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

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.