RESUMEN
This article discusses the history of the ICU and critical care medicine (CCM). It also discusses the certification of critical care nurses and allied health professionals, as well as CCM societies and congresses, education and board certification, evidence-based CCM, research and publications, and future challenges to the field.
Asunto(s)
Cuidados Críticos/historia , Unidades de Cuidados Intensivos/historia , Empleos Relacionados con Salud/historia , Investigación Biomédica/historia , Certificación/historia , Congresos como Asunto/historia , Cuidados Críticos/organización & administración , Educación de Postgrado en Medicina/historia , Educación de Postgrado en Medicina/métodos , Europa (Continente) , Medicina Basada en la Evidencia/historia , Historia del Siglo XVI , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Medicina Militar/historia , Publicaciones Periódicas como Asunto/historia , Poliomielitis/complicaciones , Poliomielitis/historia , Poliomielitis/terapia , Respiración Artificial/historia , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/historia , Insuficiencia Respiratoria/terapia , Terapia Respiratoria/historia , Sociedades Médicas/historia , Especialidades de Enfermería/historia , Transporte de Pacientes/historia , Transporte de Pacientes/métodos , Estados UnidosAsunto(s)
Obstrucción de las Vías Aéreas/terapia , Competencia Clínica , Educación de Postgrado en Medicina , Enseñanza/organización & administración , Obstrucción de las Vías Aéreas/diagnóstico , Evaluación Educacional , Tratamiento de Urgencia , Femenino , Hospitales de Enseñanza , Humanos , Internado y Residencia , Masculino , Ciudad de Nueva York , Simulación de PacienteRESUMEN
Recently, three fundamental changes have been introduced in medical education, all of particular importance to critical care medicine: (1) clinical teaching and medical practice now emphasize evidence-based medicine, (2) patient safety aspects are increasingly stressed, and (3) use of simulation in medical training is spreading rapidly. In 1999, the disturbingly high frequency of life-threatening or even lethal medical complications was emphasized by the Institute of Medicine in the book To Err Is Human. The Institute of Medicine recommended establishing interdisciplinary team training programs incorporating efficient methods such as simulation. Although simulation has been used by the aviation industry and the military for several decades, only during the past decade has this become a teaching method in medicine. Currently, two full-scale computerized simulators are available: METI, provided by Medical Education Technologies, Sarasota, Florida, and SimMan, manufactured by Laerdal Medical, in Stavanger, Norway. The simulation center at the University of Pittsburgh Medical Center was established in 1994 and has grown quickly to its current large facility, where, in academic year 2003 to 2004, approximately 8000 healthcare professionals were trained on the SimMan. Courses taught include clinical procedures and decision making in perioperative medicine, acute medicine, pharmacology, anesthesiology, airway management, bronchoscopy, pediatric versus adult crisis management, critical events in obstetrics, and crisis team training. Advantages of simulation training over traditional medical education methods include (1) provision of a safe environment for both patient and student during training in risky procedures, (2) unlimited exposure to rare but complicated and important clinical events, (3) the ability to plan and shape training opportunities rather than waiting for a suitable situation to arise clinically, (4) the ability to provide immediate feedback, (5) the opportunity to repeat performance, (6) the opportunity for team training, and (7) lower costs, both direct and indirect. Within the next decade, use of computerized simulators for evidence-based education and training in medicine is expected to develop considerably and spread rapidly into a very important domain of medical schools throughout the entire world.
Asunto(s)
Simulación por Computador , Cuidados Críticos , Educación Médica/métodos , Modelos Biológicos , Simulación de Paciente , HumanosAsunto(s)
Reanimación Cardiopulmonar/historia , Apoyo Vital Cardíaco Avanzado/educación , Apoyo Vital Cardíaco Avanzado/historia , Cuidados Críticos/historia , Auxiliares de Urgencia/educación , Auxiliares de Urgencia/historia , Medicina de Emergencia/educación , Medicina de Emergencia/historia , Historia del Siglo XX , Humanos , Respiración Artificial/historia , Estados UnidosAsunto(s)
Reanimación Cardiopulmonar/instrumentación , Reanimación Cardiopulmonar/tendencias , Reanimación Cardiopulmonar/educación , Cuidados Críticos/tendencias , Medicina de Emergencia/educación , Medicina de Emergencia/instrumentación , Medicina de Emergencia/tendencias , Paro Cardíaco/terapia , Humanos , Simulación de Paciente , Respiración Artificial/tendencias , Estados UnidosRESUMEN
OBJECTIVE: Critical care medicine trainees and faculty must acquire and maintain the skills necessary to provide state-of-the art clinical care to critically ill patients, to improve patient outcomes, optimize intensive care unit utilization, and continue to advance the theory and practice of critical care medicine. This should be accomplished in an environment dedicated to compassionate and ethical care. PARTICIPANTS: A multidisciplinary panel of professionals with expertise in critical care education and the practice of critical care medicine under the direction of the American College of Critical Care Medicine. SCOPE: Physician education in critical care medicine in the United States should encompass all disciplines that provide care in the intensive care unit and all levels of training: from medical students through all levels of postgraduate training and continuing medical education for all providers of clinical critical care. The scope of this guideline includes physician education in the United States from residency through ongoing practice after subspecialization. DATA SOURCES AND SYNTHESIS: Relevant literature was accessed via a systematic Medline search as well as by requesting references from all panel members. Subsequently, the bibliographies of obtained literature were reviewed for additional references. In addition, a search of organization-based published material was conducted via the Internet. This included but was not limited to material published by the American College of Critical Care Medicine, Accreditation Council for Graduate Medical Education, Accreditation Council for Continuing Medical Education, and other primary and specialty organizations. Collaboratively and iteratively, the task force met, by conference call and in person, to construct the tenets and ultimately the substance of this guideline. CONCLUSIONS: Guidelines for the continuum of education in critical care medicine from residency through specialty training and ongoing throughout practice will facilitate standardization of physician education in critical care medicine.
Asunto(s)
Competencia Clínica , Cuidados Críticos/normas , Educación Médica Continua/normas , Educación de Postgrado en Medicina/normas , Medicina de Emergencia/educación , Femenino , Humanos , Internado y Residencia , Masculino , Estados UnidosAsunto(s)
Resucitación/historia , Historia del Siglo XXI , Humanos , Resucitación/métodos , Estados UnidosAsunto(s)
Cuidados Críticos , Medicina de Emergencia/educación , Becas , Humanos , Maryland , Pennsylvania , Facultades de MedicinaRESUMEN
BACKGROUND: Prolonged coma is not an uncommon clinical problem following resuscitation from cardiac arrest. Early and precise prediction of outcome is highly desirable for ethical and economical reasons. The aims of this study were to use positron emission tomography (PET) to investigate the regional dynamic changes of cerebral blood flow and metabolism during the early period after cardiopulmonary resuscitation (CPR) in unconscious patients and to evaluate if PET may be a potential prognostic evaluator. METHODS AND RESULTS: PET and Glasgow Coma Scale examinations were sequentially performed on days 1, 3 and 7 in seven patients remaining comatose post CPR. Each PET included regional determinations of cerebral blood flow (rCBF), oxygen metabolism (rCMRO(2)), oxygen extraction ratio (rOER), and cerebral blood volume (rCBV). One patient was excluded due to complex trauma problems. Three patients remained unconscious until death and three woke up. All patients initially exhibited low CMRO(2) and CBF. Increased OER was only found exceptionally and when present was predominantly in focal areas. The comatose patients showed progressive depression of CMRO(2) and after 1 week had lower CMRO(2) than those patients who woke up. This difference was most pronounced in the putamen and occipital cortex. Two of the seven patients developed large focal infarcts. CONCLUSIONS: An initially low CMRO(2) was common to all patients. Early development of subclinical focal ischemic lesions was also common. The progressive depression of CMRO(2) over the first week in those patients remaining unconscious may be an indication of prolonged but not necessarily permanent coma. Further studies are required to identify pathophysiological features that can predict the long-term clinical outcome in patients who remain unconscious after 1 week.