Gestión del monitoreo multimodal, aplicando evidencia científica para optimizar el cuidado integral del paciente crítico
Palabras clave:
Monitorización multimodal, enfermería de cuidados críticos, cuidados intensivos, seguridad del paciente, (Tesauro UNESCO).
Resumen
La monitorización multimodal integra variables clave para guiar decisiones en tiempo real en la unidad de cuidados intensivos requiriendo un manejo clínico integral. El objetivo fue revisar la literatura sobre el rol cognitivo de enfermería en la monitorización multimodal, bajo el enfoque de la práctica basada en la evidencia. Se utilizó el método de revisión narrativa mediante búsqueda en bases de datos indexadas como PubMed, SciELO y Dialnet. Se evaluó el impacto de la inteligencia artificial en la interpretación algorítmica. Entre los principales resultados se declara que la enfermería integra críticamente los datos tecnológicos. Sus competencias abarcan la calibración, detección de artefactos y lectura contextual. No obstante, la fatiga por alarmas y la carga cognitiva limitan el rescate clínico. La monitorización es un sistema sociotécnico; la tecnología aporta señales objetivas, pero la enfermería ejerce el rol cognitivo superior, transformando datos en conciencia situacional y vigilancia dinámica.
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Barrit, S., Al Barajraji, M., El Hadwe, S., Niset, A., Foreman, B., Park, S., Lazaridis, C., Shutter, L., Appavu, B., Kirschen, M., Montellano, F., Rass, V., & Taccone, F. (2024). Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): An open, decentralized consensus. Critical Care, 28, 427. https://doi.org/10.1186/s13054-024-05211-8
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Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C., French, C., Machado, F., McIntyre, L., Ostermann, M., Prescott, H., Schorr, C., Simpson, S., Wiersinga, W., Alshamsi, F., Angus, D., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., & Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181-1247. https://doi.org/10.1007/s00134-021-06506-y
Ghaderi, C., Esmaeili, R., & Ebadi, A. (2022). Situation awareness in intensive care unit nurses: A qualitative directed content analysis. Frontiers in Public Health, 10, 999745. https://doi.org/10.3389/fpubh.2022.999745
Grasselli, G., Calfee, C., Camporota, L., Poole, D., Amato, M., Antonelli, M., Arabi, Y., Barbas, C., Beitler, J., Brochard, L., Brower, R., Cavalcanti, A., Combes, A., & Ferguson, N. (2023). ESICM guidelines on acute respiratory distress syndrome: Definition, phenotyping and respiratory support strategies. Intensive Care Medicine, 49(7), 727-759. https://doi.org/10.1007/s00134-023-07050-7
Hirsch, L., Fong, M., Leitinger, M., LaRoche, S., Beniczky, S., Abend, N., Lee, J., Wusthoff, C., Kane, N., & Westover, M. (2021). American Clinical Neurophysiology Society’s standardized critical care EEG terminology: 2021 version. Journal of Clinical Neurophysiology, 38(1), 1-29. https://doi.org/10.1097/WNP.0000000000000806
Honarmand, K., Sirimaturos, M., Hirshberg, E., Bircher, N., Agus, M., Carpenter, D., Downs, C., Farrington, E., Freire, A., Grow, A., Irving, S., Krinsley, J., Lanspa, M., Long, M., Nagpal, D., Preiser, J.-C., Srinivasan, V., Umpierrez, G., & Jacobi, J. (2024). Society of Critical Care Medicine guidelines on glycemic control for critically ill children and adults 2024. Critical Care Medicine, 52. https://doi.org/10.1097/CCM.0000000000006174
Klompas, M., Branson, R., Eichenwald, E., Greene, L., Howell, M., Lee, G., Magill, S., Maragakis, L., Priebe, G., Speck, K., Yokoe, D., & Berenholtz, S. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 43(6), 687-713. https://doi.org/10.1017/ice.2022.88
Kulkarni, A., Govil, D., Samavedam, S., Srinivasan, S., Ramasubban, S., Venkataraman, R., Pichamuthu, K., Jog, S., Divatia, J., & Myatra, S. (2022). ISCCM guidelines for hemodynamic monitoring in the critically ill. Indian Journal of Critical Care Medicine, 26(Suppl 2), S66-S76. https://doi.org/10.5005/jp-journals-10071-24301
Lim, L., Lee, H., Kim, J., Park, S., Lee, J., & Kim, Y. (2024). Real-time machine learning model to predict short-term mortality in critically ill patients: Development and international validation. Critical Care, 28, 114. https://doi.org/10.1186/s13054-024-04866-7
McGaughey, J., O’Halloran, P., Porter, S., & Blackwood, B. (2021). Early warning systems and rapid response systems for the prevention of patient deterioration on acute adult hospital wards. Cochrane Database of Systematic Reviews, 2021(11), CD005529. https://doi.org/10.1002/14651858.CD005529.pub3
Michard, F., Mulder, M., Gonzalez, F., & Sanfilippo, F. (2025). AI for the hemodynamic assessment of critically ill and surgical patients: Focus on clinical applications. Annals of Intensive Care, 15, 26. https://doi.org/10.1186/s13613-025-01448-w
Monnet, X., Cecconi, M., De Backer, D., Bakker, J., Mebazaa, A., & Teboul, J.-L. (2025). ESICM guidelines on circulatory shock and hemodynamic monitoring. Intensive Care Medicine. https://doi.org/10.1007/s00134-025-08137-z
Pinsky, M., & Cecconi, M. (2022). Effective hemodynamic monitoring. Critical Care, 26, 294. https://doi.org/10.1186/s13054-022-04173-z
Rae, P., Pearce, S., Greaves, P., Dall’Ora, C., Griffiths, P., & Endacott, R. (2021). Outcomes sensitive to critical care nurse staffing levels: A systematic review. Intensive and Critical Care Nursing, 67, 103110. https://doi.org/10.1016/j.iccn.2021.103110
Shaoru, C., Hui, Z., Su, W., Ruxin, J., Huiyi, Z., Hongmei, Z., & Hongyan, Z. (2023). Determinants of medical equipment alarm fatigue in practicing nurses: A systematic review. SAGE Open Nursing, 9, 23779608231207227. https://doi.org/10.1177/23779608231207227
Tas, J., Czosnyka, M., van der Horst, I., Park, S., van Heugten, C., Sekhon, M., Robba, C., Menon, D., Zeiler, F., & Aries, M. (2022). Cerebral multimodality monitoring in adult neurocritical care patients with acute brain injury: A narrative review. Frontiers in Physiology, 13, 1071161. https://doi.org/10.3389/fphys.2022.1071161
Teixeira, J., Hiremath, S., Kabli, A., Rewa, O., & Clark, E. (2025). Continuous kidney replacement therapies: Core Curriculum 2025. American Journal of Kidney Diseases, 85(6), 767-786. https://doi.org/10.1053/j.ajkd.2024.09.015
Vitt, J., Truong, T., Kiflezghi, M., Gonzalez, D., Riker, R., & Lazaridis, C. (2023). Multimodal and autoregulation monitoring in the neurointensive care unit. Frontiers in Neurology, 14, 1155986. https://doi.org/10.3389/fneur.2023.1155986
Walshe, N., Ryng, S., Drennan, J., O’Connor, P., O’Brien, S., Crowley, C., & Hegarty, J. (2021). Situation awareness and the mitigation of risk associated with patient deterioration: A meta-narrative review of theories and models and their relevance to nursing practice. International Journal of Nursing Studies, 124, 104086. https://doi.org/10.1016/j.ijnurstu.2021.104086
Xu, D., Li, X., Zhang, Y., Chen, L., & Wang, J. (2025). Exploring ICU nurses’ response to alarm management and strategies for alleviating alarm fatigue: A meta-synthesis and systematic review. BMC Nursing, 24, 359. https://doi.org/10.1186/s12912-025-03084-y
Yu, X., Ouyang, L., Li, J., Peng, Y., Zhong, D., Yang, H., & Zhou, Y. (2024). Knowledge, attitude, practice, needs, and implementation status of intensive care unit staff toward continuous renal replacement therapy: A survey of 66 hospitals in central and South China. BMC Nursing, 23, 472. https://doi.org/10.1186/s12912-024-01953-6
Chromik, J., Keller, M., Kraywinkel, K., Röhrig, R., & Strehlow, L. (2022). Computational approaches to alleviate alarm fatigue in intensive care medicine: A systematic literature review. Frontiers in Digital Health, 4, 843747. https://doi.org/10.3389/fdgth.2022.843747
Dall’Ora, C., Saville, C., Rubbo, B., Turner, L., Jones, J., & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Journal of Nursing Studies, 134, 104311. https://doi.org/10.1016/j.ijnurstu.2022.104311
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C., French, C., Machado, F., McIntyre, L., Ostermann, M., Prescott, H., Schorr, C., Simpson, S., Wiersinga, W., Alshamsi, F., Angus, D., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., & Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181-1247. https://doi.org/10.1007/s00134-021-06506-y
Ghaderi, C., Esmaeili, R., & Ebadi, A. (2022). Situation awareness in intensive care unit nurses: A qualitative directed content analysis. Frontiers in Public Health, 10, 999745. https://doi.org/10.3389/fpubh.2022.999745
Grasselli, G., Calfee, C., Camporota, L., Poole, D., Amato, M., Antonelli, M., Arabi, Y., Barbas, C., Beitler, J., Brochard, L., Brower, R., Cavalcanti, A., Combes, A., & Ferguson, N. (2023). ESICM guidelines on acute respiratory distress syndrome: Definition, phenotyping and respiratory support strategies. Intensive Care Medicine, 49(7), 727-759. https://doi.org/10.1007/s00134-023-07050-7
Hirsch, L., Fong, M., Leitinger, M., LaRoche, S., Beniczky, S., Abend, N., Lee, J., Wusthoff, C., Kane, N., & Westover, M. (2021). American Clinical Neurophysiology Society’s standardized critical care EEG terminology: 2021 version. Journal of Clinical Neurophysiology, 38(1), 1-29. https://doi.org/10.1097/WNP.0000000000000806
Honarmand, K., Sirimaturos, M., Hirshberg, E., Bircher, N., Agus, M., Carpenter, D., Downs, C., Farrington, E., Freire, A., Grow, A., Irving, S., Krinsley, J., Lanspa, M., Long, M., Nagpal, D., Preiser, J.-C., Srinivasan, V., Umpierrez, G., & Jacobi, J. (2024). Society of Critical Care Medicine guidelines on glycemic control for critically ill children and adults 2024. Critical Care Medicine, 52. https://doi.org/10.1097/CCM.0000000000006174
Klompas, M., Branson, R., Eichenwald, E., Greene, L., Howell, M., Lee, G., Magill, S., Maragakis, L., Priebe, G., Speck, K., Yokoe, D., & Berenholtz, S. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 43(6), 687-713. https://doi.org/10.1017/ice.2022.88
Kulkarni, A., Govil, D., Samavedam, S., Srinivasan, S., Ramasubban, S., Venkataraman, R., Pichamuthu, K., Jog, S., Divatia, J., & Myatra, S. (2022). ISCCM guidelines for hemodynamic monitoring in the critically ill. Indian Journal of Critical Care Medicine, 26(Suppl 2), S66-S76. https://doi.org/10.5005/jp-journals-10071-24301
Lim, L., Lee, H., Kim, J., Park, S., Lee, J., & Kim, Y. (2024). Real-time machine learning model to predict short-term mortality in critically ill patients: Development and international validation. Critical Care, 28, 114. https://doi.org/10.1186/s13054-024-04866-7
McGaughey, J., O’Halloran, P., Porter, S., & Blackwood, B. (2021). Early warning systems and rapid response systems for the prevention of patient deterioration on acute adult hospital wards. Cochrane Database of Systematic Reviews, 2021(11), CD005529. https://doi.org/10.1002/14651858.CD005529.pub3
Michard, F., Mulder, M., Gonzalez, F., & Sanfilippo, F. (2025). AI for the hemodynamic assessment of critically ill and surgical patients: Focus on clinical applications. Annals of Intensive Care, 15, 26. https://doi.org/10.1186/s13613-025-01448-w
Monnet, X., Cecconi, M., De Backer, D., Bakker, J., Mebazaa, A., & Teboul, J.-L. (2025). ESICM guidelines on circulatory shock and hemodynamic monitoring. Intensive Care Medicine. https://doi.org/10.1007/s00134-025-08137-z
Pinsky, M., & Cecconi, M. (2022). Effective hemodynamic monitoring. Critical Care, 26, 294. https://doi.org/10.1186/s13054-022-04173-z
Rae, P., Pearce, S., Greaves, P., Dall’Ora, C., Griffiths, P., & Endacott, R. (2021). Outcomes sensitive to critical care nurse staffing levels: A systematic review. Intensive and Critical Care Nursing, 67, 103110. https://doi.org/10.1016/j.iccn.2021.103110
Shaoru, C., Hui, Z., Su, W., Ruxin, J., Huiyi, Z., Hongmei, Z., & Hongyan, Z. (2023). Determinants of medical equipment alarm fatigue in practicing nurses: A systematic review. SAGE Open Nursing, 9, 23779608231207227. https://doi.org/10.1177/23779608231207227
Tas, J., Czosnyka, M., van der Horst, I., Park, S., van Heugten, C., Sekhon, M., Robba, C., Menon, D., Zeiler, F., & Aries, M. (2022). Cerebral multimodality monitoring in adult neurocritical care patients with acute brain injury: A narrative review. Frontiers in Physiology, 13, 1071161. https://doi.org/10.3389/fphys.2022.1071161
Teixeira, J., Hiremath, S., Kabli, A., Rewa, O., & Clark, E. (2025). Continuous kidney replacement therapies: Core Curriculum 2025. American Journal of Kidney Diseases, 85(6), 767-786. https://doi.org/10.1053/j.ajkd.2024.09.015
Vitt, J., Truong, T., Kiflezghi, M., Gonzalez, D., Riker, R., & Lazaridis, C. (2023). Multimodal and autoregulation monitoring in the neurointensive care unit. Frontiers in Neurology, 14, 1155986. https://doi.org/10.3389/fneur.2023.1155986
Walshe, N., Ryng, S., Drennan, J., O’Connor, P., O’Brien, S., Crowley, C., & Hegarty, J. (2021). Situation awareness and the mitigation of risk associated with patient deterioration: A meta-narrative review of theories and models and their relevance to nursing practice. International Journal of Nursing Studies, 124, 104086. https://doi.org/10.1016/j.ijnurstu.2021.104086
Xu, D., Li, X., Zhang, Y., Chen, L., & Wang, J. (2025). Exploring ICU nurses’ response to alarm management and strategies for alleviating alarm fatigue: A meta-synthesis and systematic review. BMC Nursing, 24, 359. https://doi.org/10.1186/s12912-025-03084-y
Yu, X., Ouyang, L., Li, J., Peng, Y., Zhong, D., Yang, H., & Zhou, Y. (2024). Knowledge, attitude, practice, needs, and implementation status of intensive care unit staff toward continuous renal replacement therapy: A survey of 66 hospitals in central and South China. BMC Nursing, 23, 472. https://doi.org/10.1186/s12912-024-01953-6
Publicado
2026-07-01
Cómo citar
Castellanos-Guevara, J., García-Beracierto, J., Zambrano-Sanguinetti, L., & Lemus-Abata, A. (2026). Gestión del monitoreo multimodal, aplicando evidencia científica para optimizar el cuidado integral del paciente crítico. CIENCIAMATRIA, 12(23), 81-99. https://doi.org/10.35381/cm.v12i23.2209
Sección
De Investigación
Derechos de autor 2026 Jaime Enrique Castellanos-Guevara, Juleiky García-Beracierto, Lissete Zambrano-Sanguinetti, Annie Sareth Lemus-Abata
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