ABSTRACT
INTRODUCTION: Posterior ankle arthroscopy allows the diagnosis and treatment of multiple pathologies through minimal trauma. The use of posterior portals associated or not to mechanical distraction, allows a good vision of the posterior ankle, tendons of the region, and subtalar joint. OBJECTIVES: We evaluated intra- and postoperative complications of posterior ankle arthroscopy without joint distraction, and compared them with those described in international literature. MATERIAL AND METHODS: A retrospective study that evaluated 49 patients undergoing posterior ankle arthroscopy for several pathologies. All of them operated by a single surgeon, in two health institutions, for seven years. RESULTS: were analyzed using the visual analog scale and the AOFAS score. Intra- and postoperative complications were recorded. The average follow-up was 28 months. RESULTS: 33 men and 16 women. The average age was 38.6 years old. There were seven complications (14.3%): paresthesia and - or hypoesthesia of the sural nerve (four cases), residual pain in the portal (two cases), and portal scar dehiscence (one patient). The average improvement of VAS was 5.53 points, and the improved AOFAS score was an average of 35.78 points. CONCLUSIONS: Posterior ankle arthroscopy without distraction through the classic postero-lateral and posteromedial portals is a safe technique, with a low rate of complications.
INTRODUCCIÓN: La artroscopía posterior de tobillo permite el diagnóstico y tratamiento de múltiples patologías a través de un mínimo trauma. Los portales posteriores, asociados o no a distracción mecánica, permiten una buena visión de los tendones de la región y articulación substragalina. OBJETIVO: del presente estudio es evaluar las complicaciones intraoperatorias y postoperatorias de la artroscopía posterior del tobillo y retropié sin distracción articular y compararlas con las descritas en la bibliografía internacional. MATERIAL Y MÉTODOS: Estudio retrospectivo que evaluó 49 pacientes sometidos a artroscopía posterior de tobillo por diversas patologías. Todos operados por un único cirujano, en dos instituciones de salud, durante un período de siete años. Se analizaron los resultados mediante la escala visual analógica (EVA) y la escala de la American Orthopaedic Foot and Ankle Society (AOFAS, por sus siglas en inglés). Se consignaron las complicaciones intra- y postoperatorias. El seguimiento promedio fue de 28 meses. RESULTADOS: 33 varones y 16 mujeres (edad promedio 38.6 años). Hubo siete complicaciones (14.3%): cuatro parestesias y/o hipoestesia del nervio sural, dos casos de dolor residual en un portal y un caso de dehiscencia de cicatriz. Mejoría promedio de EVA de 5.53 puntos y mejoría promedio del AOFAS de 35.78 puntos. CONCLUSIONES: La artroscopía posterior de tobillo sin distracción por medio de los clásicos portales posterolateral y posteromedial es una técnica segura, con un bajo índice de complicaciones mayores y una baja morbilidad para el paciente.
Subject(s)
Ankle , Arthroscopy , Adult , Ankle Joint/surgery , Female , Humans , Male , Retrospective Studies , TendonsABSTRACT
Objetivo Conocer el destino de los trabajos rechazados en Medicina Intensiva (MI) en el período del 2015 al 2017 con seguimiento hasta el 2019. Diseño Estudio retrospectivo observacional. Ámbito Publicaciones en revistas biomédicas. Participantes Manuscritos rechazados en la revista Medicina Intensiva. Intervenciones Ninguna Variables de interés Tiempo de publicación, factor de impacto (FI), citas generadas y variables asociadas con la publicación. Resultados De 344 originales y 263 cartas científicas, se rechazaron 420 (69,2%). Se publicaron después 205 (48,8%) y 66 de ellos generaron 180 citas. El FI de las revistas fue menor en 173 casos (84,4%). En 21, el número de citas válidas para FI fue mayor que el FI de MI. El origen del manuscrito odds ratio (OR) 2,11 (IC 95% 1,29 a 3,46), la mujer como autora OR 1,58 (IC 95% 1,03 a 2,44), que estuviera en lengua inglesa OR 2,38 (IC 95% 1,41 a 4,0) y que el artículo hubiera pasado a revisores OR 1,71 (IC 95% 1,10 a 2,66) se asociaron con mayor tasa de publicación en revistas indexadas en PubMed. Conclusiones Los artículos rechazados en MI tienen una tasa media de publicación en otras revistas, principalmente con menos FI y generando menor número de citas que el FI de MI. (AU)
Objective To know the fate of the rejected manuscripts in Medicina Intensiva journal (MI) from 2015 to 2017 with surveillance until 2019. Design Retrospective observational study. Setting Biomedical journals publication. Participants Rejected manuscripts in MI journal. Interventions None. Main variables of interest Time of publication, impact factor (IF), generated citations and variables associated to publication. Results The 69% (420) of analyzed articles (344 originals and 263 scientific letters) were rejected, and 205 (48.8%) were subsequently published, with 180 citations of 66 articles. Journal IF was lower in 173 (84.4%) articles. The number of FI-valid citations was higher than the FI of MI in 21 articles. Origin of manuscript OR 2,11 (IC 95% 1.29 3.46), female author OR 1.58 (IC 95% 1.03-2.44), english language OR 2,38 (IC 95% 1.41-4.0) and reviewed papers OR 1.71 (IC 95% 1.10-2.66) were associated to publication in PubMed database. Conclusions The rejected articles in MI have a mean publication rate in other journals. Most of these articles are published in journals with less IF and fewer citations than the IF of MI. (AU)
Subject(s)
Humans , Impact Factor , Peer Review , Bibliometrics , Gender IdentityABSTRACT
OBJECTIVE: To know the fate of the rejected manuscripts in Medicina Intensiva journal (MI) from 2015 to 2017 with surveillance until 2019. DESIGN: Retrospective observational study. SETTING: Biomedical journals publication. PARTICIPANTS: Rejected manuscripts in MI journal. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Time of publication, impact factor (IF), generated citations and variables associated to publication. RESULTS: The 69% (420) of analyzed articles (344 originals and 263 scientific letters) were rejected, and 205 (48.8%) were subsequently published, with 180 citations of 66 articles. Journal IF was lower in 173 (84.4%) articles. The number of FI-valid citations was higher than the FI of MI in 21 articles. Origin of manuscript OR 2,11 (IC 95% 1.29-3.46), female author OR 1.58 (IC 95% 1.03-2.44), english language OR 2,38 (IC 95% 1.41-4.0) and reviewed papers OR 1.71 (IC 95% 1.10-2.66) were associated to publication in PubMed database. CONCLUSIONS: The rejected articles in MI have a mean publication rate in other journals. Most of these articles are published in journals with less IF and fewer citations than the IF of MI.
Subject(s)
Peer Review, Research , Publishing , Female , Humans , Journal Impact Factor , Language , PubMedABSTRACT
OBJECTIVE: To know the fate of the rejected manuscripts in Medicina Intensiva journal (MI) from 2015 to 2017 with surveillance until 2019. DESIGN: Retrospective observational study. SETTING: Biomedical journals publication. PARTICIPANTS: Rejected manuscripts in MI journal. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Time of publication, impact factor (IF), generated citations and variables associated to publication. RESULTS: The 69% (420) of analyzed articles (344 originals and 263 scientific letters) were rejected, and 205 (48.8%) were subsequently published, with 180 citations of 66 articles. Journal IF was lower in 173 (84.4%) articles. The number of FI-valid citations was higher than the FI of MI in 21 articles. Origin of manuscript OR 2,11 (IC 95% 1.29 - 3.46), female author OR 1.58 (IC 95% 1.03-2.44), english language OR 2,38 (IC 95% 1.41-4.0) and reviewed papers OR 1.71 (IC 95% 1.10-2.66) were associated to publication in PubMed database. CONCLUSIONS: The rejected articles in MI have a mean publication rate in other journals. Most of these articles are published in journals with less IF and fewer citations than the IF of MI.
ABSTRACT
INTRODUCTION: Since William Clancy (1979) and Richard Ferkel (1997) publications, the technique of peroneal groove deepening in patients with chronic dislocation, has been used with very satisfactory results and few complications. The aim of the present study is to describe a new minimally invasive technique of peroneal groove deepening with burs and specific percutaneous surgery instrumentation and without fibula osteotomy; and to evaluate the clinical and imaging results, in 5 patients operated with this technique. MATERIAL AND METHODS: A retrospective study of 5 patients with clinical and imaging diagnosis of chronic dislocation of peroneal tendons. They were treated with minimally invasive technique. This technique was described in this paper. Results were evaluated by preoperative and postoperative AOFAS score and by images (dynamic ultrasound, TAC and RMN). RESULTS: None of the treated patients presented dislocation recurrence or pain at the time of evaluation. The AOFAS score improved an average of 25.5 points and was statistically significant (p value 0.001). In the images we observed a concavity of the groove in all the evaluated cases. CONCLUSIONS: This minimally invasive technique of deepening the groove of the peroneal tendons is reproducible, has reduced operating times compared to open surgery and has excellent results. This is a noninvasive treatment alternative for dislocation of peroneal tendons.
INTRODUCCIÓN: Desde las publicaciones de William Clancy en 1979 y las de Richard Ferkel en 1997, la técnica de profundización del surco en pacientes con luxación crónica de los peroneos ha sido ampliamente utilizada, obteniendo resultados muy satisfactorios y escasas complicaciones. El objetivo del presente trabajo es describir una nueva técnica de profundización del surco mínimamente invasiva con fresas y un motor específico de cirugía percutánea, sin osteotomía y sin dejar lecho cruento del peroné, además de evaluar los resultados clínicos e imagenológicos en cinco pacientes operados con esta técnica. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de cinco pacientes con diagnóstico clínico y de imágenes de luxación crónica de tendones peroneos intervenidos con técnica mínimamente invasiva, la cual ya fue descrita. Los resultados fueron evaluados mediante el score AOFAS (por sus siglas en inglés American Orthopedic Foot and Ankle Score) de manera pre y postquirúrgica y a través de imágenes (ecografía dinámica, tomografía axial computada y resonancia magnética nuclear). RESULTADOS: Ninguno de los pacientes tratados presentó recidiva de luxación ni dolor al momento de la evaluación. El score AOFAS mejoró en promedio 25.5 puntos y fue estadísticamente significativo (p 0.001). En las imágenes observamos una concavidad del surco en todos los casos evaluados. CONCLUSIONES: Creemos que esta técnica mínimamente invasiva de profundización del surco de los peroneos es reproducible y presenta tiempos operatorios reducidos, comparada con la cirugía a cielo abierto; además tiene excelentes resultados. Por tales motivos, consideramos que se trata de una alternativa de tratamiento poco invasiva para la luxación de los tendones peroneos.
Subject(s)
Ankle Injuries , Joint Dislocations , Tendon Injuries , Humans , Retrospective Studies , TendonsABSTRACT
En enero de 2020 China identificó un nuevo virus de la familia de los Coronaviridae como causante de varios casos de neumonía de origen desconocido. Inicialmente confinado a la ciudad de Wuhan, se extendió posteriormente fuera de las fronteras chinas. En España, el primer caso se declaró el 31 de enero de 2020. El 11 de marzo, la Organización Mundial de la Salud declaró el brote de coronavirus como pandemia. El 16 de marzo había 139 países afectados. Ante esta situación, las Sociedades Científicas SEMICYUC y SEEIUC han decidido la elaboración de este plan de contingencia para dar respuesta a las necesidades que conllevará esta nueva enfermedad. Se pretende estimar la magnitud del problema e identificar las necesidades asistenciales, de recursos humanos y materiales, de manera que los servicios de medicina intensiva del país tengan una herramienta que les permita una planificación óptima y realista con que responder a la pandemia
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies
Subject(s)
Humans , Health Planning , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Critical Care/organization & administration , Pandemics , Communicable Disease Control , Spain/epidemiology , Disease Outbreaks/prevention & controlSubject(s)
Betacoronavirus , Coronavirus Infections , Critical Care/methods , Electronic Health Records , Hospital Information Systems , Intensive Care Units , Pandemics , Pneumonia, Viral , Big Data , COVID-19 , Computer Systems , Electronic Health Records/trends , Health Services Needs and Demand , Hospital Information Systems/trends , Humans , Infection Control , SARS-CoV-2 , Telemedicine/methods , Telemedicine/trendsABSTRACT
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.
Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Care/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , COVID-19 , Humans , Spain/epidemiologyABSTRACT
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.
Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Care/organization & administration , Needs Assessment/organization & administration , Pneumonia, Viral/therapy , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Critical Care/standards , Cross Infection/prevention & control , Health Resources/organization & administration , Humans , Information Dissemination/methods , Intensive Care Units/organization & administration , Needs Assessment/statistics & numerical data , Pandemics/prevention & control , Patient Admission/standards , Personal Protective Equipment/standards , Personnel Staffing and Scheduling , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Resource Allocation/methods , Resource Allocation/organization & administration , SARS-CoV-2 , Software , Spain/epidemiology , Staff Development/organization & administrationABSTRACT
Resumen: Introducción: Desde las publicaciones de William Clancy en 1979 y las de Richard Ferkel en 1997, la técnica de profundización del surco en pacientes con luxación crónica de los peroneos ha sido ampliamente utilizada, obteniendo resultados muy satisfactorios y escasas complicaciones. El objetivo del presente trabajo es describir una nueva técnica de profundización del surco mínimamente invasiva con fresas y un motor específico de cirugía percutánea, sin osteotomía y sin dejar lecho cruento del peroné, además de evaluar los resultados clínicos e imagenológicos en cinco pacientes operados con esta técnica. Material y métodos: Se realizó un estudio retrospectivo de cinco pacientes con diagnóstico clínico y de imágenes de luxación crónica de tendones peroneos intervenidos con técnica mínimamente invasiva, la cual ya fue descrita. Los resultados fueron evaluados mediante el score AOFAS (por sus siglas en inglés American Orthopedic Foot and Ankle Score) de manera pre y postquirúrgica y a través de imágenes (ecografía dinámica, tomografía axial computada y resonancia magnética nuclear). Resultados: Ninguno de los pacientes tratados presentó recidiva de luxación ni dolor al momento de la evaluación. El score AOFAS mejoró en promedio 25.5 puntos y fue estadísticamente significativo (p < 0.001). En las imágenes observamos una concavidad del surco en todos los casos evaluados. Conclusiones: Creemos que esta técnica mínimamente invasiva de profundización del surco de los peroneos es reproducible y presenta tiempos operatorios reducidos, comparada con la cirugía a cielo abierto; además tiene excelentes resultados. Por tales motivos, consideramos que se trata de una alternativa de tratamiento poco invasiva para la luxación de los tendones peroneos.
Abstract: Introduction: Since William Clancy (1979) and Richard Ferkel (1997) publications, the technique of peroneal groove deepening in patients with chronic dislocation, has been used with very satisfactory results and few complications. The aim of the present study is to describe a new minimally invasive technique of peroneal groove deepening with burs and specific percutaneous surgery instrumentation and without fibula osteotomy; and to evaluate the clinical and imaging results, in 5 patients operated with this technique. Material and methods: A retrospective study of 5 patients with clinical and imaging diagnosis of chronic dislocation of peroneal tendons. They were treated with minimally invasive technique. This technique was described in this paper. Results were evaluated by preoperative and postoperative AOFAS score and by images (dynamic ultrasound, TAC and RMN). Results: None of the treated patients presented dislocation recurrence or pain at the time of evaluation. The AOFAS score improved an average of 25.5 points and was statistically significant (p value< 0.001). In the images we observed a concavity of the groove in all the evaluated cases. Conclusions: This minimally invasive technique of deepening the groove of the peroneal tendons is reproducible, has reduced operating times compared to open surgery and has excellent results. This is a noninvasive treatment alternative for dislocation of peroneal tendons.
Subject(s)
Humans , Tendon Injuries , Ankle Injuries , Joint Dislocations , Tendons , Retrospective StudiesABSTRACT
Dada la importancia del manejo de la sedación, analgesia y delirium en las unidades de cuidados intensivos, y con el fin de actualizar las guías publicadas anteriormente, se decidió elaborar una nueva guía de práctica clínica con los soportes, manejos e intervenciones más relevantes acordes con las publicaciones recientes. Para elaborar esta guía, se reunió un grupo de 24 intensivistas procedentes de 9 países de la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva. Se acogió la propuesta del Grading of Recommendations Assessment, Development and Evaluation Working Group para emitir el grado de recomendación y evaluar la calidad de la evidencia. Se realizó una búsqueda sistemática de la literatura utilizándose: MEDLINE, las siguientes bases de datos de la biblioteca Cochrane: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects, National Health Service Economic Evaluation Database, y la base de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Finalmente, se seleccionaron 438 referencias, permitiendo realizar 47 recomendaciones fuertes con evidencia alta y moderada, 14 recomendaciones condicionales con evidencia moderada y 65 recomendaciones condicionales con evidencia baja. Se confirma la importancia del manejo inicial y multimodal del dolor, se hace énfasis en la disminución de los niveles de sedación y la utilización de sedación profunda solo en casos específicos. Aumenta la evidencia y recomendaciones para el uso de medicamentos como dexmedetomidina, remifentanil, ketamina, entre otros
Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented
Subject(s)
Humans , Delirium/therapy , Analgesia/methods , Critical Illness , Deep Sedation , Intensive Care Units , Pain Management , Dexmedetomidine , Remifentanil , Ketamine , GRADE Approach/standardsABSTRACT
Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.
Subject(s)
Analgesia/methods , Anesthesia/methods , Critical Illness/therapy , Delirium/therapy , Analgesia/standards , Anesthesia/standards , Benzodiazepines/administration & dosage , Conscious Sedation/methods , Conscious Sedation/standards , Critical Care/methods , Critical Care/standards , Evidence-Based Medicine/standards , Humans , Hypnotics and Sedatives/administration & dosage , Intensive Care Units , Midazolam/administration & dosage , Pain Management/standardsABSTRACT
En enero de 2020 China identificó un nuevo virus de la familia de los Coronaviridae como causante de varios casos de neumonía de origen desconocido. Inicialmente confinado a la ciudad de Wuhan, se extendió posteriormente fuera de las fronteras chinas. En España, el primer caso se declaró el 31 de enero de 2020. El 11 de marzo, la Organización Mundial de la Salud declaró el brote de coronavirus como pandemia. El 16 de marzo había 139 países afectados. Ante esta situación, las Sociedades Científicas SEMICYUC y SEEIUC han decidido la elaboración de este plan de contingencia para dar respuesta a las necesidades que conllevará esta nueva enfermedad. Se pretende estimar la magnitud del problema e identificar las necesidades asistenciales, de recursos humanos y materiales, de manera que los servicios de medicina intensiva del país tengan una herramienta que les permita una planificación óptima y realista con que responder a la pandemia
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies
Subject(s)
Humans , Critical Care , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Contingency Plans , PandemicsABSTRACT
La Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva, A.C. (FEPIMCTI), ha elaborado su plan estratégico para los próximos 5 años. En este plan define su rumbo hacia el futuro, establece sus objetivos a largo plazo y trabaja para alcanzar el éxito. Sus objetivos estratégicos se enmarcan en consolidar la estructura legal, fiscal y administrativa, la actualización de sus estatutos, la implantación de un sistema de gestión de procesos englobados en una cultura de calidad, la puesta en marcha de comités de expertos, lograr la excelencia académica mediante la elaboración de programas formativos y dar visibilidad a la Federación. Sus principales valores hacen referencia a la equidad, profesionalismo, respeto y solidaridad social. La implantación del plan estratégico de forma colaborativa debe servir de motor de cambio para posicionar a la FEPIMCTI como sociedad científica relevante en la Medicina Crítica de los países miembros
The Pan-American and Iberian Federation of Critical Medicine and Intensive Therapy, A.C. (FEPIMCTI), has prepared its Strategic Plan for the next 5 years. In this Plan, it defines its course towards the future, establishes its long-term objectives and works to achieve success. Its strategic objectives are framed in consolidating the legal, fiscal and administrative structure, the updating of its statutes, the implementation of a process management system encompassed in a quality culture, the implementation of committees of experts, achieving academic excellence by developing training programs and giving visibility to the Federation. Their main values refer to equity, professionalism, respect and social solidarity. The implementation of the Strategic Plan in a collaborative manner must serve as a driving force for change to position FEPIMCTI as a relevant Scientific Society in the Critical Medicine of its member countries
Subject(s)
Health Care Coalitions/organization & administration , Critical Care/legislation & jurisprudence , Critical Care/organization & administration , Health Promotion , Health Planning , Health Care Reform , Societies, Scientific/organization & administration , Societies, Scientific/standards , Health Plan Implementation/legislation & jurisprudence , Health Plan Implementation/organization & administrationABSTRACT
The Pan-American and Iberian Federation of Critical Medicine and Intensive Therapy, A.C. (FEPIMCTI), has prepared its Strategic Plan for the next 5 years. In this Plan, it defines its course towards the future, establishes its long-term objectives and works to achieve success. Its strategic objectives are framed in consolidating the legal, fiscal and administrative structure, the updating of its statutes, the implementation of a process management system encompassed in a quality culture, the implementation of committees of experts, achieving academic excellence by developing training programs and giving visibility to the Federation. Their main values refer to equity, professionalism, respect and social solidarity. The implementation of the Strategic Plan in a collaborative manner must serve as a driving force for change to position FEPIMCTI as a relevant Scientific Society in the Critical Medicine of its member countries.
Subject(s)
Critical Care/organization & administration , Organizational Objectives , Societies, Medical/organization & administration , Strategic Planning , Americas , Forecasting , International Cooperation , SpainABSTRACT
OBJETIVOS: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. MÉTODOS: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network (LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTADOS: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B=3, 2C=3, 2D=4) y 9 negativas (1B=8, 2C=1). En 6 ocasiones no se pudieron establecer recomendaciones. CONCLUSIÓN: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones
OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used
Subject(s)
Humans , Tracheostomy/methods , Critical Illness/therapy , Respiration, Artificial/methods , Evidence-Based Practice , Practice Patterns, Physicians' , Critical Care/methodsABSTRACT
Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)
OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)
Subject(s)
Humans , Spinal Cord Injuries/rehabilitation , Critical Care/methods , Respiration, Artificial , Time Factors , Bronchoscopy , Tracheostomy , Laryngeal Masks , Length of StayABSTRACT
OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
Subject(s)
Tracheostomy , Bronchoscopy , Burns/therapy , Critical Care/standards , Evidence-Based Medicine , Humans , Laryngeal Masks , Length of Stay , Respiration, Artificial , Spinal Cord Injuries/therapy , Time Factors , Tracheostomy/adverse effects , Tracheostomy/instrumentation , Tracheostomy/methodsABSTRACT
Objetivo: Evaluar el impacto sobre la tasa de complicaciones en la intubación orotraqueal con la implementación de un protocolo de actuación en el manejo de la vía aérea. Materiales y Métodos: Pacientes admitidos al Servicio de Terapia Intensiva polivalente entre agosto de 2012 y marzo de 2014, que requirieron intubación orotraqueal. Se utilizó un protocolo de actuación "Pensar globalmente y Actuar localmente" durante el proceso de preintubación, intubación y posintubación, que incluye valoración de las vías aéreas, planes de seguridad, optimización cardiovascular y pulmonar. Las complicaciones fueron: 1) intubación dificultosa, 2) intubación esofágica, 3) traumatismo de la vía aérea superior, 4) broncoaspiración, 5) arritmias cardíacas, 6) paro cardiocirculatorio. Se compararon las tasas de complicaciones durante dos períodos: Período 1 (P1): de agosto de 2010 a julio de 2012, en el que se realizó la intubación orotraqueal mediante la Secuencia de Intubación Rápida, y Período 2 (P2): de agosto de 2012 a marzo de 2014, en el que se implementó el protocolo "Pensar globalmente y Actuar localmente". Se evaluaron características demográficas, puntajes APACHE II y SOFA, complicaciones de la intubación, estancia en Terapia Intensiva y mortalidad. El análisis estadístico se realizó utilizando la media, la desviación estándar y la prueba de Fisher para las variables cuantitativas y la prueba de χ2 para las variables dicotó- micas. Se consideró significativa una probabilidad de error <5% (p <0,05). Resultados: 374 pacientes requirieron intubación orotraqueal: 180 (48,1%) en el P1 y 194 (51,8%) en el P2; edad: 59 ± 18 años (P1) y 61 ± 18 años (P2); APACHE II: 18 (P1) y 16 (P2); SOFA: 8 ± 2 y 7 ± 3, respectivamente; complicaciones: P1, 24 (13%), P2, 7 (3,6%) (p <0,001); intubación dificultosa: P1, 8 (33,3%), P2, 1 (14,2%) (p <0,005); intubación esofágica: P1, 3 (12,5%), P2, 1 (14,2%); traumatismo de la vía aérea superior: P1, 5 (21,3%), P2, 2 (28,5%); broncoaspiración: P1, 4 (16,6%), P2, 1 (14,2%); arritmias: P1, 3 (12,5%), P2,2 (28,5%), paro cardiocirculatorio: P1, 1 (4,1%), P2: 0. Estancia en Terapia Intensiva: 13.5 ± 3 días (P1) y 12.8 ± 1.2 días (P2). Mortalidad 10% (P1) y 6,2% (P2) (NS). Conclusión: La aplicación de un protocolo para el manejo de la vía aérea redujo, con significación estadística, la tasa de complicaciones, en particular, la intubación dificultosa. (AR)
Objective: To evaluate the impact of a protocol for the management of the airway on the complication rate in tracheal intubation. Materials and Methods: Patients requiring orotracheal intubation admitted to the Intensive Care Unit from August 2012 to March 2014 were included. The "Think globally and Act locally" protocol was used during pre-intubation, intubation and after intubation, including assessment of the airway, safety plans, cardiovascular and pulmonary optimization. Complications: 1) difficult intubation, 2) esophageal intubation, 3) upper airway trauma, 4) aspiration, 5) arrhythmias, 6) cardiac arrest. Rates of complications were compared during two periods: Period 1 (P1): from August 2010 to July 2012 where orotracheal intubation was conducted through rapid sequence intubation, and Period 2 (P2) from August 2012 to March 2014, where "Think globally and Act locally" protocol was implemented. Demographic characteristics, APACHE II and SOFA scores, complications of intubation, length of stay in the Intensive Care Unit, and mortality were evaluated. Statistical analyses were performed using mean, standard deviation, and Fisher test for quantitative variables and chi square test for dichotomous variables; a probability of error <5% (p <0,05) was considered significant. Results: 374 patients required tracheal intubation: 180 (48.1%) during P1 and 194 (51.8%) during P2; mean age: 59 ± 18 years (P1) and 61 ± 18 years (P2); APACHE II score: 18 (P1) and 16 (P2); SOFA score: 8 ± 2 (P1) and 7 ± 3 (P2); complications: P1, 24 (13%); P2, 7 (3.6%) (p <0.001); difficult intubation: P1, 8 (33.3%), P2, 1 (14.2%) (p <0.005); esophageal intubation: P1, 3 (12.5%), P2, 1 (14.2%), upper airway trauma: P1, 5 (21.3%), P2, 2 (28.5%); aspiration: P1, 4 (16.6%), P2, 1 (14.2%); arrhythmias: P1, 3 (12.5%), P2, 2 (28.5%); cardiac arrest: P1, 1 (4.1%), P2, 0; stay in the Intensive Care Unit: 13.5 ± 3 (P1) and 12.8 ± 1.2 days (P2); mortality: 10% (P1) and 6.2% (P2) (NS). Conclusion: Implementation of a protocol for the management of the airway decreased complications with statistical significance, including difficult intubation.(AR)
Subject(s)
Humans , Algorithms , Health Organizations , Airway Management , IntubationABSTRACT
Introducción: El óptimo manejo de la sedación, analgesia y delirium ofrece al paciente crítico comodidad y seguridad, facilita el buen desarrollo de medidas de soporte y manejo integral y disminuye complicaciones, impactando en un mejor desenlace. Objetivo: Actualizar la Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo publicada en Medicina Intensiva en el 2007 y dar recomendaciones para el manejo de la sedación, analgesia y delirium. Metodología: Se reunió un grupo de 21 intensivistas procedentes de 9 países de la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 de ellos además especialistas en epidemiología clínica y metodología para elaboración de guías. Se acogió la propuesta del Grading of Recommendations Assessment, Development and Evaluation Working Group para emitir el grado de recomendación y evaluar la calidad de la evidencia. La fuerza de las recomendaciones fue calificada como 1=fuerte, o 2=débil, y la calidad de la evidencia como A=alta, B=moderada, o C=baja. Expertos en búsqueda de literatura apoyaron con esta estrategia de búsqueda: MEDLINE a través de PUBMED, bases de datos de la biblioteca Cochrane a través de The Cochrane Library y la base de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud. Los miembros asignados a las 11 secciones de la guía, basándose en la revisión de la literatura, presentaron las recomendaciones, sustentadas y discutidas en sesiones plenarias, aprobando aquellas que superaron el 80% del consenso. La elaboración de las guías contó con el soporte de la Asociación Colombiana de Medicina Crítica y Cuidado Intensivo. Resultados: Para la elaboración de la guía fueron finalmente seleccionadas 467 referencias, observándose un importante aumento en el número y calidad de los estudios, permitiendo realizar 64 fuertes recomendaciones con evidencia alta y moderada, contrastando con las 28 de la edición anterior. Conclusiones: Esta guía contiene recomendaciones y sugerencias basadas en la mejor evidencia para el manejo de la sedación, analgesia y delirium del paciente crítico, incluyendo un paquete de medidas (bundle). Se destacan: evaluación del dolor y la agitación/sedación mediante escalas; usar inicialmente opioides para el control de la analgesia, adicionando técnicas multimodales para disminuir consumo de opioides; promover el menor nivel de sedación necesario, evitando la sobresedación; en caso de requerir medicamentos sedantes, escoger el más apropiado, evitando el uso rutinario de benzodiazepinas; por último, identificar factores de riesgo para delirium, prevenirlo, diagnosticarlo y manejarlo, con el medicamento más conveniente, ya sea haloperidol, antipsicóticos atípicos o dexmedetomidina, evitando el uso de benzodiazepinas y disminuyendo el uso de opioides
Introduction: Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes. Objective: To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium. Methodology: A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines. Results: Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition. Conclusions: This Guidelines contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids