Ana Milena Del Valle - Academia.edu (original) (raw)

Papers by Ana Milena Del Valle

Research paper thumbnail of Endoprótesis biliar en el manejo transitorio de la coledocolitiasis

Revista médica de Chile, 2006

Research paper thumbnail of Intraoperative combination of resuscitative endovascular balloon occlusion of the aorta and a median sternotomy in hemodynamically unstable patients with penetrating chest trauma: Is this feasible?

The journal of trauma and acute care surgery, 2018

Recent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) i... more Recent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective life-saving intervention in patients with severe torso trauma. However, the deployment of REBOA in patients with isolated penetrating intrathoracic injuries remains controversial. We propose that a median sternotomy be performed in conjunction with REBOA as a feasible and effective means of hemorrhage control in patients suffering from penetrating chest trauma who present hemodynamically unstable. The objective of our study was to present our initial experience with this approach. A prospectively collected case series of the use of REBOA (10 Fr) in conjunction with a median sternotomy from January 2015 to December 2016 at a Level I Trauma Center. We included hemodynamically unstable non-compressible torso hemorrhage patients with penetrating chest trauma who underwent intraoperative REBOA deployment plus median sternotomy. A total of 68 trauma-related emergent thoracic sur...

Research paper thumbnail of Single Pass Whole-Body versus Organ-Selective Computed Tomography for Trauma: Timely diagnosis versus radiation exposure? – An observational Study

Background Single Pass Whole-Body Computed Tomography (WBCT) has been used as a high yield diagno... more Background Single Pass Whole-Body Computed Tomography (WBCT) has been used as a high yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment, have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to Organ-Selective CT and it does not inflict further delays in treatment. Methods We retrospectively review all trauma patients in whom CT-scans were performed on arrival at a Level I Trauma Center from January, 2016 to December, 2017. Results 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma and head injuries were the most common (71.9%) injured organ. The OSCT group required subsequent trips to the scanner suite for follow-up studies to rule out other potential injuries which i...

Research paper thumbnail of Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2020

Aim: Whole-body computed tomography (WBCT) has been used as a high-yield diagnostic tool in traum... more Aim: Whole-body computed tomography (WBCT) has been used as a high-yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to organ-selective CT (OSCT), and it does not inflict further delays in diagnosis. Materials and methods: We retrospectively review all trauma patients in whom CT scans were performed on arrival at a level I trauma center, from January 2016 to December 2017. Results: A total of 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma, and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma, and head injuries were the most common (71.9%). The OSCT group required subsequent follow-up studies to rule out other injuries, which in turn did not occur in the WBCT group (47.2% vs 0%, p < 0.001). The total radiation exposure dose was higher in the OSCT group [22 mSv (IQR 6-31) vs 15.1 mSv (IQR 9.9-24.8) p < 0.001]. The median CT scan-to-diagnosis time was lower in the WBCT group [22 minutes (14-32) vs 32 minutes (21-65); p < 0.001]. Conclusion: The OSCT has the potential of missing potentially life-threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient's overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in diagnosis. Level of evidence: V, therapeutic.

Research paper thumbnail of REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

Colombia médica, 2020

Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An ... more Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompress...

Research paper thumbnail of Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

Colombia Médica : CM, 2020

Purpose: The objective of this study was to evaluate the implementation of a new single-pass whol... more Purpose: The objective of this study was to evaluate the implementation of a new single-pass whole-body computed tomography Protocol in the management of patients with severe trauma. Methods: This was a descriptive evaluation of polytrauma patients who underwent whole-body computed tomography. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, whole-body computed tomography parameters and outcome variables were evaluated. Results: Were included 263 patients. Median injury severity score was 22 (IQR: 16-22). Time between arrival to the emergency department and completing the whole-body computed tomography was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50; p= 0.96)]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among ...

Research paper thumbnail of Vascular Exposures in the Upper Extremities

Atlas of Trauma, 2019

Owing to technological advances and lessons learned in modern wars, vascular trauma management ha... more Owing to technological advances and lessons learned in modern wars, vascular trauma management has undergone multiple changes. Despite this, acute traumatic hemorrhage remains responsible for 90% of military and 40% of civilian deaths, with vascular injuries of the extremities being the most frequent. According to the Western Trauma Association (WTA), peripheral vascular trauma is defined as injury to the axillobrachial axis and its branches in the upper extremity, or trauma of the femoral-popliteal axis and its collaterals in the lower limb. Forty to 75% of these injuries are secondary to penetrating trauma, mainly gunshot, while blunt trauma occurs in approximately 5–25% of cases. In the upper extremity, brachial artery has the highest incidence of injury. When we confront vascular trauma, physical examination will lead us to its management and treatment, which will be informed by the hemodynamic stability of the patient and the presence of hard or soft signs. In the asymptomatic patient, physical examination and the ankle-brachial index (ABI) or ankle-brachial pressure index (ABPI) will allow a triage management. Currently, the gold standard study for vascular injuries is the Computed Tomography Angiography (CTA). The findings of this test will lead to the type of treatment to be performed, from medical management of vasospasm to endovascular and classic techniques of open surgery.

Research paper thumbnail of Vascular Exposures in the Lower Extremities

Research paper thumbnail of Resuscitative Endovascular Balloon of the Aorta is feasible in penetrating chest trauma with major hemorrhage

Journal of Trauma and Acute Care Surgery, 2020

BACKGROUND Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an emerging optio... more BACKGROUND Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an emerging option for hemorrhage control, but its use is limited in scenarios such as penetrating chest trauma. The aim of this study was to describe the use of REBOA as a resuscitative adjunct in these cases with major hemorrhage and to propose a new clinical management algorithm. METHODS This was a prospective, observational study conducted at a single level I trauma center in Colombia. We included all patients greater than 14 years of age with severe trauma who underwent REBOA from January, 2015 to December, 2019. Patients received REBOA if they were in hemorrhagic shock and were unresponsive to resuscitation. RESULTS A total of 56 patients underwent REBOA placement of which 37 had penetrating trauma, and 23 had chest trauma. All patients were hemodynamically unstable upon arrival to the emergency department, median of systolic blood pressure of 69 (IQR: 57-90) mm Hg and median ISS was 25 (IQR: 25-41). All REBOA's were deployed and inflated in Zone 1, median inflation time was 40 minutes (IQR:26-55), and no adverse neurologic outcomes were observed. Fifteen patients had REBOA and a median sternotomy. Eleven patients had concomitant abdominal wounds. Overall mortality was 28.6% and there was no significant difference between penetrating versus blunt trauma patients (21.6% vs 42.1%, p = 0.11). The survival rate of thoracic injured patients was similar to the predicted survival (65.2 % vs 63.3%). CONCLUSION REBOA can be used safely in penetrating chest trauma and the implementation of a REBOA management algorithm is feasible with a well-trained multidisciplinary team. LEVEL OF EVIDENCE V, therapeutic.

Research paper thumbnail of Uso de la tomografía corporal total en pacientes con trauma grave

Revista Colombiana de Cirugía, 2020

Introducción. La tomografía corporal (TC) total en la evaluación de pacientes con trauma grave, p... more Introducción. La tomografía corporal (TC) total en la evaluación de pacientes con trauma grave, puede ser una herramienta eficaz y segura para decidir entre un tratamiento quirúrgico y uno no quirúrgico, pero aún no son claras las implicaciones diagnósticas y los riesgos asociados con esta técnica. Métodos. Se incluyeron pacientes mayores de 15 años con trauma grave que fueron sometidos a TC total. Se evaluaron la seguridad, la efectividad y la eficiencia por medio de los parámetros de incidencia de nefropatía inducida por los medios de contraste, dosis total de radiación por paciente, proporción de casos en los que la TC total cambió el manejo, y el retraso en el diagnóstico. Resultados. Se incluyeron 263 pacientes, 83 % sufrieron trauma cerrado y 17 % sufrieron trauma penetrante. La gravedad de la lesión fue mayor en estos últimos y, sin embargo, el trauma cerrado con inestabilidad hemodinámica se presentó con mayores grados de choque. El 65 % de los pacientes recibió tratamiento ...

Research paper thumbnail of Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma

Colombian Journal of Anesthesiology, 2017

Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. T... more Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. This has led to the development of new devices to control bleeding, including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Objective: To perform a non-systematic review of the literature on the use of Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma. Materials and methods: A systematic literature search through Medline was conducted. Articles relevant to our objective were selected. A qualitative and narrative synthesis of results is presented. Results: Our qualitative and narrative results show that Resuscitative Endovascular Balloon Occlusion of the Aorta could be a safe and effective intervention for the control of haemorrhage in abdomino-pelvic trauma. Its use is controversial in thoracic trauma. Finally, the performance of this intervention may cause complications. Conclusion: Resuscitative Endovascular Balloon Occlusion of the Aorta is an alternative that can be used in damage control surgery. It could be effective for early control of bleeding in patients with non-compressible torso haemorrhage. As a complex intervention, REBOA

Research paper thumbnail of Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma

Colombian Journal of Anesthesiology, 2017

Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. T... more Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. This has led to the development of new devices to control bleeding, including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Objective: To perform a non-systematic review of the literature on the use of Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma. Materials and methods: A systematic literature search through Medline was conducted. Articles relevant to our objective were selected. A qualitative and narrative synthesis of results is presented. Results: Our qualitative and narrative results show that Resuscitative Endovascular Balloon Occlusion of the Aorta could be a safe and effective intervention for the control of haemorrhage in abdomino-pelvic trauma. Its use is controversial in thoracic trauma. Finally, the performance of this intervention may cause complications. Conclusion: Resuscitative Endovascular Balloon Occlusion of the Aorta is an alternative that can be used in damage control surgery. It could be effective for early control of bleeding in patients with non-compressible torso haemorrhage. As a complex intervention, REBOA

Research paper thumbnail of Caracterización de lesiones causadas por accidentes de tránsito en dos instituciones de nivel I en Cali entre 2012-2014 y su relación con la aplicación de un plan de seguridad vial

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2018

Research paper thumbnail of Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses

Colombia Medica, 2021

Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life ... more Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed postoperatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. Al...

Research paper thumbnail of Uso actual del balón de resucitación aórtico endovascular (REBOA) en trauma

Revista Colombiana de Anestesiología

Introducción: La hemorragia no compresible del torso es la principal causa de muerte asociada al ... more Introducción: La hemorragia no compresible del torso es la principal causa de muerte asociada al trauma. Esto ha llevado al desarrollo de nuevos dispositivos para el control hemorrágico, y uno de estos es el balón de resucitación aórtico endovascular (REBOA). Objetivo: Realizar una revisión no sistemática de la literatura con respecto al uso del REBOA en trauma. Materiales y métodos: Se realizó una búsqueda sistemática de la literatura en Medline, se seleccionaron los artículos relevantes para el logro de nuestro objetivo y con estos se realizó una síntesis cualitativa y narrativa de la literatura disponible. Resultados: Nuestra síntesis cualitativa y narrativa muestra que el REBOA podría ser una intervención segura y efectiva para el control de la hemorragia en trauma abdominopélvico. Su uso es controvertido en trauma torácico. Finalmente, el uso del balón de resucitación aórtico endovascular puede causar complicaciones relacionadas con su aplicación. Conclusión: El REBOA es una alternativa en la cirugía de control de daños que podría ser efectiva en el control de la hemorragia no compresible del torso de origen abdominopélvico. Al ser una intervención compleja, el REBOA se encuentra todavía en fase de desarrollo y la evidencia disponible no es suficiente para proveer recomendaciones fuertes.

Research paper thumbnail of Endoprótesis biliar en el manejo transitorio de la coledocolitiasis

Revista médica de Chile, 2006

Research paper thumbnail of Intraoperative combination of resuscitative endovascular balloon occlusion of the aorta and a median sternotomy in hemodynamically unstable patients with penetrating chest trauma: Is this feasible?

The journal of trauma and acute care surgery, 2018

Recent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) i... more Recent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective life-saving intervention in patients with severe torso trauma. However, the deployment of REBOA in patients with isolated penetrating intrathoracic injuries remains controversial. We propose that a median sternotomy be performed in conjunction with REBOA as a feasible and effective means of hemorrhage control in patients suffering from penetrating chest trauma who present hemodynamically unstable. The objective of our study was to present our initial experience with this approach. A prospectively collected case series of the use of REBOA (10 Fr) in conjunction with a median sternotomy from January 2015 to December 2016 at a Level I Trauma Center. We included hemodynamically unstable non-compressible torso hemorrhage patients with penetrating chest trauma who underwent intraoperative REBOA deployment plus median sternotomy. A total of 68 trauma-related emergent thoracic sur...

Research paper thumbnail of Single Pass Whole-Body versus Organ-Selective Computed Tomography for Trauma: Timely diagnosis versus radiation exposure? – An observational Study

Background Single Pass Whole-Body Computed Tomography (WBCT) has been used as a high yield diagno... more Background Single Pass Whole-Body Computed Tomography (WBCT) has been used as a high yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment, have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to Organ-Selective CT and it does not inflict further delays in treatment. Methods We retrospectively review all trauma patients in whom CT-scans were performed on arrival at a Level I Trauma Center from January, 2016 to December, 2017. Results 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma and head injuries were the most common (71.9%) injured organ. The OSCT group required subsequent trips to the scanner suite for follow-up studies to rule out other potential injuries which i...

Research paper thumbnail of Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2020

Aim: Whole-body computed tomography (WBCT) has been used as a high-yield diagnostic tool in traum... more Aim: Whole-body computed tomography (WBCT) has been used as a high-yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to organ-selective CT (OSCT), and it does not inflict further delays in diagnosis. Materials and methods: We retrospectively review all trauma patients in whom CT scans were performed on arrival at a level I trauma center, from January 2016 to December 2017. Results: A total of 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma, and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma, and head injuries were the most common (71.9%). The OSCT group required subsequent follow-up studies to rule out other injuries, which in turn did not occur in the WBCT group (47.2% vs 0%, p < 0.001). The total radiation exposure dose was higher in the OSCT group [22 mSv (IQR 6-31) vs 15.1 mSv (IQR 9.9-24.8) p < 0.001]. The median CT scan-to-diagnosis time was lower in the WBCT group [22 minutes (14-32) vs 32 minutes (21-65); p < 0.001]. Conclusion: The OSCT has the potential of missing potentially life-threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient's overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in diagnosis. Level of evidence: V, therapeutic.

Research paper thumbnail of REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

Colombia médica, 2020

Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An ... more Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompress...

Research paper thumbnail of Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

Colombia Médica : CM, 2020

Purpose: The objective of this study was to evaluate the implementation of a new single-pass whol... more Purpose: The objective of this study was to evaluate the implementation of a new single-pass whole-body computed tomography Protocol in the management of patients with severe trauma. Methods: This was a descriptive evaluation of polytrauma patients who underwent whole-body computed tomography. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, whole-body computed tomography parameters and outcome variables were evaluated. Results: Were included 263 patients. Median injury severity score was 22 (IQR: 16-22). Time between arrival to the emergency department and completing the whole-body computed tomography was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50; p= 0.96)]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among ...

Research paper thumbnail of Vascular Exposures in the Upper Extremities

Atlas of Trauma, 2019

Owing to technological advances and lessons learned in modern wars, vascular trauma management ha... more Owing to technological advances and lessons learned in modern wars, vascular trauma management has undergone multiple changes. Despite this, acute traumatic hemorrhage remains responsible for 90% of military and 40% of civilian deaths, with vascular injuries of the extremities being the most frequent. According to the Western Trauma Association (WTA), peripheral vascular trauma is defined as injury to the axillobrachial axis and its branches in the upper extremity, or trauma of the femoral-popliteal axis and its collaterals in the lower limb. Forty to 75% of these injuries are secondary to penetrating trauma, mainly gunshot, while blunt trauma occurs in approximately 5–25% of cases. In the upper extremity, brachial artery has the highest incidence of injury. When we confront vascular trauma, physical examination will lead us to its management and treatment, which will be informed by the hemodynamic stability of the patient and the presence of hard or soft signs. In the asymptomatic patient, physical examination and the ankle-brachial index (ABI) or ankle-brachial pressure index (ABPI) will allow a triage management. Currently, the gold standard study for vascular injuries is the Computed Tomography Angiography (CTA). The findings of this test will lead to the type of treatment to be performed, from medical management of vasospasm to endovascular and classic techniques of open surgery.

Research paper thumbnail of Vascular Exposures in the Lower Extremities

Research paper thumbnail of Resuscitative Endovascular Balloon of the Aorta is feasible in penetrating chest trauma with major hemorrhage

Journal of Trauma and Acute Care Surgery, 2020

BACKGROUND Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an emerging optio... more BACKGROUND Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an emerging option for hemorrhage control, but its use is limited in scenarios such as penetrating chest trauma. The aim of this study was to describe the use of REBOA as a resuscitative adjunct in these cases with major hemorrhage and to propose a new clinical management algorithm. METHODS This was a prospective, observational study conducted at a single level I trauma center in Colombia. We included all patients greater than 14 years of age with severe trauma who underwent REBOA from January, 2015 to December, 2019. Patients received REBOA if they were in hemorrhagic shock and were unresponsive to resuscitation. RESULTS A total of 56 patients underwent REBOA placement of which 37 had penetrating trauma, and 23 had chest trauma. All patients were hemodynamically unstable upon arrival to the emergency department, median of systolic blood pressure of 69 (IQR: 57-90) mm Hg and median ISS was 25 (IQR: 25-41). All REBOA's were deployed and inflated in Zone 1, median inflation time was 40 minutes (IQR:26-55), and no adverse neurologic outcomes were observed. Fifteen patients had REBOA and a median sternotomy. Eleven patients had concomitant abdominal wounds. Overall mortality was 28.6% and there was no significant difference between penetrating versus blunt trauma patients (21.6% vs 42.1%, p = 0.11). The survival rate of thoracic injured patients was similar to the predicted survival (65.2 % vs 63.3%). CONCLUSION REBOA can be used safely in penetrating chest trauma and the implementation of a REBOA management algorithm is feasible with a well-trained multidisciplinary team. LEVEL OF EVIDENCE V, therapeutic.

Research paper thumbnail of Uso de la tomografía corporal total en pacientes con trauma grave

Revista Colombiana de Cirugía, 2020

Introducción. La tomografía corporal (TC) total en la evaluación de pacientes con trauma grave, p... more Introducción. La tomografía corporal (TC) total en la evaluación de pacientes con trauma grave, puede ser una herramienta eficaz y segura para decidir entre un tratamiento quirúrgico y uno no quirúrgico, pero aún no son claras las implicaciones diagnósticas y los riesgos asociados con esta técnica. Métodos. Se incluyeron pacientes mayores de 15 años con trauma grave que fueron sometidos a TC total. Se evaluaron la seguridad, la efectividad y la eficiencia por medio de los parámetros de incidencia de nefropatía inducida por los medios de contraste, dosis total de radiación por paciente, proporción de casos en los que la TC total cambió el manejo, y el retraso en el diagnóstico. Resultados. Se incluyeron 263 pacientes, 83 % sufrieron trauma cerrado y 17 % sufrieron trauma penetrante. La gravedad de la lesión fue mayor en estos últimos y, sin embargo, el trauma cerrado con inestabilidad hemodinámica se presentó con mayores grados de choque. El 65 % de los pacientes recibió tratamiento ...

Research paper thumbnail of Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma

Colombian Journal of Anesthesiology, 2017

Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. T... more Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. This has led to the development of new devices to control bleeding, including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Objective: To perform a non-systematic review of the literature on the use of Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma. Materials and methods: A systematic literature search through Medline was conducted. Articles relevant to our objective were selected. A qualitative and narrative synthesis of results is presented. Results: Our qualitative and narrative results show that Resuscitative Endovascular Balloon Occlusion of the Aorta could be a safe and effective intervention for the control of haemorrhage in abdomino-pelvic trauma. Its use is controversial in thoracic trauma. Finally, the performance of this intervention may cause complications. Conclusion: Resuscitative Endovascular Balloon Occlusion of the Aorta is an alternative that can be used in damage control surgery. It could be effective for early control of bleeding in patients with non-compressible torso haemorrhage. As a complex intervention, REBOA

Research paper thumbnail of Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma

Colombian Journal of Anesthesiology, 2017

Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. T... more Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. This has led to the development of new devices to control bleeding, including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Objective: To perform a non-systematic review of the literature on the use of Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma. Materials and methods: A systematic literature search through Medline was conducted. Articles relevant to our objective were selected. A qualitative and narrative synthesis of results is presented. Results: Our qualitative and narrative results show that Resuscitative Endovascular Balloon Occlusion of the Aorta could be a safe and effective intervention for the control of haemorrhage in abdomino-pelvic trauma. Its use is controversial in thoracic trauma. Finally, the performance of this intervention may cause complications. Conclusion: Resuscitative Endovascular Balloon Occlusion of the Aorta is an alternative that can be used in damage control surgery. It could be effective for early control of bleeding in patients with non-compressible torso haemorrhage. As a complex intervention, REBOA

Research paper thumbnail of Caracterización de lesiones causadas por accidentes de tránsito en dos instituciones de nivel I en Cali entre 2012-2014 y su relación con la aplicación de un plan de seguridad vial

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2018

Research paper thumbnail of Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses

Colombia Medica, 2021

Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life ... more Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed postoperatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. Al...

Research paper thumbnail of Uso actual del balón de resucitación aórtico endovascular (REBOA) en trauma

Revista Colombiana de Anestesiología

Introducción: La hemorragia no compresible del torso es la principal causa de muerte asociada al ... more Introducción: La hemorragia no compresible del torso es la principal causa de muerte asociada al trauma. Esto ha llevado al desarrollo de nuevos dispositivos para el control hemorrágico, y uno de estos es el balón de resucitación aórtico endovascular (REBOA). Objetivo: Realizar una revisión no sistemática de la literatura con respecto al uso del REBOA en trauma. Materiales y métodos: Se realizó una búsqueda sistemática de la literatura en Medline, se seleccionaron los artículos relevantes para el logro de nuestro objetivo y con estos se realizó una síntesis cualitativa y narrativa de la literatura disponible. Resultados: Nuestra síntesis cualitativa y narrativa muestra que el REBOA podría ser una intervención segura y efectiva para el control de la hemorragia en trauma abdominopélvico. Su uso es controvertido en trauma torácico. Finalmente, el uso del balón de resucitación aórtico endovascular puede causar complicaciones relacionadas con su aplicación. Conclusión: El REBOA es una alternativa en la cirugía de control de daños que podría ser efectiva en el control de la hemorragia no compresible del torso de origen abdominopélvico. Al ser una intervención compleja, el REBOA se encuentra todavía en fase de desarrollo y la evidencia disponible no es suficiente para proveer recomendaciones fuertes.