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Publications

Journal Article Review Epublish

PubMed: 40585555 DOI: 10.1016/j.lana.2025.101144

Colombian consensus on the care of critically ill patients with suspected or confirmed severe yellow fever.

Lancet Reg Health Am 48:101144

Authors: Alex Julián Forero-Delgadillo, Jeison Andrés Morales-Olivera, Julián Fernando Celis-Guzmán, Omar Eduardo Zapata-Díaz, Gustavo Adolfo González-Varona, Camilo Alberto Acevedo-Bedoya, Rómulo Salazar-Fernández, Jaime Orlando Ordoñez, Henry Robayo-Amortegui, Alejandro Quintero-Altare, Diana Catalina Ramírez-Reyes, Juan Diego Melo-Pedraza, Juan Olivella-Gomez, Jessica María Forero, Abraham Katime-Zuñiga, Wilmer E Villamil-Gomez, Alfonso J Rodriguez-Morales, Ricardo Buitrago-Bernal, Fernando Bozza, Luis Felipe Reyes

Affiliations

  • Clinical and Translational Medicine Research Group, Critical Physiology Subdivision, Intensive Care Department, Hospital Federico Lleras Acosta, Ibagué, Colombia.
  • Intensive Care Department, Hospital Federico Lleras Acosta, Ibagué, Colombia.
  • School of Medicine, Faculty of Health Sciences, Universidad del Tolima, Ibagué, Colombia.
  • Department of Critical Care Medicine, Extracorporeal Life Support Unit (USVEC), Fundación Clínica Shaio, Bogotá, DC, Colombia.
  • Critical Care Medicine, School of Medicine, Universidad de La Sabana, Chía, Colombia.
  • Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia.
  • Department of Pediatric Nephrology, Funación Valle del Lili, Cali, Colombia.
  • Programa de Medicina, Universidad del Magdalena, Santa Marta, Magdalena, Colombia.
  • Servicio de Infectología, Universitario Julio Méndez Barreneche, Santa Marta, Magdalena, Colombia.
  • Comité de Medicina Tropical, Zoonosis y Medicina del Viajero, Asociación Colombiana de Infectología, Bogotá, DC, Colombia.
  • Centro de Investigación en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla, Colombia.
  • Faculty of Health Sciences, Universidad Científica del Sur, Lima, Peru.
  • Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira 660003, Risaralda, Colombia.
  • Unidad de Cuidados Intensivos, Fundación Clínica Shaio, Bogotá, DC, Colombia.
  • Department of Critical Care, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
  • National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.
  • ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, UK.

Abstract

Yellow fever is an arboviral disease transmitted by Aedes, Haemagogus and Sabethes mosquitoes. It features both urban and jungle transmission cycles. Its incidence has risen in Colombia due to deforestation, human expansion, and climate change. The disease can progress from a nonspecific febrile stage to a severe intoxication phase, characterised by multiple organ failure and high mortality rates. This consensus establishes criteria for early identification and management of severe yellow fever and recommendations for admission to the Intensive Care Unit in cases of liver dysfunction, kidney failure, or shock. An individualised haemodynamic resuscitation strategy is emphasised to avoid volume overload and not delay the use of norepinephrine in persistent hypotension. Additionally, we recommend addressing haematological and respiratory complications, including platelet transfusion restrictions and strict intra-abdominal pressure monitoring. In more severe cases, plasma exchange and renal replacement therapies are recommended. Based on evidence and the GRADE methodology, implementing these strategies aims to improve survival and reduce morbidity in critically ill yellow fever patients.

MeSH

Critical Illness, Yellow Fever