Ecografía a la cabecera (POCUS) en el paciente crítico: aplicaciones consolidadas, incertidumbres metodológicas y agenda de investigación para América Latina
Resumen
Introducción. La ecografía a la cabecera (point-of-care ultrasound, POCUS) se ha consolidado como competencia nuclear en medicina crítica, pero la velocidad de su adopción ha superado la maduración de su base empírica, con confusión sistemática entre aplicaciones de alta certeza y extrapolaciones fisiopatológicas no validadas. Objetivo. Sintetizar críticamente la evidencia sobre POCUS en el paciente crítico adulto, discriminando el nivel de certeza de cada dominio, analizando las fuentes de sesgo y proponiendo una agenda de investigación priorizada viable en América Latina. Métodos. Revisión narrativa (MEDLINE, Embase, Cochrane, Scopus, Web of Science y LILACS; enero 2008–julio 2026), priorizando guías GRADE, consensos Delphi, revisiones sistemáticas, ensayos aleatorizados y estudios de precisión diagnóstica; redacción ajustada a la escala SANRA. Síntesis. El rendimiento diagnóstico es alto y consistente en preguntas anatómicas dicotómicas y en la guía de procedimientos. Las guías SCCM 2024 sugieren —con recomendación condicional— la ultrasonografía para guiar el manejo del choque séptico, la disnea o falla respiratoria aguda y el choque cardiogénico, y para el manejo volémico dirigido; en paro cardíaco los datos son insuficientes. El metaanálisis de soporte (17 ensayos; n=1765) estimó reducción de mortalidad (RR 0,79; IC 95 % 0,67–0,95; certeza baja). La ecografía diafragmática predice el destete con precisión moderada (excursión: AUC 0,87; DOR 17,1; n=1204). El VExUS se asocia a lesión renal aguda (OR 2,63; IC 95 % 1,06–6,54; I²=74 %), efecto concentrado en cirugía cardíaca (OR 3,86; I²=0 %) y sin asociación con mortalidad. Conclusiones. El POCUS reduce la incertidumbre diagnóstica con impacto probable, no establecido con certeza alta, sobre desenlaces centrados en el paciente; su consolidación exige definiciones operacionales de la intervención, umbrales de competencia preespecificados, algoritmos terapéuticos vinculados y validación en escenarios de recursos restringidos.
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Derechos de autor 2026 Leidy Dayana Mora Torrejano , María Camila Jaimes Beltrán , Laura Alejandra Ochoa Ortiz
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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