Aportaciones al conocimiento de la hepatitis fulminante realizadas por la Unidad de Cuidados Intensivos Hepática del Hospital Clínic de Barcelona: revisión histórica / Contributions to our understanding of fulminant hepatitis from the Liver ICU of Hospital Clínic Barcelona: Historical review

No disponible

The Genesis, Maturation, and Future of Critical Care Cardiology.

The cardiac intensive care unit (CICU) has changed considerably over time and now serves a unique patient population with a high burden of cardiovascular and noncardiovascular critical illness. Patient complexity and technological evolutions in the CICU have catalyzed the development of critical care cardiology, a fledgling discipline that combines specialization in cardiovascular diseases with knowledge and experience in critical care medicine. Numerous uncertainties and challenges threaten to stymie the growth of this field. A multidisciplinary dialogue focused on the best care design for the CICU patient is needed as we consider alternative approaches to clinical training, staffing, and investigation in this rapidly evolving arena.

The ten advances that have defined modern cardiology.

Modern cardiology was born early in the twentieth century. Here I list and review what I believe to be the ten most important advances in the twentieth century in this field. They are as follows: electrocardiography, cholesterol-induced atherosclerosis, cardiac catheterization, cardiovascular surgery, coronary angiography and percutaneous coronary angioplasty, the coronary care unit, the development of new cardiovascular drugs, preventive cardiology, cardiac imaging, and implanted cardiac pacemakers/defibrillators.

The American Heart Association's recent scientific statement on cardiac critical care: implications for pediatric practice.

A writing group sponsored by the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the Council on Quality of Care and Outcomes Research of The American Heart Association has recently formulated a roadmap to meet the changing needs of the patient with cardiovascular disease requiring critical care. Although this roadmap has been formulated primarily to address the care needs of the adult with critical cardiovascular disease, it contains useful lessons pertinent to the care of the patient with pediatric and congenital cardiovascular disease. In this document, we have examined The Statement and applied its framework to the evolving field of pediatric cardiac critical care.

The rise of cardiovascular medicine.

Modern cardiology was born at the turn of the nineteenth to twentieth centuries with three great discoveries: the X ray, the sphygmomanometer, and the electrocardiograph. This was followed by cardiac catheterization, which led to coronary angiography and to percutaneous coronary intervention. The coronary care units and early reperfusion reduced the early mortality owing to acute myocardial infarction, and the discovery of coronary risk factors led to the development of Preventive Cardiology. Other major advances include several cardiac imaging techniques, the birth and development of cardiac surgery, and the control of cardiac arrhythmias. The treatment of heart failure, although greatly improved, remains a challenge. Current cardiology practice is evidence-based and global in scope. Research and practice are increasingly conducted in cardiovascular centres and institutes. It is likely that in the future, a greater emphasis will be placed on prevention, which will be enhanced by genetic information.

The First Coronary Care Unit in Sudan

Until the end of the eighties El Shaab Hospital was the only hospital in the country capable of receiving cardiac; pulmonary medicine and neurosurgery. It consisted of nine wards accommodating the above specialties. A well-equipped operating theatre and recovery room were stationed at the south east corner. By 1981 a cardiac catheter laboratory was installed. Patients who were referred from all provinces for cardiac care were seen at the referred outpatient where they would either be admitted to hospital for treatment or followed up at the outpatient clinics. There were basic equipment like ECG; chest X-ray facility and small laboratory for basic haematology and biochemistry investigations. 2D and M-mode echo equipment was supplied. Dr. Khalid Gharieb was the first to perform studies on that machine. By the mid-eighties it became clear to all cardiologist and physicians in the country that the toll from coronary artery disease was increasing. Very ill patients with acute myocardial infarction were coming to hospital looking for help. Some of them were admitted at the recovery room of the operating theater where monitoring and oxygen supply were available

Cardiogenic shock: a historical perspective.

Significant progress has been made over the past 60 years in defining and recognizing cardiogenic shock (CS), and there have been tremendous advances in the care of patients who have this illness. Although there are many causes of this condition, acute myocardial infarction with loss of a large amount of functioning myocardium is the most frequent cause. It was recognized early in the study of CS that prompt diagnosis and rapid initiation of therapy could improve the prognosis, and this remains true today. Although the mortality from CS remains high, especially in elderly populations, modern therapies improve the chance of survival from this critical illness.

Unidades coronarias de cuidados intermedios: base racional, infraestructura, equipamiento e indicaciones de ingreso / Intermediate coronary care units: rationale, infrastructure, equipment, and referral criteria

La Sección de Cardiopatía Isquémica y Unidades de la Sociedad Española ha considerado necesario el desarrollo de este documento sobre la necesidad, la estructura y la organización de las unidades coronarias de cuidados intermedios (UCCI). Los registros de síndrome coronario agudo (SCA) realizados en España indican que una proporción importante de pacientes recibe una atención subóptima, en parte debido a una organización inadecuada de los recursos asistenciales o a la falta de éstos. Las UCCI surgen de la necesidad de corregir estos aspectos y gestionar con eficiencia unos recursos escasos y costosos. Sus objetivos son: a) proporcionar a cada paciente el grado de cuidados que requiere; b) optimizar los recursos estructurales, técnicos y humanos, y c) facilitar el continuo asistencial y el gradiente de cuidados. Las UCCI se deben constituir en una parte esencial del servicio de cardiología destinada a la atención de enfermos cardiológicos que requieren monitorización, cuidados y capacidad de respuesta médica superiores a los disponibles en una planta de hospitalización convencional de cardiología, pero cuyo riesgo no justifica la utilización de los recursos técnicos y humanos de una unidad coronaria. Este documento describe la infraestructura (equipamiento, dotación de personal y organización) que se precisa para cumplir los objetivos descritos anteriormente y contiene recomendaciones sobre las indicaciones de ingreso en estas unidades intermedias. Éstas incluyen a determinados pacientes con: a) SCA sin elevación del segmento ST de riesgo intermedio o alto pero estables hemodinámicamente, y b) infarto agudo de miocardio con elevación del segmento ST no de alto riesgo, o bien, de alto riesgo, pero estabilizado después de una fase inicial complicada en la unidad coronaria. También se contempla el ingreso de algunos pacientes después de determinados procedimientos invasivos y de algunas formas de cardiopatías agudas no coronarias (AU)

The Spanish Working Group on Coronary Artery Disease of Spanish Society of Cardiology has considered to be necessary the development of this document on the need, structure and organization of Intermediate Cardiac Care Units (ICCU). Acute coronary syndrome registries show that an important percentage of patients receive a suboptimal care, due to an inadequate management of health resources or absence of them. Intermediate cardiac care units arise to solve these challenges and to manage in an efficient way these expensive and limited resources. Their aims are: a) to provide each patient the level of care required; b) to optimize the structural, technical and human resources, and c) to make easier continuous care and care gradient. As a result, ICCU should be established as an essential part of the cardiology department aim to cardiac patients requiring monitoring and medical care superior to those available in a regular cardiac ward but whose risk does not justify the technical and human costs of a Coronary Unit. This document describes the structure (equipment, human resources, management) required to reach the goals previously reported and includes recommendations about indications of admission in a ICCU. These indications include: a) patients with NSTE-ACS with intermediate or high risk but hemodynamically stable, and b) low risk STEAMI or high risk STEAMI stabilized after an initial admission at the Coronary Unit. The admission of some patients undergoing invasive procedures or suffering non-coronary acute cardiac diseases, is also considered (AU)

The history of the coronary care unit.

The first coronary care units were established in the early 1960s in an attempt to reduce mortality from acute myocardial infarction. Pioneering cardiologists recognized the threat of death due to malignant arrhythmias in the postinfarction setting, and developed techniques for successful external defibrillation. The ability to abort sudden death led to continuous monitoring of the cardiac rhythm and an organized system of cardiopulmonary resuscitation, incorporating external defibrillation with cardiac drugs and specialized equipment. Arrhythmia monitoring and cardiopulmonary resuscitation could be performed by trained nursing staff, which eliminated delays in treatment and significantly reduced mortality. These early triumphs in aborting sudden death led to the development of techniques to treat cardiogenic shock, limit infarct size and initiate prehospital coronary care, all of which laid the foundation for the current era of interventional cardiology.