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Published on 26 de febrero de 2026 | http://doi.org/10.5867/medwave.2026.01.3162

Contextual factors and use of heuristics in the care of critically ill patients by intensivists during the COVID-19 pandemic: a quasi-experimental vignette study in Chile

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Vignettes models and their corresponding cases.
Vignette modelCases corresponding to this vignette modelStudied heuristicGeneral description of the vignette modelContextual variables analyzed(specific to each case)Alternative response
1AGStatu quoA 44-year-old woman with morbid obesity admitted to the ICU, who on day 10 of admission is sedated and relaxed in volume control with an FiO2 of 50%, blood gas analysis with pH of 7.40, PaCO2 49 mmHg, PaO₂ 90 mmHg, arterial O₂ saturation 90% (Pa/FiO₂ ratio 180).Time of dayDecision at 10 AM (case A)Decision at 3 AM (case G)A.- Remove relaxation and progress in awakening (no use of heuristic).B.- Maintain sedo-relaxation (use of heuristic).
2BFIMStatu quoThe patient was admitted to the ICU 30 days ago for severe respiratory sepsis with little improvement.Age and pandemic wave74 years old, 1st wave (case B)54 years old, last wave (case F)54 years old, 1st wave (case I)74 years old, last wave (case M)A.- Talk to the family and adjust the therapeutic effort (no use of heuristics).B.- Maintain the same treatment and expectant attitude (use of heuristics).
3CJLPRepresentativenessThe hospital emergency department admits a patient with acute respiratory failure, oxygen saturation of 60% barely rising to 70% with a reservoir mask, respiratory rate > 45 rpm with significant respiratory effort, blood pressure 170/78 mmHg, and heart rate 130 bpm.Age and pandemic wave81 years old, active lifestyle, previously in good general health, last wave (case C)45 years old, sedentary, multimorbidity, 1st wave (case J)45 years old, sedentary, multimorbidity, last wave (case L)81 years old, active lifestyle, previously in good health, first wave (case P)Cases C and P (81 years old)A.- Orotracheal intubation and admission to the ICU (no use of heuristics).B.- Conservative management and palliative sedation (use of heuristics).Cases J and L (45 years old)A.- Orotracheal intubation and admission to the ICU (use of heuristic).B.- Conservative management and palliative sedation (no use of heuristic).
4DHKNStatu quoA 60-year-old patient admitted to the ICU for COVID-19 pneumonia, on mechanical ventilation on day 10 of evolution. He presents with sudden desaturation requiring an increase in FiO2 to 100% and tachycardia of 130 bpm, with blood pressure remaining stable without vasoactive drugs.Available clinical information and pandemic waveCT scan already ordered in first wave (case D)CT scan already ordered in last wave (case H)CT scan not ordered during last wave (case K)CT scan not ordered during first wave (case N)With CT scan already ordered:A.- Withdraw anticoagulation and suspend CT scan. Supinate and reassess (no use of heuristics).B.- Wait for CT scan results (use of heuristics).Without CT scan ordered:A.- Maintain anticoagulation and monitor progress (use heuristic).B.- Order contrast-enhanced CT scan (do not use heuristic).
5EOAvailabilityA 34-year-old patient was seen in the emergency department with suspected COVID-19 infection and associated hypoxia. The PCR result was negative. The chest X-ray showed non-specific multifocal opacities in the airspace.Pandemic waveLast wave (case E)First wave (case O)A.- Handle the situation as a COVID-19 case, repeating the PCR test the following day (use of heuristics).B.- Rule out COVID-19 and reassess the situation (no use of heuristics).

ICU, intensive care unit. FIO2, fractional inspired oxygen. PaCO2, alveolar carbon dioxide pressure. mmHg, millimeters of mercury. PaO2, alveolar partial pressure of oxygen. rpm, respirations per minute. bpm, beats per minute. CT, computed tomography. PCR, polymerase chain reaction. AM, before noon. PM, after noon.

Source: Prepared by the authors.