunction caused by the betacoronaviruses MHV-3 and SARS-CoV-2. Wild-type C57BL/6 (WT) and knockout mice for inducible nitric oxide synthase (iNOS-/-) or TNF receptor 1 (TNFR1-/-) were infected with MHV-3, and K18-hACE2 transgenic mice expressing human ACE2 were infected with SARS-CoV-2. Isometric tension was used to evaluate vascular function. Protein expression was determined by immunofluorescence. Tail-cuff plethysmography and Doppler were used to assess blood pressure and flow, respectively. Nitric oxide (NO) was quantified with the DAF probe. ELISA was used to assess cytokine production. Survival curves were estimated using Kaplan-Meier. MHV-3 infection reduced aortic and vena cava contractility, arterial blood pressure, and blood flow, resulting in death. Resistance mesenteric arteries showed increased contractility. The contractility of the aorta was normalized by removing the endothelium, inhibiting iNOS, genetically deleting iNOS, or scavenging NO. In the aorta, iNOS and phospho-NF-kB p65 subunit expression was enhanced, along with basal NO production. TNF production was increased in plasma and vascular tissue. Genetic deletion of TNFR1 prevented vascular changes triggered by MHV-3, and death. Basal NO production and iNOS expression were also increased by SARS-CoV-2. In conclusion, betacoronavirus induces an endothelium-dependent decrease in contractility in macro-arteries and veins, leading to circulatory failure and death via TNF/iNOS/NO. These data highlight the key role of the vascular endothelium and TNF in the pathogenesis and lethality of coronaviruses.

[Kawasaki disease cytokine release syndrome and Kawasaki disease shock syndrome: A case report]. / Síndrome de tormenta de citocinas y síndrome de choque por enfermedad de Kawasaki: reporte de un caso.

BACKGROUND: Kawasaki disease is a vasculitis of small and medium vessels, with a high prevalence throughout the world. In addition to coronary aneurysms, this vasculitis can lead to a number of systemic complications, including Kawasaki disease shock syndrome and Kawasaki disease cytokine storm syndrome. CASE REPORT: : Case report: A 12-year-old male patient, who began his condition with heartburn, sudden fever of 40 ºC and jaundice, for which he was prescribed treatment with antipyretics and bismuth subsalicylate, without satisfactory reaction. Gastroalimentary content was added three times, and centripetal maculopapular dermatosis. After 12 hospital stays, he was evaluated by personnel from the Pediatric Immunology service, who reported data on hemodynamic instability due to persistent tachycardia for hours, immediate capillary refill, intense pulse, oliguria of 0.3 mL/kg/h of partial urinary output with condensed urine; the systolic blood pressure figures were below the 50% percentile, and there was polypnea and limit saturation in 93%. In the paraclinical studies, the rapid decrease in platelet count (from 297,000 to 59,000 in 24 hours), as well as a neutrophil-lymphocyte index of 12, drew attention. The concentrations of NS1 size, IgM and IgG for dengue and PCR for SARS virus were determined. -CoV-2, which were negative. The definitive diagnosis of Kawasaki disease was established with Kawasaki disease shock syndrome. The evolution of the patient was satisfactory, with a decrease in fever after the administration of gamma globulin on the tenth day of hospitalization, and a new protocol with prednisone (50 mg/day) was started, when the cytokine storm syndrome due to illness was integrated. Kawasaki syndrome simultaneous with pre-existing disorders, that is, Kawasaki disease and Kawasaki disease shock syndrome due to thrombocytopenia, hepatosplenomegaly, fever, lymphadenopathy; in addition, ferritin of 605 mg/dL and transaminasemia. The control echocardiogram did not show coronary abnormalities and hospital discharge was granted 48 hours after starting treatment with the corticosteroid, with a 14-day follow-up plan. CONCLUSIONS: Kawasaki disease is an autoimmune vasculitis that can worsen with simultaneous syndromes associated with high mortality. It is important to know this type of alterations and their differences to properly discern and implement effective and timely treatment.

INTRODUCCIÓN: La enfermedad de Kawasaki es una vasculitis de pequeños y medianos vasos, con elevada prevalencia en todo el mundo. Además de los aneurismas coronarios, esta vasculitis puede generar diversas complicaciones sistémicas, como el síndrome de choque por enfermedad de Kawasaki y el síndrome de tormenta de citocinas por enfermedad de Kawasaki. REPORTE DE CASO: Paciente masculino de 12 años de edad, que inició su padecimiento con pirosis, fiebre súbita de 40 ºC e ictericia, por lo que se le prescribió tratamiento con antipiréticos y subsalicilato de bismuto, sin reacción satisfactoria. Se agregó vómito de contenido gastroalimentario en tres ocasiones y dermatosis maculopapular centrípeta. Después de 12 horas de estancia intrahospitalaria fue valorado por personal del servicio de Inmunología Pediátrica, quienes informaron datos de inestabilidad hemodinámica por taquicardia persistente, llenado capilar inmediato, pulso intenso, oliguria de 0.3 mL/kg/h de gasto urinario parcial con orina condensada; las cifras de tensión arterial sistólica se encontraban debajo del percentil 50%, y había polipnea y saturación limítrofe en 93%. En los estudios paraclínicos llamó la atención el rápido descenso del conteo plaquetario (de 297,000 a 59,000 en 24 horas), así como el índice neutrófilo-linfocito de 12. Se determinaron las concentraciones de antígeno NS1, IgM e IgG para dengue y PCR para virus SARS-CoV-2, que resultaron negativas. Se estableció el diagnóstico definitivo de enfermedad de Kawasaki con síndrome de choque por enfermedad de Kawasaki. La evolución del paciente fue satisfactoria, con disminución de la fiebre luego de la administración de gammaglobulina en el décimo día de hospitalización, y se inició un nuevo protocolo con prednisona (50 mg/día), al integrarse el síndrome de tormenta de citocinas por enfermedad de Kawasaki simultáneo con las alteraciones preexistentes, es decir: enfermedad de Kawasaki y síndrome de choque por enfermedad de Kawasaki por trombocitopenia, hepatoesplenomegalia, fiebre, adenopatías; además, ferritina de 605 mg/dL y transaminasemia. El ecocardiograma de control no mostró modificaciones coronarias y se otorgó el alta hospitalaria después de 48 horas de iniciar el tratamiento con el corticosteroide, con plan de seguimiento en 14 días. CONCLUSIONES: La enfermedad de Kawasaki es una vasculitis autoinmunitaria que puede agravarse con síndromes simultáneos asociados y generar elevada mortalidad. Es importante conocer este tipo de alteraciones y sus diferencias para discernir de forma adecuada e implementar el tratamiento eficaz y oportuno.

Aporte de fluidos en el pacientes pediátricos hospitalizados / Fluid intake in hospitalized pediatric patients

El aporte de fluidos constituye un elemento central en la atención del paciente pediátrico hospitalizado, existiendo aún controversias acerca de cuál es la composición óptima, la dosis adecuada y la mejor estrategia para administrar los mismos. El propósito de este artículo de actualización es brindar al médico que se desempeña en las diferentes áreas de la internación pediátrica, conceptos y enfoques terapéuticos que lo ayuden en la asistencia de los pacientes que por diversos motivos requieren la administración de fluidos endovenosos. La recomendación de utilizar cristaloides en la reanimación es casi uniforme. Se observa una clara tendencia al uso de soluciones isotónicas balanceadas para la reposición del déficit previo y el aporte de fluidos de mantenimiento. En relación a la dosis y a la estrategia, es generalizada la recomendación de un enfoque más restrictivo en el aporte de volumen, aún en los pacientes con shock, donde es necesario lograr un balance entre una resucitación efectiva y el riesgo de sobrecarga de fluidos. Respecto a la administración de albúmina al 20% en el paciente crítico con hipoalbuminemia, la evidencia existente es escasa y no permite formular recomendaciones. Sin embargo, es frecuente su uso en la práctica asistencial

Intravenous fluids administration is a central element in the care of hospitalized pediatric patients, and there are still controversies about what is the optimal composition, the appropriate dose, and the best strategy for their administration. The purpose of this narrative review is to provide the physicians who works in the different areas of pediatric hospitalization, concepts and therapeutic approaches that help them in the care of patients who for diverse reasons require administration of intravenous fluids. The recommendation to use crystalloids in resuscitation is almost uniform. There is a clear trend towards the use of balanced isotonic solutions to replace the previous deficit and the supply of maintenance fluids. In relation to the dose and strategy, the recommendation of a more restrictive approach in volume administration is generalized, even in patients with shock, where it is necessary to strike a balance between effective resuscitation and the risk of fluid overload. Regarding the administration of 20% albumin in critically ill patients with hypoalbuminemia, the existing evidence is scarce and does not allow recommendations to be formulated. However, it is frequently used in healthcare practice

Hemorragia postparto: intervenciones y tratamiento del profesional de enfermería para prevenir shock hipovolémico / Postpartum hemorrhage: Nursing interventions and management to prevent hypovolemic shock

Introducción: En Colombia la hemorragia postparto es la segunda causa de mortalidad en mujeres gestantes de 24 a 34 años con 6,9 casos por cada 1000 nacidos vivos. Después del parto se prevé que el 8.2% de las mujeres latinoamericanas presentarán hemorragia postparto. Objetivo: Describir el cuidado de enfermería a mujeres que presentan hemorragia postparto para disminuir el riesgo de shock hipovolémico, a través de una revisión integrativa de la literatura. Metodología: Revisión integrativa de la literatura siguiendo la propuesta por Sasso, de Campos y Galvão, se realizó una búsqueda en ClinicalKey, LILACS, CINAHL, Epistemonikos, Cochrane Library, PubMed, Scielo y Google Scholar; se incluyeron artículos publicados en los últimos cinco años, en español, inglés y portugués, se clasificaron por nivel de evidencia y grado de recomendación. Esta investigación es de bajo riesgo por ser de tipo documental. Resultados: Se recopilaron 41 artículos definitivos. La información se organizó en: cuadro clínico, cuidados de enfermería y dificultades en la atención gineco-obstétrica. Discusión: El profesional de enfermería debe identificar barreras en la atención evaluando la capacidad resolutiva de las instituciones y analizando los casos de muerte materna. Se recomienda el uso de misoprostol con oxitocina o únicamente de carbetocina y la combinación de ergometrina con oxitocina según el volumen de sangrado. Conclusión: Es pertinente realizar un examen físico para reconocer signos de inestabilidad hemodinámica, y de shock hipovolémico. Además, los diagnósticos e intervenciones de enfermería se enfocan en brindar cuidados de calidad, para evitar complicaciones como la muerte.

Introduction: In Colombia, postpartum hemorrhage is the second leading cause of death in pregnant women at a rate of 6.9 deaths per 1,000 live births. After childbirth, 8.2% of Latin American women are expected to have postpartum hemorrhage. Objective: To describe nursing care delivered to women with postpartum hemorrhage to reduce the risk of hypovolemic shock by means of an integrative literature review. Materials and Methods: Following the approach suggested by Sasso, de Campos and Galvão, an integrative literature review was conducted on ClinicalKey, LILACS, CINAHL, Epistemonikos, Cochrane Library, PubMed and ScieELO Google Scholar databases. Articles published in the last five years in Spanish, English and Portuguese were selected and classified by their level of evidence and degree of recommendation. This is a low-risk research due to its documentary nature. Results: 41 articles were finally selected and classified into clinical picture, nursing care and challenges in OBGYN care. Discussion: Nursing professionals should identify barriers to care by evaluating institutional problem-solving capacity and analyzing maternal death cases. Using misoprostol and oxytocin or only carbetocin and ergometrine-oxytocin is suggested based on the quantity of blood loss. Conclusions: Performing a physical examination is important to recognize signs of hemodynamic instability and hypovolemic shock. Nursing diagnoses and interventions focus on providing quality patient care to prevent certain complications such as death.

Introdução: Na Colômbia, a hemorragia pós-parto é a segunda principal causa de mortalidade em mulheres grávidas de 24-34 anos, com 6,9 casos por 1000 nascidos vivos. Após o parto, 8,2% das mulheres latino-americanas devem sofrer de hemorragia pós-parto. Objetivo: Descrever os cuidados de enfermagem a mulheres com hemorragia pós-parto para reduzir o risco de choque hipovolêmico, através de uma revisão integrativa da bibliografia. Metodologia: Revisão integrativa da bibliografia seguindo a proposta de Sasso, de Campos e Galvão, foi realizada uma pesquisa em ClinicalKey, LILACS, CINAHL, Epistemonikos, Cochrane Library, PubMed, Scielo e Google Scholar; foram incluídos artigos publicados nos últimos cinco anos em espanhol, inglês e português, classificados por nível de evidência e grau de recomendação. Esta é uma pesquisa de baixo risco, pois é do tipo documental. Resultados: Foram recolhidos 41 artigos definitivos. A informação foi organizada em: quadro clínico, cuidados de enfermagem e dificuldades nos cuidados gineco-obstetrítricos. Discussão: O profissional de enfermagem deve identificar as barreiras ao cuidado, avaliando a capacidade das instituições e analisando os casos de morte materna. O uso de misoprostol com ocitocina, ou carbetocina isoladamente, e a combinação de ergometrina com ocitocina são recomendados dependendo do volume de sangramento. Conclusão: O exame físico para sinais de instabilidade hemodinâmica e choque hipovolêmico é relevante. Além disso, os diagnósticos e intervenções de enfermagem concentram-se na prestação de cuidados de qualidade para evitar complicações como a morte.

Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19. / Incidência e fatores de risco para hipotensão pós-intubação em pacientes críticos com COVID-19.

OBJECTIVE: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. METHODS: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. RESULTS: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). CONCLUSION: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.

OBJETIVO: Avaliar a incidência de fatores de risco para hipotensão pósintubação em pacientes críticos com COVID-19. METÓDOS: Foi realizado um estudo retrospectivo com 141 pacientes com COVID-19 que foram intubados na unidade de terapia intensiva. Hipotensão pós-intubação foi definida como a necessidade de qualquer dose de vasopressor a qualquer momento em até 60 minutos após a intubação. Pacientes com parada cardiorrespiratória relacionada à intubação e hipotensão antes da intubação foram excluídos do estudo. RESULTADOS: Dos 141 pacientes incluídos, 53 pacientes (37,5%) e 43,6% dos pacientes (n = 17) eram do sexo feminino. A idade mediana do grupo com hipotensão pós-intubação foi de 75 anos (amplitude interquartil: 67,0 - 84,0). Na análise multivariada, índice de choque ≥ 0,90 (RC = 7,76; IC95% 3,14 - 19,21; p < 0,001), níveis de albumina < 2,92g/dL (RC = 3,65; IC95% 1,49 - 8,96; p = 0,005) e níveis de procalcitonina (RC = 1,07, IC95% 1,01 - 1,15; p = 0,045) foram fatores de risco independentes para hipotensão pós-intubação. A mortalidade hospitalar foi semelhante em pacientes com hipotensão pós-intubação e pacientes sem hipotensão pós-intubação (92,5% versus 85,2%; p = 0,29). CONCLUSÃO: A incidência de hipotensão pós-intubação foi de 37,5% em pacientes críticos com COVID-19. Um índice de choque ≥ 0,90 e níveis de albumina < 2,92g/ dL foram independentemente associados à hipotensão pós-intubação. Além disso, índice de choque ≥ 0,90 pode ser uma ferramenta do leito antes da intubação endotraqueal. Neste estudo, a hipotensão pós-intubação não esteve associada ao aumento da mortalidade hospitalar em pacientes com COVID-19.

Caracterización de los pacientes con enfermedades vasculares periféricas fallecidos en un período de cuatro años / Characterization of patients with peripheral vascular diseases who died in a period of four years

Introducción: Las enfermedades vasculares periféricas constituyen un problema de salud en el ámbito mundial por resultar causa importante de discapacidad y de invalidez. Objetivo: Caracterizar a los pacientes con enfermedades vasculares periféricas fallecidos en un período de cuatro años. Método: Se realizó un estudio descriptivo y analítico en los pacientes fallecidos entre enero de 2015 y diciembre de 2018. Se estudiaron variables sociodemográficas y clínicas. Se estimaron las frecuencias absolutas y relativas, así como la tasa de mortalidad. Se identificó la asociación entre las variables con la causa directa de muerte. Resultados: El 42,7 por ciento de los diabéticos fallecieron; de estos, el 57,5 por ciento estaban descompensados. La hipertensión arterial, el tabaquismo y la diabetes mellitus fueron los factores de riesgo más frecuentes. La tasa de mortalidad total resultó 0,171/1000 ingresos. Como enfermedades arteriales más frecuente aparecieron los AAA (28,1 por ciento ) y la angiopatía diabética (25 por ciento ); y, como parte de esta última, el pie (25,7 por ciento ). La aneurismectomía con injerto por sustitución representó la cirugía revascularizadora más realizada (58,8 por ciento ). El shock hipovolémico y el tromboembolismo pulmonar predominaron como complicaciones posquirúrgicas (15,7 por ciento ). El shock séptico (31,6 por ciento ) y la bronconeumonía bacteriana (25,7 por ciento) fueron las causas directas de muerte. Conclusiones: Se logró caracterizar a los pacientes con enfermedades vasculares periféricas fallecidos en los últimos cuatro años, por lo que estimaron la tasa de prevalencia y la tendencia anual de la mortalidad en el Instituto Nacional de Angiología y Cirugía Vascular en ese período; asimismo, las variables asociadas a las causas directas de muerte(AU)

Introduction: Peripheral vascular diseases are a global health problem because they are a major cause of disability. Objective: Characterize patients with peripheral vascular diseases who died over a period of four years. Method: A descriptive and analytical study was conducted in patients who died between January 2015 and December 2018. Socio-demographic and clinical variables were studied. Absolute and relative frequencies were estimated, as well as the mortality rate. The association between the variables with the direct cause of death was identified. Results: 42.7 percent of diabetic patients died; of these, 57.5 percent were decompensated. High blood pressure, smoking and diabetes mellitus were the most frequent risk factors. The total mortality rate was 0.171/1000 admissions. The most frequent arterial diseases were AAA (28.1 percent) and diabetic angiopathy (25 percent); and, as part of the latter, foot angiopathy (25.7 percent). Aneurysmectomy with graft substitution represented the most performed revascularizing surgery (58.8 percent). Hypovolemic shock and pulmonary thromboembolism predominated as post-surgical complications (15.7 percent). Septic shock (31.6 percent) and bacterial bronchopneumonia (25.7 percent) were the direct causes of death. Conclusions: It was possible to characterize patients with peripheral vascular diseases who died in the last four years, so they estimated the prevalence rate and the annual trend of mortality at the National Institute of Angiology and Vascular Surgery in that period; also, the variables associated with direct causes of death(AU)

Características clínico quirúrgicas de los pacientes con trauma cerrado de abdomen / Clinical-Surgical Characteristics of Patients with Blunt Abdominal Trauma

Introducción: El traumatismo abdominal cerrado puede provocar lesiones orgánicas graves con hemorragias que demandan un tratamiento quirúrgico emergente y es la principal causa de muertes evitables en todos los grupos de edad. Objetivo: Evaluar las características clínico quirúrgicas de los pacientes con trauma cerrado de abdomen. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo para evaluar el comportamiento del trauma cerrado de abdomen en 81 pacientes atendidos en el Hospital General Provincial Docente "Roberto Rodríguez Fernández" de Morón desde enero del 2014 hasta diciembre de 2019. Resultados: El adulto joven fue el grupo de edad predominante (34,6 por ciento) del sexo masculino (19,8 por ciento), el accidente de tránsito (48,1 por ciento) fue la causa principal. El cuadro hemorrágico (39,5 por ciento) seguidos del cuadro doloroso abdominal (38,3 por ciento) representaron los síntomas clínicos más relevantes. La positividad de los exámenes auxiliares estuvo representada por la ecografía abdominal (74,1 por ciento) seguida de la punción abdominal (9,9 por ciento. Las lesiones hepáticas (27,0 por ciento) seguidas de las esplénicas (19,0 percent) fueron las vísceras macizas más afectadas. El 77,8 por ciento fue intervenido quirúrgicamente y las técnicas quirúrgicas hepáticas fueron las más empleadas para un total de 17 casos (26,9 por ciento). El choque hipovolémico (12,7 por ciento) fue la complicación posoperatoria más encontrada. Se reportó un 12,3 por ciento de fallecidos. Conclusiones: El paciente con trauma cerrado de abdomen debe ser considerado siempre politraumatizado cuyo tratamiento inicial se dirige a la estabilización rápida e identificación de lesiones que amenacen la vida(AU)

Introduction: Blunt abdominal trauma can cause severe organ injury with hemorrhage demanding emergent surgical treatment. It is the leading cause of preventable death among all age groups. Objective: To assess the clinical-surgical characteristics of patients with blunt abdominal trauma. Methods: A descriptive and retrospective observational study was carried out to assess the characteristics of blunt abdominal trauma in 81 patients treated at Roberto Rodríguez Fernández General Provincial Teaching Hospital of Morón from January 2014 to December 2019. Results: Young adults represented the predominant age group (34.6 percent), together with the male sex (19.8 percent). Traffic accident (48.1 percent) was the main cause. Hemorrhagic symptoms (39.5 percent) was the most relevant clinical symptoms, followed by abdominal pain (38.3 percent). Positive results in complementary tests were represented by abdominal ultrasound (74.1 percent), followed by abdominal puncture (9.9 percent). Hepatic lesions (27.0 percent) was the most affected solid viscera, followed by splenic lesions (19.0 percent). 77.8 percent of cases were operated on and hepatic surgical techniques were the most frequently used, accounting for 17 cases (26.9 percent). Hypovolemic shock (12.7 percent) was the most frequent postoperative complication. A death rate of 12.3 percent was reported. Conclusions: The patient with blunt abdominal trauma should always be considered polytraumatized, in which case the initial treatment is aimed at rapid stabilization and identification of life-threatening injuries(AU)

Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning. / Predição de choque séptico e hipovolêmico em pacientes de unidade de terapia intensiva com o uso de machine learning.

OBJECTIVE: To create and validate a model for predicting septic or hypovolemic shock from easily obtainable variables collected from patients at admission to an intensive care unit. METHODS: A predictive modeling study with concurrent cohort data was conducted in a hospital in the interior of northeastern Brazil. Patients aged 18 years or older who were not using vasoactive drugs on the day of admission and were hospitalized from November 2020 to July 2021 were included. The Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost classification algorithms were tested for use in building the model. The validation method used was k-fold cross validation. The evaluation metrics used were recall, precision and area under the Receiver Operating Characteristic curve. RESULTS: A total of 720 patients were used to create and validate the model. The models showed high predictive capacity with areas under the Receiver Operating Characteristic curve of 0.979; 0.999; 0.980; 0.998 and 1.00 for the Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost algorithms, respectively. CONCLUSION: The predictive model created and validated showed a high ability to predict septic and hypovolemic shock from the time of admission of patients to the intensive care unit.

OBJETIVO: Criar e validar um modelo de predição de choque séptico ou hipovolêmico a partir de variáveis de fácil obtenção coletadas na admissão de pacientes internados em uma unidade de terapia intensiva. MÉTODOS: Estudo de modelagem preditiva com dados de coorte concorrente realizada em um hospital do interior do nordeste brasileiro. Foram incluídos pacientes com 18 anos ou mais sem uso de droga vasoativa no dia da admissão e que foram internados entre novembro de 2020 e julho de 2021. Foram testados os algoritmos de classificação do tipo Decision Tree, Random Forest, AdaBoost, Gradient Boosting e XGBoost para a construção do modelo. O método de validação utilizado foi o k-fold cross validation. As métricas de avaliação utilizadas foram recall, precisão e área sob a curva Receiver Operating Characteristic. RESULTADOS: Foram utilizados 720 pacientes para criação e validação do modelo. Os modelos apresentaram alta capacidade preditiva com área sob a curva Receiver Operating Characteristic de 0,979; 0,999; 0,980; 0,998 e 1,00 para os algoritmos de Decision Tree, Random Forest, AdaBoost, Gradient Boosting e XGBoost, respectivamente. CONCLUSÃO: O modelo preditivo criado e validado apresentou elevada capacidade de predição do choque séptico e hipovolêmico desde o momento da admissão de pacientes na unidade de terapia intensiva.