Awake prone positioning in nonintubated spontaneous breathing ICU patients with acute hypoxemic respiratory failure (PRONELIFE)-protocol for a randomized clinical trial.

BACKGROUND: It is uncertain whether awake prone positioning can prevent intubation for invasive ventilation in spontaneous breathing critically ill patients with acute hypoxemic respiratory failure. Awake prone positioning could benefit these patients for various reasons, including a reduction in direct harm to lung tissue, and prevention of tracheal intubation-related complications. DESIGN AND METHODS: The PRONELIFE study is an investigator-initiated, international, multicenter, randomized clinical trial in patients who may need invasive ventilation because of acute hypoxemic respiratory failure. Consecutive patients admitted to participating ICUs are randomly assigned to standard care with awake prone positioning, versus standard care without awake prone positioning. The primary endpoint is a composite of tracheal intubation and all-cause mortality in the first 14 days after enrolment. Secondary endpoints include time to tracheal intubation and effects of awake prone positioning on oxygenation parameters, dyspnea sensation, and complications. Other endpoints are the number of days free from ventilation and alive at 28 days, total duration of use of noninvasive respiratory support, total duration of invasive ventilation, length of stay in ICU and hospital, and mortality in ICU and hospital, and at 28, 60, and 90 days. We will also collect data regarding the tolerance of prone positioning. DISCUSSION: The PRONELIFE study is among the first randomized clinical trials investigating the effect of awake prone positioning on intubation rate in ICU patients with acute hypoxemic failure from any cause. The PRONELIFE study is sufficiently sized to determine the effect of awake prone positioning on intubation for invasive ventilation-patients are eligible in case of acute hypoxemic respiratory failure without restrictions regarding etiology. The PRONELIFE study is a pragmatic trial in which blinding is impossible-however, as around 35 ICUs worldwide will participate in this study, its findings will be highly generalizable. The findings of the PRONELIFE study have the potential to change clinical management of patients who may need invasive ventilation because of acute hypoxemic respiratory failure. TRIAL REGISTRATION: ISRCTN ISRCTN11536318 . Registered on 17 September 2021. The PRONELIFE study is registered at clinicaltrials.gov with reference number NCT04142736 (October, 2019).

Los sistemas de información clínica: una oportunidad para medir valor, investigar e innovar a partir del mundo real / Clinical information systems: An opportunity to measure value, investigate and innovate from the real world

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Situación actual de la realización de fibrobroncoscopias en los Servicios de Medicina Intensiva / Current status of fibreoptic bronchoscopy in intensive care medicine

La fibrobroncoscopia (FBC) flexible en el campo de la Medicina Intensiva ha supuesto la introducción de una técnica de gran ayuda para el manejo de pacientes críticamente enfermos. Su seguridad y utilidad, en manos de un profesional adecuadamente entrenado y con las debidas precauciones, ha derivado en un uso cada vez más extendido, incluso en pacientes críticos inestables ventilados mecánicamente y con requerimientos elevados de oxígeno. La Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), mediante el Grupo de Trabajo de Insuficiencia Respiratoria Aguda (GT-IRA) y Enfermedades Infecciosas (GTEI), tiene como objetivo promover el conocimiento y los estándares de calidad de la práctica de la FBC en todos los especialistas de Medicina Intensiva. La SEMICYUC se ha propuesto como objetivo, a través de un comité de expertos, acreditar la formación aportando para ello un currículum, así como las unidades con capacidad para formar en las distintas técnicas y niveles. El proceso de acreditación busca estimular las buenas prácticas de aprendizaje y de calidad en la formación. Tanto el especialista en Medicina Intensiva como otros especialistas médicos y los pacientes se beneficiarán del nivel de compromiso y de control que la acreditación conlleva y del aprendizaje y el entrenamiento que involucra este proceso (AU)

Flexible bronchoscopy (FB) has been of great help in the management of critically ill patients. Its safety and usefulness in the hands of experienced professionals, with the required measures of caution, has resulted in the increasingly widespread use of the technique even in unstable critical patients subjected to mechanical ventilation and with high oxygen demands. The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), through its Acute Respiratory Failure (GT-IRA) and Infectious Diseases (GT-EI) Work Groups, aims to promote knowledge and standards of quality in the use of FB among all specialists in Intensive Care Medicine. Through an expert committee, the SEMICYUC has established the objective of accrediting such training, with the preparation of a curriculum and definition of those Units qualified for providing training in the different techniques and levels. The accreditation process seeks to stimulate good learning practice and quality in training. Both specialists in Intensive Care Medicine and other specialists, and the patients, will benefit from the commitment and control afforded by such accreditation, and from the learning and training which the mentioned process entails (AU)

[Current status of fibreoptic bronchoscopy in intensive care medicine]. / Situación actual de la realización de fibrobroncoscopias en los servicios de medicina intensiva.

Flexible bronchoscopy (FB) has been of great help in the management of critically ill patients. Its safety and usefulness in the hands of experienced professionals, with the required measures of caution, has resulted in the increasingly widespread use of the technique even in unstable critical patients subjected to mechanical ventilation and with high oxygen demands. The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), through its Acute Respiratory Failure (GT-IRA) and Infectious Diseases (GT-EI) Work Groups, aims to promote knowledge and standards of quality in the use of FB among all specialists in Intensive Care Medicine. Through an expert committee, the SEMICYUC has established the objective of accrediting such training, with the preparation of a curriculum and definition of those Units qualified for providing training in the different techniques and levels. The accreditation process seeks to stimulate good learning practice and quality in training. Both specialists in Intensive Care Medicine and other specialists, and the patients, will benefit from the commitment and control afforded by such accreditation, and from the learning and training which the mentioned process entails.

[Indicators of quality in the critical patient]. / Indicadores de calidad en el enfermo crítico.

The utility of using quality indicators as a tool to measure the common practice and evaluate efficacy of measures established to improve quality has been demonstrated, making it possible to identify and make known the improvements carried out. The project "Quality indicators in the critical patient" has been conducted by the Spanish Society of Intensive and Critical Medicine (SEMICYUC) under the methodological management of the Foundation Avedis Donabedian (FAD) of Barcelona. Its objective was to develop key indicators in the care of the critical patient, considering the following as added values: reaching an agreement on the quality criteria in these patients and providing the professionals with a potent and reliable instrument for clinical evaluation and management, introducing common evaluation methods that make it possible to unify the measure, making a comparative evaluation (benchmarking), having information that makes it possible to develop quality plans (quantitative, objective, reliable and valid data) and having a system that assures total quality of care to the critical patient.

Indicadores de calidad en el enfermo crítico / Indicators of quality in the critical patient

El uso de indicadores de calidad ha demostrado su utilidad como herramienta para medir la práctica habitual y evaluar la eficacia de medidas establecidas para la mejora de la calidad permitiendo identificar y diseminar las mejores prácticas. El proyecto «Indicadores de calidad en el enfermo crítico» ha sido realizado por la Sociedad Española de Medicina Intensiva y Crítica (SEMICYUC), bajo la dirección metodológica de la Fundación Avedis Donabedian (FAD) de Barcelona. El objetivo del mismo fue el desarrollo de indicadores clave en la atención del enfermo crítico considerándose como valores añadidos: consensuar los criterios de calidad en estos pacientes, y facilitar a los profesionales un instrumento potente y fiable para la evaluación y la gestión clínica; introducir métodos de evaluación comunes que permitan unificar la medida, evaluar comparativamente (benchmarking), disponer de información que permita el desarrollo de planes de calidad (datos cuantitativos, objetivos, fiables y válidos) y disponer de un sistema que garantice la calidad total de la asistencia del enfermo crítico

The utility of using quality indicators as a tool to measure the common practice and evaluate efficacy of measures established to improve quality has been demonstrated, making it possible to identify and make known the improvements carried out. The project «Quality indicators in the critical patient» has been conducted by the Spanish Society of Intensive and Critical Medicine (SEMICYUC) under the methodological management of the Foundation Avedis Donabedian (FAD) of Barcelona. Its objective was to develop key indicators in the care of the critical patient, considering the following as added values: reaching an agreement on the quality criteria in these patients and providing the professionals with a potent and reliable instrument for clinical evaluation and management, introducing common evaluation methods that make it possible to unify the measure, making a comparative evaluation (benchmarking), having information that makes it possible to develop quality plans (quantitative, objective, reliable and valid data) and having a system that assures total quality of care to the critical patient

Análisis del nivel de satisfacción profesional y de la visión de futuro de la medicina intensiva como especialidad / Analysis of levels of professional satisfaction and view of the future of critical care medicine as a speciality

Fundamento. Dos objetivos fundamentan este estudio: conocer el nivel de satisfacción profesional de los médicos adscritos a los servicios de medicina intensiva y averiguar cuál es la visión de futuro de la medicina intensiva como especialidad. Métodos. Mediante una encuesta realizada a 245 médicos intensivistas de un mismo ámbito territorial y contestada por 46, se describen y analizan las respuestas obtenidas en cuanto al nivel de satisfacción laboral, la organización del servicio de medicina intensiva, los valores de los profesionales y el posicionamiento estratégico de la especialidad. Se analizan las características consideradas más positivas y más negativas por sus profesionales. Resultados. El análisis del nivel de satisfacción profesional es en general positivo. Mayoritariamente existe un acuerdo con el modelo actual de organización del staff en los servicios de medicina intensiva. Aunque la actividad asistencial es considerada prioritaria, se valora de forma positiva la docencia e investigación. El modelo actual de la medicina intensiva no parece ser el más adecuado, y la mayoría está de acuerdo en aceptar planteamientos de cambio. Las características positivas de la medicina intensiva hacen referencia al propio enfermo crítico y a su atención global y continuada; así como al know-how de sus profesionales. Las características negativas se relacionan principalmente con el síndrome de burnout. Conclusiones. Factores internos característicos de la medicina intensiva condicionan el nivel de satisfacción profesional, pero éste se ve influido también por factores externos. Existe un deseo de adaptar la organización de la medicina intensiva al futuro de la especialidad, pero sin perder una serie de "privilegios" inherentes a la organización clásica de atención del enfermo crítico (AU)