41 research outputs found
Es necesario convertir en inteligentes los Sistemas de Detección de Gravedad: Paul E Schmidt, Paul Meredith, David R Prytherch, Duncan Watson, Valerie Watson, Roger M Killen, Peter Greengross, Mohammed A Mohammed, Gary B Smith. Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Qual Saf 2015;24:10–20. doi:10.1136/bmjqs-2014-003073.
Aunque disponemos de gran número de registros de la situación clínica de los pacientes hospitalizados, a día de hoy, el retraso en la detección de mala evolución o potencial gravedad y en la posible intervención sigue siendo una de las principales causas evitables de mortalidad y morbilidad.
La toma de constantes intermitente en los pacientes está sujeta a potenciales errores como una frecuencia de monitorización inadecuada, datos incompletos, cálculo erróneos del “early warning score” (EWS), gráficas poco legibles que impiden un adecuado reconocimiento y/o respuesta rápida al deterioro clínico de los pacientes.
En este estudio observacional se pretende valorar el efecto sobre la mortalidad hospitalaria mediante el uso de la tecnología que mejore la fiabilidad en la recogida, interpretación y análisis de los datos y consiga un mejor soporte en las decisiones clínicas
Perioperative intensive care medicine.
Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1–4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. Recently, there have been significant advances related to organizational aspects, new anesthetic and surgical techniques, prognostic scales, perioperative management and greater participation and involvement of the patient. This new series of Medicina Intensiva will address fundamental aspects of how Departments of Intensive Care Medicine can add value to the surgical process, in a coordinated manner with other services. Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.post-print823 K
Evolución a la detección precoz de gravedad. ¿Hacia dónde vamos?.
En publicaciones recientes (1,2), se ha puesto de manifiesto como es necesario incrementar la monitorización de los pacientes ingresados en plantas convencionales del hospital, con el objetivo de evitar su posible deterioro clínico, bien aplicando un tratamiento adecuado de forma precoz, o bien mediante el incremento de su monitorización mediante su traslado a Unidades de Cuidados Intensivos (UCI). Se ha podido establecer cómo los diferentes sistemas o algoritmos de identificación de gravedad, aplicados en estos pacientes, han podido reducir la aparición de eventos adversos, prevenir la aparición de paradas cardiorrespiratorias (PCR) y mejorar su pronóstico.pre-print409 K
Management of severe ARDS due to SARS-CoV-2 pneumonia using low-flow extracorporeal CO2 extraction.
post-print695 K
Detección precoz del paciente que requiere cuidados intensivos.
La evolución de los pacientes en situación crítica es claramente dependiente de la rapidez en su diagnóstico y de recibir una estabilización y tratamiento ade-cuado de forma precoz. Por otra parte, también es necesario diagnosticar e in-crementar la monitorización o vigilancia de los pacientes en situación potencial-mente crítica con riesgo de deterioro clínico. En la actualidad, se están dise-ñando diferentes estrategias de colaboración con el apoyo de la tecnología que nos permiten una identificación más rápida de estos casos y establecer puentes entre los diferentes profesionales con el fin de mejorar la atención de estos pa-cientes. Estas estrategias pueden incluir sistemas de alerta de laboratorio, de signos vitales y la creación de un Código UCI.pre-print522 K
Ventilación mecánica sí, pero no de cualquier forma.
La ventilación mecánica (VM), tanto invasiva a través de tubo endotraqueal o traqueotomía, como no invasiva (a través de diferentes interfaces) es una técnica de soporte vital que puede potencialmente salvar muchas vidas pero que no está exenta de complicaciones potencialmente letales. Recientemente, incluso se ha publicado como el empleo inadecuado de las técnicas de ventilación puede conducir al agravamiento de una posible lesión pulmonar en pacientes en ventilación espontánea en las que se permite un excesivo aumento del trabajo respiratorio que conlleva un incremento en su presión transpulmonar. Esto nos lleva a pensar que la aplicación de la ventilación mecánica va a tener aún mayores indicaciones y que se deben plantear de forma aún más precoz, incluso desde el ámbito extra-hospitalario, de lo que se realiza en la actualidad.pre-print119 K
Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation.
Extracorporeal membrane oxygenation (ECMO) support is indicated for patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. The practitioner’s experience and quantity of necessary resources are reasons why regionalization could benefit these types of patients, establishing ECMO reference centers and integrating a transportation network specialized in ECMO.
This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and interterritorial approach.
ECMO transportation is safer than without mechanical support, although there are currently no criteria for starting the therapy on patients being transferred. Criteria of lesser severity might be necessary for these patients. The training and specialization of the team in extracorporeal support therapies, interfacility transport and the systemization of the transfer can improve results.
There are no studies on the conditions that must be met by the transportation media, although space and stability are important characteristics. Air transfer with ECMO is an increasingly frequent option. Although there are data on its safety, there are none on the physiology of patients undergoing ECMO at high altitudes, data that could help with the indication and management of this type of transportation.pre-print916 K
Secondary use of data extracted from a clinical information system to assess the adherence of tidal volume and its impact on outcomes.
Objectives
To extract data from clinical information systems to automatically calculate high-resolution quality indicators to assess adherence to recommendations for low tidal volume.
Design
We devised two indicators: the percentage of time under mechanical ventilation with excessive tidal volume (>8 mL/kg predicted body weight) and the percentage of patients who received appropriate tidal volume (≤8 mL/kg PBW) at least 80% of the time under mechanical ventilation. We developed an algorithm to automatically calculate these indicators from clinical information system data and analyzed associations between them and patients’ characteristics and outcomes.
Settings
This study has been carried out in our 30-bed polyvalent intensive care unit between January 1, 2014 and November 30, 2019.
Patients
All patients admitted to intensive care unit ventilated >72 h were included.
Intervention
Use data collected automatically from the clinical information systems to assess adherence to tidal volume recommendations and its outcomes.
Main variables of interest
Mechanical ventilation days, ICU length of stay and mortality.
Results
Of all admitted patients, 340 met the inclusion criteria. Median percentage of time under mechanical ventilation with excessive tidal volume was 70% (23%–93%); only 22.3% of patients received appropriate tidal volume at least 80% of the time. Receiving appropriate tidal volume was associated with shorter duration of mechanical ventilation and intensive care unit stay. Patients receiving appropriate tidal volume were mostly male, younger, taller, and less severely ill. Adjusted intensive care unit mortality did not differ according to percentage of time with excessive tidal volume or to receiving appropriate tidal volume at least 80% of the time.
Conclusions
Automatic calculation of process-of-care indicators from clinical information systems high-resolution data can provide an accurate and continuous measure of adherence to recommendations. Adherence to tidal volume recommendations was associated with shorter duration of mechanical ventilation and intensive care unit stay.pre-print1126 K