Plan de negocio para Las Vertientes de Maule.

89 p.Las Vertientes de Maule es una empresa que pertenece a la industria de los eventos de la ciudad de Talca, cuyo nivel de ventas durante los 5 últimos años ha sido inferior al obtenido durante su época de mayores ingresos, entre los años 1995 y 1998, a tal punto que su continuidad en el rubro, era incierta. Es por lo anterior que el objetivo general de este trabajo consiste en aplicar herramientas te6ricas para la obtenci6n y desarrollo de una ventaja competitiva que le permita a Las Vertientes de Maule permanecer y obtener retornos por sobre el promedio de la industria a mediano plazo. La consecuci6n de este objetivo fue alcanzado y ha derivado en un plan de negocios diseñado a partir de las directrices presentadas en el marco te6rico, el cual principalmente describe la manera en que debe analizarse el entorno, tanto a nivel externo e industrial como el interno de la empresa de forma de obtener los elementos necesarios para realizar un análisis FODA y definir como deben establecerse los cursos de acción de cada área de la empresa una vez identificada la estrategia a seguir. A continuación se definen las directrices que permitirán implementar la estrategia definida para marketing, operaciones, recursos humanos y finanzas, todo lo cual se conjuga en una carta gannt, con las principales tareas, plazos y responsables y así lograr que la empresa se posicione en el segmento objetivo como la alternativa que responde mejor a sus necesidades en términos de calidad y precio. Palabras clave: estrategia, entorno, plan, negocio, FODA

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society