[Consensus conference on providing information of adverse events to patients and relatives]. / Conferencia de consenso sobre información de eventos adversos a pacientes y familiares.

OBJECTIVE: To develop recommendations regarding «Information about adverse events to patients and their families¼, through the implementation of a consensus conference. MATERIAL AND METHODS: A literature review was conducted to identify all relevant articles, the major policies and international guidelines, and the specific legislation developed in some countries on this process. The literature review was the basis for responding to a series of questions posed in a public session. A group of experts presented the best available evidence, interacting with stakeholders. At the end of the session, an interdisciplinary and multi-professional jury established the final recommendations of the consensus conference. RESULTS: The main recommendations advocate the need to develop policies and institutional guidelines in our field, favouring the patient adverse events disclosure process. The recommendations emphasize the need for the training of professionals in communication skills and patient safety, as well as the development of strategies for supporting professionals who are involved in an adverse event. The assessment of the interest and impact of specific legislation that would help the implementation of these policies was also considered. CONCLUSIONS: A cultural change is needed at all levels, nuanced and adapted to the specific social and cultural aspects of our social and health spheres, and involves all stakeholders in the system to create a framework of trust and credibility in which the processing of information about adverse events may become effective.

Effectiveness and safety of prehospital urapidil for hypertensive emergencies.

The objective was to evaluate both the effectiveness and safety of urapidil in management of hypertensive emergencies (HE) in the prehospital setting. This was an open, prospective study for 6 months. We evaluated systolic (SBP), diastolic (DBP), and mean blood pressure (MBP), and heart rate (HR) with continuous noninvasive hemodynamic monitoring in 16 consecutive cases of HE. We used urapidil at different doses (25 to 100 mg) at 5 minute intervals, according to the blood pressure response. The basal DBP was 127 +/- 16 mmHg. Urapidil was effective in 15 patients. ANOVA test showed a significant drop out in DBP (P <.0001) and HR (P <.004). The highest decrease was obtained in the first 10 minutes. The decrease in DBP and HR values were significant at 5 minutes versus basal (P <.05) and at 10 versus 5 minutes (P <.01). All adverse effects had little relevance. Urapidil is effective and safe in management of HE when used by a medical team in the prehospital setting.

[Acute respiratory distress syndrome: incidence and course in a Spanish ICU]. / Síndrome de distrés respiratorio agudo: incidencia y evolución en una UCI española.

We have analyzed the 57 ARDS admitted at the Intensive Care Unit (ICU) of the Hospital General Vall d'Hebron of Barcelona in 1996 (the 5.7% of the ICU and the 0.18% of the hospital admission). We have studied the epidemiological characteristics, as well as their ICU complications and mortality. This year was the first to have nitric oxide (NO) as complementary treatment in the ARDS patients at our hospital. They were 42 males and 15 females, with a mean age of 60 years, APACHE II 21 and a lung injury score 3.1. The 87% of the patients need vasoactive drugs. The 47% need Swan-Ganz catheter to optimize the haemodynamic management. The 77% presented a multiple organ disfunction syndrome (MODS) and the 56% acute renal failure. The total mortality was 70%, basically due to MODS (68%), while due to hypoxemia only in the 22%. The group treated with NO (the 35% of the ARDS patients) were younger, without any other differences the patients who did not received this treatment and with the same stage and mortality. Patients who presented MODS, renal failure or hemodynamic unstableness presented a higher mortality (p < 0.05).