[Recommendations for psychology and youth sports. A consensus document].

Sports organisations involved in grassroots sports have trainers, managers and referees whose attitudes, work and dedication show that many of them are volunteers with little knowledge of psychology as a working method. This document, promoted by the Programa Talento Deportivo of the University of Navarra and the Official Association of Psychologists of Navarra, considers the role of psychology in children's and adolescents' sport and the benefits it can offer to sports players, parents, trainers, referees and managers. It also establishes a consensus in the form of a set of guidelines and twenty-seven recommendations. The aim of this consensus is to recognise the benefits of including psychology in the profiles involved in grassroots sport, to enable those involved to acquire skills that can help to improve performance and psychological states, promoting directives to be used when managing and training young sports players.

Decálogo de recomendaciones sobre psicología y deporte juvenil. Documento de consenso / Recommendations for psychology and youth sports. A consensus document

Las organizaciones deportivas involucradas en el deporte-base cuentan con entrenadores, directivos y árbitros cuya actitud, trabajo y dedicación permite deducir que la mayoría son ciudadanos voluntarios con escaso conocimiento sobre la psicología como método de trabajo. Este documento, impulsado por el Programa Talento Deportivo de la Universidad de Navarra y el Colegio Oficial de Psicólogos de Navarra, aborda el papel de la psicología en el deporte infanto-juvenil y los beneficios que puede aportar a deportistas, padres, entrenadores, árbitros o directivos. También establece un consenso en forma de decálogo y veintisiete recomendaciones con el objetivo de reconocer los beneficios de mejorar el conocimiento psicológico de los distintos perfiles implicados en el deporte-base con el fin de adquirir destrezas que beneficien tanto el rendimiento como el estado psicológico. Su objetivo es proveer unas directrices psicológicas para utilizarlas en el manejo y entrenamiento de los deportistas infanto-juveniles

Sports organisations involved in grassroots sports have trainers, managers and referees whose attitudes, work and dedication show that many of them are volunteers with little knowledge of psychology as a working method. This document, promoted by the Programa Talento Deportivo of the University of Navarra and the Official Association of Psychologists of Navarra, considers the role of psychology in children's and adolescents' sport and the benefits it can offer to sports players, parents, trainers, referees and managers. It also establishes a consensus in the form of a set of guidelines and twenty-seven recommendations. The aim of this consensus is to recognise the benefits of including psychology in the profiles involved in grassroots sport, to enable those involved to acquire skills that can help to improve performance and psychological states, promoting directives to be used when managing and training young sports players

[International multidisciplinary classification of acute pancreatitis severity: the 2013 Spanish edition]. / Clasificación Internacional y Multidisciplinaria de la Pancreatitis Aguda: Edición Española 2013.

OBJECTIVE: To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of the published evidence, and worldwide consultation. BACKGROUNDS: The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of specialist in pancreatic diseases, but are suboptimal because these definitions are based on the empiric description of events not associated with severity. METHODS: A personal invitation to contribute to the development of a new classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists and radiologists currently active in the field of clinical acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global web-based survey was conducted, and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. RESULTS: The new classification of severity is based on the actual local and systemic determinants of severity, rather than on the description of events that are non-causally associated with severity. The local determinant relates to whether there is (peri) pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another, whereby the presence of both infected (peri) pancreatic necrosis and persistent organ failure has a greater impact upon severity than either determinant alone. The derivation of a classification based on the above principles results in four categories of severity: mild, moderate, severe, and critical. CONCLUSIONS: This classification is the result of a consultative process among specialists in pancreatic diseases from 49 countries spanning North America, South America, Europe, Asia, Oceania and Africa. It provides a set of concise up to date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.

[Multidisciplinar international classification of the severity of acute pancreatitis: Italian version 2013]. / Classificazione Internazionale Multidisciplinare della Gravità della Pancreatite Acuta Versione Italiana 2013.

AIM: The aim of this paper was to present the 2013 Italian edition of a new international classification of acute pancreatitis severity. The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric description of occurrences that are merely associated with severity. METHODS: A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in clinical research on acute pancreatitis. A global web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. RESULTS: The new international classification is based on the actual local and systemic determinants of severity, rather than description of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity-mild, moderate, severe, and critical. CONCLUSION: This classification provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research.

[Determinant-based classification of acute pancreatitis severity. International multidisciplinary classification of acute pancreatitis severity: the 2013 German edition]. / Einteilung des Schweregrads der akuten Pankreatitis. Internationale, multidisziplinäre klinische Klassifikation auf Basis pathogenetischer Determinanten: Deutsche Version 2013.

OBJECTIVE: The aim of this study was to develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. BACKGROUND: The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric descriptions of occurrences that are merely associated with severity. METHODS: A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensive medicine specialists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organised to bring contributors from different disciplines together and discuss the concept and definitions. RESULT: The new international classification is based on the actual local and systemic determinants of severity, rather than descriptions of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity - mild, moderate, severe, and critical. CONCLUSIONS: This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.

SEMICYUC 2012. Recommendations for intensive care management of acute pancreatitis.

OBJECTIVE: Significant changes in the management of acute pancreatitis have taken place since the 2004 Pamplona Consensus Conference. The objective of this conference has been the revision and updating of the Conference recommendations, in order to unify the integral management of potentially severe acute pancreatitis in an ICU. PARTICIPANTS: Spanish and international intensive medicine physicians, radiologists, surgeons, gastroenterologists, emergency care physicians and other physicians involved in the treatment of acute pancreatitis. LEVELS OF EVIDENCE AND GRADES OF RECOMMENDATION: The GRADE method has been used for drawing them up. DRAWING UP THE RECOMMENDATIONS: The selection of the committee members was performed by means of a public announcement. The bibliography has been revised from 2004 to the present day and 16 blocks of questions on acute pancreatitis in a ICU have been drawn up. Firstly, all the questions according to groups have been drawn up in order to prepare one document. This document has been debated and agreed upon by computer at the SEMICYUC Congress and lastly at the Consensus Conference which was held with the sole objective of drawing up these recommendations. CONCLUSIONS: Eighty two recommendations for acute pancreatitis management in an ICU have been presented. Of these 84 recommendations, we would emphasize the new determinants-based classification of acute pancreatitis severity, new surgical techniques and nutritional recommendations. Note. This summary only lists the 84 recommendations of the 16 questions blocks except blocks greater relevance and impact of its novelty or because they modify the current management.

[Clinical pathways in acute pancreatitis: recommendations for early multidisciplinary management. Scientific Committee of the SEMICYUC. Working Group on Infectious Diseases (GTEI-SEMICYUC)]. / Hoja de ruta de los cuidados clínicos para la pancreatitis aguda: recomendaciones para el manejo anticipado multidisciplinar (clinical pathways).

There is a growing body of evidence that early management of patients with acute pancreatitis may alter the natural course of disease and improve outcomes of patients. The aim of this paper is to optimize the management of patients with acute pancreatitis during the first 72 h after hospital admission by proposing several clinical care pathways. The proposed pathways are based on the SEMICYUC 2005 Recommendations with incorporation of the latest developments in the field, particularly the determinants-based classification of acute pancreatitis severity. The pathways also incorporate the "alarm signs", the use of therapeutic modalities known as PANCREAS, and the "call to ICU" criteria. Further studies will need to assess whether the adoption of these pathway reduces mortality and morbidity in patients with acute pancreatitis. The previous SEMICYUC guidelines on management of patients with acute pancreatitis in Intensive Care will need to be revised to reflect the recent developments in the field.

Gripe A pandémica en una unidad de cuidados intensivos: experiencia en España y Latinoamérica (Grupo Español de Trabajo de Gripe A Grave/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias) / Pandemic Influenza A in the ICU: Experience in Spain and Latin America GETGAG/SEMICYUC/(Spanish Work Group on Severe Pandemic Influenza A/SEMICYUC)

Introducción: La pandemia de gripe A (H1N1)v es la primera pandemia en la que las unidades de cuidados intensivos (UCI) desempeñan un papel fundamental. Su evolución ha sido muy rápida desde los primeros casos diagnosticados en México y la afectación posterior de países del cono sur hasta su llegada a Europa durante la época estival. Objetivo: Comparar las características clínicas y de evolución de los pacientes críticos ingresados hasta el 31 de julio de 2009 en España con algunas series de Latinoamérica. Material y método: Se consideraron 6 series de pacientes ingresados en la UCI. Se realizaron comparaciones de las características clínicas, complicaciones y evolución entre las series. Resultados: Los datos evidencian una población joven (35-45 años) con predominio de ingresos por neumonía viral con grave insuficiencia respiratoria y una elevada necesidad de ventilación mecánica (60-100%). Si bien algunas determinadas poblaciones, como los obesos, las embarazadas y los pacientes con enfermedad pulmonar crónica, parecen estar expuestas a un riesgo más elevado, la ausencia de comorbilidades alcanza un porcentaje considerable en casi todas las series (40-50%). La mortalidad superior en Latinoamérica osciló entre el 25 y el 50%, y demostró el particular potencial patogénico del nuevo virus. El uso del tratamiento antiviral es tardío (entre 3 y 6 días) y poco generalizado, con mayor retraso en Latinoamérica respecto de España. Conclusiones: Estos datos indican que una estrategia de tratamiento más intensivo con un acceso más precoz y fácil al antiviral podría reducir el número de pacientes que requieren UCI y su mortalidad (AU)

Introduction: Pandemic Influenza A (H1N1)v infection is the first pandemic in which intensive care units (ICU) play a fundamental role. It has spread very rapidly since the first cases were diagnosed in Mexico with the subsequent spread of the virus throughout the Southern Cone and Europe during the summer season. Objective: This study has aimed to compare the clinical presentation and outcome among the critical patients admitted to the ICU until July 31, 2009 in Spain with some series from Latin America. Material and method: Six series of critically ill patients admitted to the ICU were considered. Clinical characteristics, complications and outcome were compared between series. Results: Young patients (35-45 years) with viral pneumonia as a predominant ICU admission cause with severe respiratory failure and a high need of mechanical ventilation (60-100%) were affected. Obesity, pregnancy and chronic lung disease were risk factors associated with a worse outcome, however there was a high number of patients without comorbidities (40-50%). Mortality rate was between 25-50% and higher in the Latin America series, demonstrating the specific potential pathogenesis of the new virus. The use of antiviral treatment was delayed (between 3 and 6 days) and not generalized, with greater delay in Latin America in regards to Spain. Conclusions: These data suggest that a more aggressive treatment strategy, with earlier and easier access to the antiviral treatment might reduce the number of ICU admissions and mortality (AU)

[Pandemic influenza A in the ICU: experience in Spain and Latin America. GETGAG/SEMICYUC/(Spanish Working Group on Severe Pandemic Influenza A/SEMICYUC)]. / Gripe A pandémica en una unidad de cuidados intensivos: experiencia en España y Latinoamérica (Grupo Español de Trabajo de Gripe A Grave/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias).

INTRODUCTION: Pandemic Influenza A (H1N1)v infection is the first pandemic in which intensive care units (ICU) play a fundamental role. It has spread very rapidly since the first cases were diagnosed in Mexico with the subsequent spread of the virus throughout the Southern Cone and Europe during the summer season. OBJECTIVE: This study has aimed to compare the clinical presentation and outcome among the critical patients admitted to the ICU until July 31, 2009 in Spain with some series from Latin America. MATERIAL AND METHOD: Six series of critically ill patients admitted to the ICU were considered. Clinical characteristics, complications and outcome were compared between series. RESULTS: Young patients (35-45 years) with viral pneumonia as a predominant ICU admission cause with severe respiratory failure and a high need of mechanical ventilation (60-100%) were affected. Obesity, pregnancy and chronic lung disease were risk factors associated with a worse outcome, however there was a high number of patients without comorbidities (40-50%). Mortality rate was between 25-50% and higher in the Latin America series, demonstrating the specific potential pathogenesis of the new virus. The use of antiviral treatment was delayed (between 3 and 6 days) and not generalized, with greater delay in Latin America in regards to Spain. CONCLUSIONS: These data suggest that a more aggressive treatment strategy, with earlier and easier access to the antiviral treatment might reduce the number of ICU admissions and mortality.

Antibióticos y pancreatitis aguda grave en Medicina Intensiva. Estado actual. Recomendaciones de la 7.ª Conferencia de Consenso de la SEMICYUC / Antibiotics and severe acute pancreatitisin Intensive Medicine. Current status. Recommendations of the 7th ConsensusConference of the SEMICYUC

No disponible

[Transplant coordination and logistics of intra and extra-hospital cadaver donor tissue. "The Pamplona Model". Sequence of tasks performed from 1992-2006]. / Coordinación y logística del trasplante de tejidos de donantes de cadáver intra y extra-hospitalarios. "Modelo Pamplona". Cadena de actuación 1992-2006.

INTRODUCTION: Tissue and organ donations are the only option for many patients. Cerebral death (CD) facilitates this approach. However, hospitals that do not provide CD donors have to adapt in order to obtain donors, referred to as tissue donors (TD), who have died from cardiac arrest. OBJECTIVE: Is this paper it descripte the model for coordination and donation of intra and extra-hospital TD in the Autonomous Community of Navarra. It creats a program for detection, donation and extractions called the Pamplona Model, from 1992-2006. MATERIAL AND METHODS: In 1990, a transplant team was created by an Intensive Medicine Physician of HVC, INML and SOS-Navarra. In 1996, VCH Transplant Coordination is defined as a reference centre for the Tissue Transplant Programme in the Autonomous Community of Navarra. RESULTS: Consensus protocols for "intra and extra-hospital detection" of persons having died from cardiac arrest are developed: - Alerts from NHS-O hospitals, SOS-Navarra; judges and INML forensic pathologists. - Criteria for selection, search and contacts with relatives. - Alert serology, extraction and transport teams. - Logistics and distribution of tissue. - Agreed incentives: Economic, administrative and relevant regulations. CONCLUSIONS: The Pamplona Model, with the Virgen Del Camino hospital has made important contributions and is unique in the world. Intra and extra-hospital coordination of cadaver donor from a referred hospital, it is a scientific and organizational advance to have in it counts for the creation of extraction and transplant tissues teams.

[Cornea transplant]. / Trasplante de córnea.

The keratoplasty, or cornea transplant, is one of the oldest surgical techniques in opthalmology, whose indication are: 1) tectonic, in order to preserve corneal anatomy and integrity; 2) clinical, in order to eliminate the inflamed corneal tissue in cases refractory to medical treatment; 3) optical, in order to improve visual acuity; and 4) cosmetic, in order to improve the appearance of the eye. Improvements in technique and instruments, as well as in post-operative treatment and the means of preserving donated tissue, have improved survival of the grafts. The Pamplona Model of transplant coordination of the Virgen del Camino Hospital is considered to be original and unique in Spain. The logistics of this program include the protocol for detection and extraction of corneas as well as for keratoplasties.

Coordinación y logística del trasplante de tejidos de donantes de cadáver intra y extra-hospitalarios. “Modelo Pamplona”. Cadena de actuación 1992-2006 / Transplant coordination and logistics of intra and extra-hospital cadaver donor tissue. “The Pamplona Model”. Sequence of tasks performed from 1992-2006

Fundamento. La donación de tejidos y órganos constituye la única alternativa para muchos pacientes. La muerte cerebral (MC) facilita esta actitud. Aquellos hospitales no-generadores de donantes con MC, tienen que generar donantes a partir de fallecidos por parada cardiorrespiratoria, llamados donantes de tejidos (DT). En este trabajo se expone el modelo de coordinación y donación de tejidos de DT intra y extra-hospitalarios en la Comunidad Foral de Navarra. Se crea un Programa de detección, donación, extracción, denominado Modelo Pamplona, desde 1992-2006. Material y métodos. A partir de 1990 se organiza el Equipo de Trasplantes formado por un médico de la Unidad de Cuidados Intensivos del hospital Virgen del Camino, Instituto Navarro de Medicina Legal (INML) y SOS-Navarra. En 1996 la Coordinación de Trasplantes del HVC es definido como centro de referencia para el Programa de Trasplantes de Tejidos de la Comunidad de Navarra. Resultados. Se desarrollan protocolos consensuados para la detección intra y extrahospitalaria de los fallecidos en parada cardiorrespiratoria: – Alarma desde hospitales del SNS-O, SOS-Navarra, jueces y forenses del INML. – Criterios de selección, búsqueda y contacto con familiares. – Aviso a equipos de serología, extracción y transporte. – Logística y reparto de los tejidos. – Incentivos pactados: económicos, administrativos y normativa al respecto. Conclusiones. El modelo Pamplona, desde el hospital Virgen del Camino resulta positivo y es único en el mundo. La coordinación intra y extrahospitalaria de trasplantes de donantes cadáver desde un hospital de referencia, es un avance científico y organizativo a tener en cuenta para la creación de equipos de extracción y trasplante de tejidos

Introduction. Tissue and organ donations are the only option for many patients. Cerebral death (CD) facilitates this approach. However, hospitals that do not provide CD donors have to adapt in order to obtain donors, referred to as tissue donors (TD), who have died from cardiac arrest. Objective. Is this paper it descripte the model for coordination and donation of intra and extra-hospital TD in the Autonomous Community of Navarra. It creats a program for detection, donation and extractions called the Pamplona Model, from 1992-2006. Material and methods. In 1990, a transplant team was created by an Intensive Medicine Physician of HVC, INML and SOS-Navarra. In 1996, VCH Transplant Coordination is defined as a reference centre for the Tissue Transplant Programme in the Autonomous Community of Navarra. Results. Consensus protocols for “intra and extra-hospital detection” of persons having died from cardiac arrest are developed: – Alerts from NHS-O hospitals, SOS-Navarra; judges and INML forensic pathologists. – Criteria for selection, search and contacts with relatives. – Alert serology, extraction and transport teams. – Logistics and distribution of tissue. – Agreed incentives: Economic, administrative and relevant regulations. Conclusions. The Pamplona Model, with the Virgen Del Camino hospital has made important contributions and is unique in the world. Intra and extra-hospital coordination of cadaver donor from a referred hospital, it is a scientific and organizational advance to have in it counts for the creation of extraction and transplant tissues teams

Trasplante de córnea / Cornea transplant

La queratoplastia o trasplante de córnea es una de las técnicas quirúrgicas más antiguas de la oftalmología cuyas indicaciones son: 1) tectónicas, para preservar la anatomía e integridad corneal, 2) clínicas, para eliminar el tejido corneal inflamado en casos refractarios al tratamiento médico, 3) ópticas, para mejorar la agudeza visual y 4) cosméticas para mejorar el aspecto del ojo. El perfeccionamiento en la técnica y en el instrumental, así como en el tratamiento postoperatorio y en los medios de conservación del tejido donante han mejorado la supervivencia de los injertos realizados. El Modelo Pamplona de coordinación de trasplantes del Hospital Virgen del Camino (HVC) está considerado como original y único en España, y en la logística de este programa se incluye el protocolo de detección y extracción de córneas así como el de queratoplastias

The keratoplasty, or corena transplant, is one of the oldest surgical techniques in opthalmology, whose indication are: 1) tectonic, in order to preserve corneal anatomy and integrity; 2) clinical, in order to eliminate the inflamed corneal tissue in cases refractory to medical treatment; 3) optical, in order to improve visual acuity; and 4) cosmetic, in order to improve the appearance of the eye. Improvements in technique and instruments, as well as in post-operative treatment and the means of preserving donated tissue, have improved survival of the grafts. The Pamplona Model of transplant coordination of the Virgen del Camino Hospital is considered to be original and unique in Spain. The logistics of this program include the protocol for detection and extraction of corneas as well as for keratoplasties

Recomendaciones de la 7ª Conferencia de Consenso de la SEMICYUC. Pancreatitis aguda grave en Medicina Intensiva / Recommendations of the 7th consensus conference of the SEMICYUC. Severe acute pancreatitis in Intensive Medicine

Objetivo. La pancreatitis aguda grave (PAG) no se ha estudiado desde la Medicina Intensiva y menos su manejo integral. El objetivo es consensuar el diagnóstico y tratamiento en una UCI, con todas las Sociedades implicadas y ofrecer unas recomendaciones que uniformicen el manejo integral de las PAG. Ámbito. Español. Pamplona, 11 y 12 de marzo de 2004. Participantes. Intensivistas nacionales, gastroenterólogos de la Asociación Española de Gastroenterología (AEGE) y Club Español Biliopancreático (CEBP), cirujanos de la Asociación Española de Cirugía, Sección de Infección Quirúrgica (IQ-AEC), radiólogos de la Sociedad Española de Radiología Médica (SERAM), y Sección de Imagen Abdominal (SEDIA) y miembros de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). Niveles de evidencia y grados de recomendación. Se eligieron las escalas del Oxford Centre for Evidence based Medicine. Elaboración de las recomendaciones. Se realizó una convocatoria pública en la que se discutieron todos los temas previamente seleccionados, que se distribuyeron en 4 bloques de preguntas: 1.ª ¿Diagnóstico, criterios precoces de gravedad y de ingreso de las PAG en UCI?. 2.ª ¿Cuáles son las medidas más relevantes y aplicables en el tratamiento del paciente con PAG en UCI?. 3.ª ¿Cuál es el tratamiento actual de la PAG?. 4.ª ¿Qué actitud quirúrgica se debe adoptar ante la PAG con necrosis no-infectada y la sepsis pancreática? Tras la discusión pública el Jurado elaboró un documento de recomendaciones. Este documento fue enviado para su comentario a los miembros del Comité Organizador, a los ponentes y a los asistentes a la Conferencia de Consenso. Por último, las recomendaciones fueron de nuevo discutidas en una sesión pública y abierta en el Congreso Nacional de la SEMICYUC. Conclusiones. Recomendaciones en PAG entre las que destacamos: la disminución de la mortalidad de la PAG depende de la estratificación temprana de las formas graves a la puerta del hospital, durante las primeras 48-96 horas y del ingreso precoz en Intensivos. Los pacientes que muestran un progresivo deterioro orgánico, aunque no precisen soporte ventilatorio, deben ingresar en UCI. Cada Centro debe consensuar un protocolo interdisciplinario. Los antibióticos como profilaxis no tienen una base de evidencia potente sólo estarían indicados en las formas necrotizantes y a la espera de un nuevo ensayo doble-ciego con meropenem en marcha. El tratamiento quirúrgico se indica en la necrosis pancreática infectada o absceso identificadas por radiología o punción radiodirigida. El manejo de las formas estériles debe ser conservador

Objective. Severe acute pancreatitis (SAP) has not been studied from the point of view of Intensive Medicine and even less its integral management. The objective is to reach a consensus on the diagnosis and treatment in an ICU with all the societies involved and to offer some recommendations that make the integral management of SAP uniform. Scope. Spanish. He took place in Pamplona, the 11-12 March 2004. Participants. National Intensivists, Gastroenterologists of the Spanish Association of Gastroenterology (AEGE) and Biliopancreatic Spanish Club (CEBP), Surgeons of the Spanish Association of Surgery, Surgical Infection Section (IQ-AEC), Radiologists of the Spanish Society of Medical Radiology (SERAM), and Abdominal Image Section (SEDIA) as well as member of the Spanish Society of Urgency and Emergency Medicine (SEMES). Evidence levels and recommendation grades. The Oxford Centre for Evidence based Medicine scales were chosen. Elaboration of the recommendations. A public examination session was called in which all the previously selected subjects were discussed. They were distributed into 4 blocks of questions: 1) Diagnostic, Early Severity criteria and Admission of SAP in the ICU? 2) What are the most relevant and applicable measures in the treatment of the patients with SAP in the ICU? 3) What is the present treatment of SAP? 4) What surgical attitude should be adopted in the face of SAP with non-infected necrosis and pancreatic sepsis? After the public discussion, the Jury elaborated a recommendations document. This document was sent to the members of the Organizing Committee, to the speakers and those attending the consensus Conference for their comments. Finally, the recommendations were discussed again in a public and open session in the National Congress of SEMICYUC.Conclusions. Recommendations in SAP, among which we emphasize: Decrease in mortality of SAP depends on the early stratifying of the serious forms to the hospital door, during the first 48-96 hours and early admission in Intensive Care. Patient who have a progressive organic deterioration, although they do not require ventilatory support, should be admitted to the ICU. Each Center should agree on an interdisciplinary protocol. Antibiotics as prophylaxis do not have a strong evidence base. They would only be indicated in necrotizing forms and while waiting for a new on-going double blind clinical trial with meropenem. Surgical treatment is indicated in infected pancreatic necrosis or abscess, identified by radiology or radioguided puncture. Management of the sterile forms should be conservative

Traumatismo abdominal cerrado con sección pancreática / Pancreatic lesions in closed abdominal trauma

Las lesiones traumáticas del páncreas son poco frecuentes pero se acompañan de una gran morbimortalidad, sobre todo si se demora el diagnóstico y consecuentemente el tratamiento, cosa relativamente habitual dada su escasa sintomatología. Por tanto, es muy importante valorar el mecanismo lesional que nos hará sospechar este tipo de lesión. La tomografía computarizada (TC) helicoidal es de gran utilidad diagnóstica. La actitud terapéutica está condicionada por la integridad o no del conducto pancreático. Presentamos el caso de un paciente con trauma abdominal cerrado en el que la TC de ingreso fue normal a pesar de tener una sección pancreática que se visualizó tres días después. Se complicó con una disfunción multiorgánica que evolucionó favorablemente

Traumatic lesions of the pancreas are not very common but accompanied by a high morbimortality rate, especially if diagnosis and subsequent treatment are delayed, which is relatively common given its poor symptomology. It is, therefore, very important to evaluate the lesional mechanism which would lead one to suspect this type of lesion. Spiral CAT is very useful diagnostic tool. Therapeutic approach is conditioned on pancreatic duct integrity. Herein is presented the case of a patient with closed abdominal trauma whose CT at admittance was normal in spite of having had a pancreatic lesion being observed three days later. It was further complicated by a multiorgan dysfunction which evolved favorably

Neumonía grave por varicela / Severe chickenpox pneumonia

Objetivo. Estudio retrospectivo de los datos epidemiológicos, clínicos, diagnósticos y terapéuticos de los pacientes adultos con neumonía por varicela que precisaron ingreso en la Unidad de Medicina Intensiva (UMI) en los últimos 10 años. Material y métodos. El diagnóstico se estableció por criterios clinicorradiológicos en el curso de una varicela. Se valoraron datos como enfermedades de base, embarazo, hábito tabáquico, datos analíticos, evolución a síndrome de distrés respiratorio del adulto (SDRA), necesidad de ventilación mecánica y tratamiento farmacológico. Resultados. Se estudiaron 8 pacientes (7 mujeres y 1 hombre) con una edad media de 30 años (rango: 25-38). Sólo uno de los pacientes presentaba patología subyacente (hepatitis B crónica y alcoholismo) y otra estaba embarazada de 24 semanas. Todos eran fumadores. Los síntomas respiratorios aparecieron entre el segundo y cuarto día de iniciarse el exantema. Todos presentaron disnea y en 7 de ellos se asoció tos seca. La radiografía de tórax al ingreso presentaba en todos los pacientes un infiltrado intersticial de predominio bibasal. En 7 de los 8 casos se observó menos de 150.000 plaquetas/mm3, en 5 aumento de transaminasas y en todos elevación de la deshidrogenasa láctica (LDH). En 6 pacientes se objetivó hipoxemia (PaO2 < 60 mmHg), precisando 3 de ellos intubación orotraqueal y ventilación mecánica. Estos 3 pacientes evolucionaron a SDRA. Todos los casos estudiados fueron tratados con aciclovir intravenoso. No falleció ninguno de los pacientes ingresados. Conclusiones. La neumonía por varicela es una complicación grave que puede precisar ingreso en UMI. La gravedad de la enfermedad puede variar desde anormalidades radiológicas asintomáticas hasta SDRA. La mortalidad es alta, pero está disminuyendo en los últimos años probablemente debido al tratamiento antivírico precoz y a las adecuadas medidas de soporte (AU)

[Severe chickenpox pneumonia]. / Neumonía grave por varicela.

OBJECTIVE: Retrospective study of the epidemiological, clinical, diagnostic and therapeutic data corresponding to adult patients with chickenpox pneumonia that needed admission in the Intensive Care Unit (ICU) in the last 10 years. MATERIAL AND METHODS: The diagnosis was established through clinicoradiological criteria along the chickenpox progress. Assessed parameters are underlying diseases, pregnancy, smoking habits, analytical data, progress toward adult respiratory distress syndrome (ARDS), need for mechanical ventilation, and pharmacological treatment. RESULTS: They were studied 8 patients (7 women and 1 man) with an average age of 30 years (range: 25-38). Only one of the patients showed underlying pathology (chronic B hepatitis and alcoholism), and another patient was pregnant with 24 weeks of gestation. All of them were smokers. The respiratory symptoms appeared between the second and fourth day from the onset of the exanthema. All the patients showed dyspnea and in seven of them it was associated to dry cough. The chest x-ray at the time of the admission showed in all the patients a bilateral interstitial infiltrate of basal predominance. In 7 of the 8 cases less than 150,000 platelets/mm3 were observed, in 5 patients an increase of transaminases was detected, and all the patients showed elevation of LDH. In 6 patients hypoxemia (PaO2<60 mmHg) was detected with need in 3 of them of orotracheal intubation and mechanical ventilation. These 3 patients progressed toward ARDS. All the cases studied were treated with intravenous aciclovir. None of the hospitalized patients died. CONCLUSIONS: Chickenpox pneumonia is a serious complication that can force hospitalization in the ICU. The severity of the disease can range from the observation of asymptomatic radiological alterations up to ARDS. Mortality is high, but is probably declining in recent years due to the early antiviral treatment and to the application of appropriate support measures.

Pancreatitis aguda desde la perspectiva de la medicina intensiva y crítica. Antibioterapia profiláctica: argumentos a favor / Acute pancreatitis from the perspective of intensive and critical care medicine. prophylactic antibiotic therapy: arguments in favor

La pancreatitis aguda necrosante es una forma grave de pancreatitis aguda, cuyo tratamiento temprano consiste en la combinación de tratamiento médico intensivo y prevención de la infección con profilaxis antibiótica, ya que la infección de la necrosis aumenta la mortalidad de forma significativa. El mecanismo principal de infección bacteriana es la translocación del colon. La infección de la necrosis pancreática se desarrolla en el 29 por ciento de casos y suele presentarse a partir de la tercera semana. Los microorganismos aislados con más frecuencia son: bacilos gramnegativos (BGN): 75 por ciento, cocos grampositivos (CGP): 53 por ciento, Candida: 8 por ciento, anaerobios: 8 por ciento y mixtos: 54 por ciento. El diagnóstico se realiza mediante cultivo o tinción de Gram del material aspirado mediante la punción aspiración con aguja fina de la zona pancreática sospechosa de infección clínica, guiada por ecografía o tomografía axial computarizada (TAC). El beneficio del tratamiento antibiótico temprano está basado en una creciente evidencia científica, lo que obliga a modificar el tratamiento en estos enfermos, mediante el inicio inmediato de la antibioterapia contínua durante 14 días o hasta que persistan las complicaciones. Esto hace posible retardar la intervención quirúrgica y hacerla en condiciones óptimas.Los fármacos de elección para el tratamiento y profilaxis de las infecciones pancreáticas son el imipenem y las quinolonas en combinación con el metronidazol, aunque recientemente se ha demostrado que el imipenem es superior a las quinolonas. Retardan la intervención quirúrgica y permiten hacerla en condiciones óptimas. Sin embargo, para determinar exactamente la elección del antibiótico, son necesarios estudios prospectivos, controlados, aleatorios y ciegos (AU)