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Llompart-Pou JA, Pérez-Bárcena J, Lagares A, Godoy DA. Twelve controversial questions in aneurysmal subarachnoid hemorrhage. Med Intensiva 2024; 48:92-102. [PMID: 37951804 DOI: 10.1016/j.medine.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023]
Abstract
Critical care management of aneurysmal subarachnoid hemorrhage (aSAH) remains a major challenge. Despite the recent publication of guidelines from the American Heart Association/American Stroke Association and the Neurocritical Care Society, there are many controversial questions in the intensive care unit (ICU) management of this population. The authors provide an analysis of common issues in the ICU and provide guidance on the daily management of this specific population of neurocritical care patients.
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Affiliation(s)
- Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva. Hospital Universitari Son Espases. Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain.
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva. Hospital Universitari Son Espases. Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - Alfonso Lagares
- Servicio de Neurocirugía. Hospital Universitario 12 de Octubre. Madrid. Spain
| | - Daniel Agustín Godoy
- Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, San Fernando del Valle de Catamarca, Argentina
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2
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Gutiérrez Gutiérrez J, Carrasco González MD, Montiel González R, San Barón M, Barea Mendoza JA, Giménez-Esparza Vich C, Chico Fernández M, Martín Delgado MC. Challenges in intensive medicine: Diversity, equity and inclusion. Gender statement of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC). Med Intensiva 2023:S2173-5727(23)00059-0. [PMID: 37248094 DOI: 10.1016/j.medine.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023]
Abstract
Gender is a social determinant that impacts health and generates inequalities at all levels. It has impacts patients and critical conditions, health professionals and professional career development, and scientific societies from a perspective of social justice. All the International scientific societies of Intensive Care Medicine committed to contributing a gender perspective agree on the institutional need for achieving a formal positioning standpoint. The Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) is committed to ensuring the equality, inclusion and representativeness of its health professionals to fight the existing gender gap in the field of Intensive Medicine.
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3
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Sirgo G, Olona M, Martín-Delgado MC, Gordo F, Trenado J, García M, Bodí M. Cross-cultural adaptation of the SCORE survey and evaluation of the impact of Real-Time Random Safety Audits in organizational culture: A multicenter study. Med Intensiva 2022; 46:568-576. [PMID: 36155679 DOI: 10.1016/j.medine.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/20/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To establish a cross-cultural adaptation of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey and to use this instrument to evaluate the impact of a safety intervention. DESIGN Cross-cultural adaptation and before-and-after evaluation study. SETTING 5 ICU. PARTICIPANTS Medical residents, attending physicians, and nurses at those ICU. INTERVENTIONS Adaptation of the SCORE survey to Spanish culture. The adapted survey was used to assess all safety-culture-related domains before and one-year after implementing the use of a safety tool, Real-Time Random Safety Audits (in Spanish: Análisis Aleatorios de Seguridad en Tiempo Real, AASTRE). MAIN OUTCOME MEASURE Adaptabiliy of the Spanish version of SCORE survey in the ICU setting and evaluation of the effect of AASTRE on their domains. RESULTS The cross-cultural adaptation was adequate. Post-AASTRE survey scores [mean (standard deviation, SD)] were significantly better in the domains learning environment [50.55 (SD 20.62) vs 60.76 (SD 23.66), p<.0001], perception of local leadership [47.98 (SD 23.57) vs 62.82 (SD 27.46), p<.0001], teamwork climate [51.19 (SD 18.55) vs 55.89 (SD 20.25), p=.031], safety climate [45.07 (SD 17.60) vs 50.36 (SD 19.65), p=.01], participation decision making [3 (SD 0.82) vs 3.65 (SD 0.87), p<.0001] and advancement in the organization [3.21 (SD 0.77) vs 4.04 (SD 0.77), p<.0001]. However, post-AASTRE scores were significantly worse in the domains workload and burnout climate. CONCLUSIONS The cross-cultural adaptation of the SCORE survey into Spanish is a useful tool for ICUs. The application of the AASTRE is associated with improvements in six SCORE domains, including the safety climate.
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Affiliation(s)
- G Sirgo
- Intensive Care Unit, University Hospital Joan XXIII, Pere Virgili Institute for Health Research, Rovira i Virgili University, Tarragona, Spain.
| | - M Olona
- Department of Preventive Medicine, University Hospital Joan XXIII, Rovira i Virgili University, Tarragona, Spain
| | - M C Martín-Delgado
- Intensive Care Unit, University Hospital Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - F Gordo
- Intensive Care Unit, University Hospital Henares, Coslada, Madrid, Spain
| | - J Trenado
- Intensive Care Unit, University Hospital Mutua de Terrasa, Terrasa, Barcelona , Spain
| | - M García
- Intensive Care Unit, University Hospital Río Ortega, Valladolid, Spain
| | - M Bodí
- Intensive Care Unit, University Hospital Joan XXIII, Pere Virgili Institute for Health Research, Rovira i Virgili University, Tarragona, Spain
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Castellanos-Ortega Á, Broch MJ, Palacios-Castañeda D, Gómez-Tello V, Valdivia M, Vicent C, Madrid I, Martinez N, Párraga MJ, Sancho E, Fuentes-Dura MDC, Sancerni-Beitia MD, García-Ros R. Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study. Med Intensiva 2022; 46:491-500. [PMID: 36057440 DOI: 10.1016/j.medine.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites. DESIGN Observational multicenter study. SETTING Thirteen Spanish ICU Departments. PARTICIPANTS Thirty six R3. INTERVENTION The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters. MAIN VARIABLES OF INTEREST Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency. RESULTS A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64-0.79). Inter-rater reliability was strong [median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65-0.97)]. Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed. CONCLUSION The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency. TRIAL REGISTRATION COBALIDATION. NCT04278976. (https://register. CLINICALTRIALS gov).
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Affiliation(s)
- Á Castellanos-Ortega
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M J Broch
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - V Gómez-Tello
- Intensive Care Department, University Hospital Moncloa, Madrid, Spain
| | - M Valdivia
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - C Vicent
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - I Madrid
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - N Martinez
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - M J Párraga
- Intensive Care Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - E Sancho
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M D C Fuentes-Dura
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - M D Sancerni-Beitia
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - R García-Ros
- Department of Developmental and Educational Psychology, University of Valencia, Spain.
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Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Claraco Vega LM, Gurpegui Puente M, González Almárcegui I, Gutiérrez Ibañes P, Carrillo López A, Castiella García CM, Miguelena Hycka J. Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery. Med Intensiva 2022; 46:239-247. [PMID: 35248506 DOI: 10.1016/j.medine.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery. DESIGN Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019. SETTING Surgical ICU of a third level hospital. PATIENTS Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months. INTERVENTIONS Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index. MAIN VARIABLES OF INTEREST ICU, in-hospital and 6-month mortality. RESULTS The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84). CONCLUSIONS Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.
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Affiliation(s)
| | | | - L M Claraco Vega
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Gurpegui Puente
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - I González Almárcegui
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - P Gutiérrez Ibañes
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Carrillo López
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - J Miguelena Hycka
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, Spain
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6
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Sirgo G, Olona M, Martín-Delgado MC, Gordo F, Trenado J, García M, Bodí M. Cross-cultural adaptation of the SCORE survey and evaluation of the impact of Real-Time Random Safety Audits in organizational culture: A multicenter study. Med Intensiva 2021; 46:S0210-5691(21)00074-7. [PMID: 34052044 DOI: 10.1016/j.medin.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To establish a cross-cultural adaptation of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey and to use this instrument to evaluate the impact of a safety intervention. DESIGN Cross-cultural adaptation and before-and-after evaluation study. SETTING 5 ICU. PARTICIPANTS Medical residents, attending physicians, and nurses at those ICU. INTERVENTIONS Adaptation of the SCORE survey to Spanish culture. The adapted survey was used to assess all safety-culture-related domains before and one-year after implementing the use of a safety tool, Real-Time Random Safety Audits (in Spanish: Análisis Aleatorios de Seguridad en Tiempo Real, AASTRE). MAIN OUTCOME MEASURE Adaptabiliy of the Spanish version of SCORE survey in the ICU setting and evaluation of the effect of AASTRE on their domains. RESULTS The cross-cultural adaptation was adequate. Post-AASTRE survey scores [mean (standard deviation, SD)] were significantly better in the domains learning environment [50.55 (SD 20.62) vs 60.76 (SD 23.66), p<.0001], perception of local leadership [47.98 (SD 23.57) vs 62.82 (SD 27.46), p<.0001], teamwork climate [51.19 (SD 18.55) vs 55.89 (SD 20.25), p=.031], safety climate [45.07 (SD 17.60) vs 50.36 (SD 19.65), p=.01], participation decision making [3 (SD 0.82) vs 3.65 (SD 0.87), p<.0001] and advancement in the organization [3.21 (SD 0.77) vs 4.04 (SD 0.77), p<.0001]. However, post-AASTRE scores were significantly worse in the domains workload and burnout climate. CONCLUSIONS The cross-cultural adaptation of the SCORE survey into Spanish is a useful tool for ICUs. The application of the AASTRE is associated with improvements in six SCORE domains, including the safety climate.
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Affiliation(s)
- G Sirgo
- Intensive Care Unit, University Hospital Joan XXIII, Pere Virgili Institute for Health Research, Rovira i Virgili University, Tarragona, Spain.
| | - M Olona
- Department of Preventive Medicine, University Hospital Joan XXIII, Rovira i Virgili University, Tarragona, Spain
| | - M C Martín-Delgado
- Intensive Care Unit, University Hospital Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - F Gordo
- Intensive Care Unit, University Hospital Henares, Coslada, Madrid, Spain
| | - J Trenado
- Intensive Care Unit, University Hospital Mutua de Terrasa, Terrasa, Barcelona , Spain
| | - M García
- Intensive Care Unit, University Hospital Río Ortega, Valladolid, Spain
| | - M Bodí
- Intensive Care Unit, University Hospital Joan XXIII, Pere Virgili Institute for Health Research, Rovira i Virgili University, Tarragona, Spain
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7
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Hurtado J, Coitinho C, Nin N, Buroni M, Hurtado FJ, Robello C, Greif G. Clinical and epidemiological features of tuberculosis isolated from critically ill patients. Rev Argent Microbiol 2021; 54:43-47. [PMID: 34001412 DOI: 10.1016/j.ram.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/20/2020] [Accepted: 02/03/2021] [Indexed: 11/30/2022] Open
Abstract
Human tuberculosis is still a major world health concern. In Uruguay, contrary to the world trend, an increase in cases has been observed since 2006. Although the incidence of MDR-resistant strains is low and no cases of XDR-TB were registered, an increase in the number of patients with severe tuberculosis requiring critical care admission was observed. As a first aim, we performed the analysis of the genetic structure of strains isolated from patients with severe tuberculosis admitted to an intensive care unit. We compared these results with those corresponding to the general population observing a statistically significant increase in the Haarlem genotypes among ICU patients (53.3% vs 34.7%; p<0.05). In addition, we investigated the association of clinical outcomes with the genotype observing a major incidence of hepatic dysfunctions among patients infected with the Haarlem strain (p<0.05). The cohort presented is one of the largest studied series of critically ill patients with tuberculosis.
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Affiliation(s)
- Joaquín Hurtado
- Laboratorio de Interacciones Hospedero-Patógeno/Unidad de Biología Molecular, Institut Pasteur Montevideo (IPM), Montevideo, Uruguay
| | - Cecilia Coitinho
- Laboratory of Microbiology, Anti-tuberculosis and Prevalent Diseases Honorary Commission (CHLA-EP), Montevideo, Uruguay
| | - Nicolás Nin
- Intensive Care Unit, Hospital Español Dr. "Juan J. Crottoggini", ASSE, Montevideo, Uruguay
| | - María Buroni
- Intensive Care Unit, Hospital Español Dr. "Juan J. Crottoggini", ASSE, Montevideo, Uruguay
| | - Francisco Javier Hurtado
- Intensive Care Unit, Hospital Español Dr. "Juan J. Crottoggini", ASSE, Montevideo, Uruguay; Departamento de Fisiopatología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Carlos Robello
- Laboratorio de Interacciones Hospedero-Patógeno/Unidad de Biología Molecular, Institut Pasteur Montevideo (IPM), Montevideo, Uruguay; Departamento de Bioquímica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Gonzalo Greif
- Laboratorio de Interacciones Hospedero-Patógeno/Unidad de Biología Molecular, Institut Pasteur Montevideo (IPM), Montevideo, Uruguay.
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8
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Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Claraco Vega LM, Gurpegui Puente M, González Almárcegui I, Gutiérrez Ibañes P, Carrillo López A, Castiella García CM, Miguelena Hycka J. Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery. Med Intensiva 2021; 46:S0210-5691(20)30341-7. [PMID: 33446376 DOI: 10.1016/j.medin.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery. DESIGN Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019. SETTING Surgical ICU of a third level hospital. PATIENTS Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months. INTERVENTIONS Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index. MAIN VARIABLES OF INTEREST ICU, in-hospital and 6-month mortality. RESULTS The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84). CONCLUSIONS Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.
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Affiliation(s)
| | | | - L M Claraco Vega
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - M Gurpegui Puente
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - I González Almárcegui
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - P Gutiérrez Ibañes
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - A Carrillo López
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | | | - J Miguelena Hycka
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, España
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9
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Jiménez Rivera JJ, Llanos Jorge C, López Gude MJ, Pérez Vela JL. Perioperative management in cardiovascular surgery. Med Intensiva 2020; 45:175-183. [PMID: 33358388 DOI: 10.1016/j.medin.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022]
Abstract
Cardio-surgical patient care requires a comprehensive and multidisciplinary approach to develop strategies to improve patient safety and outcomes. In the preoperative period, prophylaxis for frequent postoperative complications, such as de novo atrial fibrillation or bleeding, and prehabilitation based on exercise training, respiratory physiotherapy and nutritional and cognitive therapy, especially in fragile patients, stand out. There have been great advances, during the intraoperative phase, such as minimally invasive surgery, improved myocardial preservation, enhanced systemic perfusion and brain protection during extracorporeal circulation, or implementation of Safe Surgery protocols. Postoperative care should include goal-directed hemodynamic theraphy, a correct approach to coagulation disorders, and a multimodal analgesic protocol to facilitate early extubation and mobilization. Finally, optimal management of postoperative complications is key, including arrhythmias, vasoplegia, bleeding, and myocardial stunning that can lead to low cardiac output syndrome or, in extreme cases, cardiogenic shock. This global approach and the high degree of complexity require highly specialised units where intensive care specialists add value and are key to obtain more effective and efficient clinical results.
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Affiliation(s)
- J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, España.
| | - C Llanos Jorge
- Servicio de Medicina Intensiva, Hospital Quirón salud Tenerife, Santa Cruz de Tenerife, España
| | - M J López Gude
- Servicio de Cirugía Cardiovascular, Hospital Universitario Doce de Octubre, Madrid, España
| | - J L Pérez Vela
- Servicio de Medicina Intensiva, Hospital Universitario Doce de Octubre, Madrid, España
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10
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Guzmán Herrador BR, Romero Muñoz MJ, Ruiz Montero R, de la Fuente Martos C, Salcedo Leal I, Barranco Quintana JL, Amor Díaz I, González Priego ML, Díaz Molina C. [Discussion groups as an approach to assess knowledge, attitudes and practices of hand hygiene among the adult intensive care unit professionals from a referral hospital]. J Healthc Qual Res 2020; 35:297-304. [PMID: 32972904 DOI: 10.1016/j.jhqr.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The adherence to hand hygiene practices among the adult Intensive Care Unit (ICU) professionals in this hospital has not improved substantially in the last years, regardless of the theoretical training sessions conducted. A study was made of the knowledge, attitudes, and practices of the ICU personnel in this field. METHODS Several small discussion groups with ICU staff organised by preventive medicine professionals were scheduled in March 2018. Semi-structured questions on hand hygiene and use of gloves were included. The points discussed were listed into strengths and weaknesses. Knowledge was then assessed using an anonymous questionnaire, after the sessions. RESULTS Thirteen 60-minute sessions were carried out with 157 participants from all professional categories (82% from ICU, median=11 participants / session). The majority perceived hand hygiene as a priority issue of personal responsibility for patient safety. They identified factors that limit their ability to improve their adherence. Certain habits have more to do with personal preferences than with theoretical knowledge or technical indications. CONCLUSIONS The discussion groups have helped to make a diagnosis of the situation that will be useful to strengthen those areas of improvement that have been identified. If we aim for a cultural change, and eliminate incorrect habits, it seems more useful to carry out adequate continuing education as part of the daily routine of professionals.
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Affiliation(s)
- B R Guzmán Herrador
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España.
| | - M J Romero Muñoz
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - R Ruiz Montero
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - C de la Fuente Martos
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España; Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España
| | - I Salcedo Leal
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - J L Barranco Quintana
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - I Amor Díaz
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España
| | - M L González Priego
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España
| | - C Díaz Molina
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
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11
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Muñoz de Cabo C, Hermoso Alarza F, Cossio Rodriguez AM, Martín Delgado MC. Perioperative management in thoracic surgery. Med Intensiva 2019; 44:185-191. [PMID: 31870510 DOI: 10.1016/j.medin.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022]
Abstract
Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, especially related to pulmonary resection, is not without risk, and is associated to considerable morbidity and mortality. Fast track or enhanced recovery after anesthesia protocols, minimally invasive surgery, and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery. Patients in the postoperative period of major thoracic surgery require intensive surveillance, especially the first 24-72hours after surgery. Admission to the ICU is especially recommended in those patients with comorbidities, a reduced cardiopulmonary reserve, extensive lung resections, and those requiring support due to life-threatening organ failure. During the postoperative period, intensive cardiorespiratory monitoring, proper management of thoracic drainage, aggressive pain control (multimodal analgesia and regional anesthetic techniques), nausea and multimodal rehabilitation are key elements for avoiding adverse events. Medical complications include respiratory failure, arrhythmias, respiratory infections, atelectasis and thromboembolic lung disease. The most frequent surgical complications are hemothorax, chylothorax, bronchopleural fistula and prolonged air leakage. The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes.
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Affiliation(s)
- C Muñoz de Cabo
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - F Hermoso Alarza
- Servicio de Cirugía Torácica, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - A M Cossio Rodriguez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Grado Medicina, Universidad Francisco de Vitoria, Madrid, España.
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12
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Gracia Gozalo RM, Ferrer Tarrés JM, Ayora Ayora A, Alonso Herrero M, Amutio Kareaga A, Ferrer Roca R. Application of a mindfulness program among healthcare professionals in an intensive care unit: Effect on burnout, empathy and self-compassion. Med Intensiva 2018; 43:207-216. [PMID: 29544729 DOI: 10.1016/j.medin.2018.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/04/2018] [Accepted: 02/04/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital. DESIGN A longitudinal study with an intrasubject pre-post intervention design was carried out. SETTING Intensive Care Unit of a tertiary hospital. PARTICIPANTS A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study. INTERVENTION A clinical session/workshop was held on the practice of mindfulness and its usefulness. The possibility of following an 8-week training program with specifically designed short guided practices supported by a virtual community based on a WhatsApp group was offered. A weekly proposal in audio and text format and daily reminders with stimulating messages of practice were sent. MAIN MEASUREMENTS Various psychometric measures were self-reported: burnout (MBI), mindfulness (FFMQ), empathy (Jefferson) and self-compassion (SCS), before and after the training program. Demographic and workplace variables were also compiled. RESULTS Among the factors affecting burnout, the level of emotional exhaustion decreased (-3.78 points; P=.012), mindfulness levels measured by the FFMQ were not globally modified, though "observation" and "non-reacting" factors increased. Empathy was not modified, and self-compassion levels increased (3.7 points; P=.001). Satisfaction and program adherence levels were very high. CONCLUSIONS In the population described, this program showed a decrease in emotional exhaustion and an increase in self-compassion -these being factors that can produce well-being and exert a positive impact upon burnout in this vulnerable group.
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Affiliation(s)
- R M Gracia Gozalo
- Servicio de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación de Shock, Disfunción Orgánica y Resucitación (SODIR-VHIR), Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - J M Ferrer Tarrés
- Dirección de Calidad, Docencia e Investigación, Fundació Sanitària de Mollet, Mollet del Vallès, Barcelona, España
| | - A Ayora Ayora
- Unidad de Prevención de Riesgos Laborales, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Alonso Herrero
- Unidad de Prevención de Riesgos Laborales, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - A Amutio Kareaga
- Departamento de Psicología Social y Metodología de las Ciencias del Comportamiento, Universidad del País Vasco (UPV/EHU), San Sebastián, España
| | - R Ferrer Roca
- Servicio de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación de Shock, Disfunción Orgánica y Resucitación (SODIR-VHIR), Hospital Universitari Vall d'Hebron, Barcelona, España
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13
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Sirgo Rodríguez G, Chico Fernández M, Gordo Vidal F, García Arias M, Holanda Peña MS, Azcarate Ayerdi B, Bisbal Andrés E, Ferrándiz Sellés A, Lorente García PJ, García García M, Merino de Cos P, Allegue Gallego JM, García de Lorenzo Y Mateos A, Trenado Álvarez J, Rebollo Gómez P, Martín Delgado MC. Handover in Intensive Care. Med Intensiva 2018; 42:168-179. [PMID: 29426704 DOI: 10.1016/j.medin.2017.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/21/2017] [Accepted: 12/01/2017] [Indexed: 01/12/2023]
Abstract
Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.
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Affiliation(s)
- G Sirgo Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Tarragona, España
| | - M Chico Fernández
- UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M García Arias
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B Azcarate Ayerdi
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - A Ferrándiz Sellés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - P J Lorente García
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - M García García
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - J M Allegue Gallego
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | | | - J Trenado Álvarez
- Servicio de Medicina Intensiva, Hospital de Terrassa, Terrassa, España
| | - P Rebollo Gómez
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid.
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14
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Garnacho-Montero J, Gutiérrez-Pizarraya A, Díaz-Martín A, Cisneros-Herreros JM, Cano ME, Gato E, Ruiz de Alegría C, Fernández-Cuenca F, Vila J, Martínez-Martínez L, Tomás-Carmona MDM, Pascual Á, Bou G, Pachón-Diaz J, Rodríguez-Baño J. Acinetobacter baumannii in critically ill patients: Molecular epidemiology, clinical features and predictors of mortality. Enferm Infecc Microbiol Clin 2016; 34:551-558. [PMID: 26821549 DOI: 10.1016/j.eimc.2015.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The main aim of this study was to assess changes in the epidemiology and clinical presentation of Acinetobacter baumannii over a 10-year period, as well as risk factors of mortality in infected patients. METHOD Prospective, multicentre, hospital-based cohort studies including critically ill patients with A. baumannii isolated from any clinical sample were included. These were divided into a first period ("2000 study") (one month), and a second period ("2010 study") (two months). Molecular typing was performed by REP-PCR, PFGE and MSLT. The primary endpoint was 30-day mortality. RESULTS In 2000 and 2010, 103 and 108 patients were included, and the incidence of A. baumannii colonization/infection in the ICU decreased in 2010 (1.23 vs. 4.35 cases/1000 patient-days; p<0.0001). No differences were found in the colonization rates (44.3 vs. 38.6%) or infected patients (55.7 vs. 61.4%) in both periods. Overall, 30-day mortality was similar in both periods (29.1 vs. 27.8%). The rate of pneumonia increased from 46.2 in 2000 to 64.8% in 2010 (p<0.001). Performing MSLT, 18 different sequence types (ST) were identified (18 in 2000, 8 in 2010), but ST2 and ST79 were the predominant clones. ST2 isolates in the ICU increased from 53.4% in the year 2000 to 73.8% in 2010 (p=0.002). In patients with A. baumannii infection, the multivariate analysis identified appropriate antimicrobial therapy and ST79 clonal group as protective factors for mortality. CONCLUSIONS At 10 years of the first analysis, some variations have been observed in the epidemiology of A. baumannii in the ICU, with no changes in mortality. Epidemic ST79 clone seems to be associated with a better prognosis and adequate treatment is crucial in terms of survival.
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Affiliation(s)
- José Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Spain; Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain.
| | - Antonio Gutiérrez-Pizarraya
- Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain
| | - Ana Díaz-Martín
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Spain; Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain
| | - José Miguel Cisneros-Herreros
- Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Virgen del Rocío, Spain
| | - María Eugenia Cano
- Service of Microbiology, University Hospital Marqués de Valdecilla, Spain
| | - Eva Gato
- Service of Microbiology, University Hospital Marqués de Valdecilla, Spain
| | | | - Felipe Fernández-Cuenca
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, Hospital Clínic, Barcelona Centre for International Health Research, Barcelona, Spain
| | - Luis Martínez-Martínez
- Service of Microbiology, University Hospital Marqués de Valdecilla, Spain; IDIVAL, Department of Molecular Biology, University of Cantabria, Spain
| | | | - Álvaro Pascual
- Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain
| | - Germán Bou
- Microbiology Department, A Coruña University Hospital Complex, A Coruña, Spain
| | - Jerónimo Pachón-Diaz
- Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Virgen del Rocío, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for the Research in Infectious Diseases (REIPI), Spain; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen Macarena Hospital, Spain
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15
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Masclans JR, Pérez-Terán P, Roca O. The role of high flow oxygen therapy in acute respiratory failure. Med Intensiva 2015; 39:505-15. [PMID: 26429697 DOI: 10.1016/j.medin.2015.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
Acute respiratory failure represents one of the most common causes of intensive care unit admission and oxygen therapy remains the first-line therapy in the management of these patients. In recent years, high-flow oxygen via nasal cannula has been described as a useful alternative to conventional oxygen therapy in patients with acute respiratory failure. High-flow oxygen via nasal cannula rapidly alleviates symptoms of acute respiratory failure and improves oxygenation by several mechanisms, including dead space washout, reduction in oxygen dilution and inspiratory nasopharyngeal resistance, a moderate positive airway pressure effect that may generate alveolar recruitment and an overall greater tolerance and comfort with the interface and the heated and humidified inspired gases. However, the experience in adults is still limited and there are no clinical guidelines to establish recommendations for their use. This article aims to review the existing evidence on the use of high-flow oxygen via nasal cannula in adults with acute respiratory failure and its possible applications, advantages and limitations.
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Affiliation(s)
- J R Masclans
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - P Pérez-Terán
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - O Roca
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Medicina Intensiva, Área General, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universidad Autónoma de Barcelona, Barcelona, España
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16
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Gordo F, Abella A. Intensive care unit without walls: seeking patient safety by improving the efficiency of the system. Med Intensiva 2014; 38:438-43. [PMID: 24661919 DOI: 10.1016/j.medin.2014.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 12/11/2022]
Abstract
The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process. At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved. It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology.
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Affiliation(s)
- F Gordo
- Intensive Care Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain; Francisco de Vitoria University, Madrid, Spain.
| | - A Abella
- Intensive Care Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
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