RESUMEN
OBJECTIVES: To evaluate a new organizational model in an intensive care unit, with the implementation of early warning systems and a support unit. DESIGN: A retrospective, comparative cohort study was carried out. SETTING: The study was carried out in the Department of Intensive Care Medicine (DICM) of a tertiary hospital (2009-2011), with the comparison of three time periods (P1, P2 and P3) that differed in terms of organization and logistics. PATIENTS: We analyzed all patients admitted to the ICU during the study period. Patients from maternal and infant intensive care were excluded. VARIABLES OF INTEREST: Percentage of patients with stays of under two days, with invasiveness used; readmission to the DICM, type of admission and percentage of stays of longer than one month; APACHE II score, mean stay in the ICU and shift distribution of the admissions. RESULTS: We analyzed a sample of 3209 patients (65% males), with a mean age of 58.23 (18.23) years, a mean APACHE II score of 16.67 (8.23), and presenting an occupancy rate of 7.3 (10.3) days in the analyzed period. The ratio APACHE II score/number of beds was 0.69 (0.34) in P1, compared to 0.68 (0.33) in P2 and 0.76 (0.37) in P3 (p<0.001). The intervention surveillance grade (grade 1) was 42% (39-46%) in P1, 40% (37-43%) in P2 and 31% (28-35%) in P3 (p<0.001). The average stay in the ICU ranged from 7.10 days (8.82) in P1 to 6.60 days (9.49) in P2 and 8.42 days (12.73) in P3 (p<0.001). CONCLUSIONS: There has been an increase in the number of patients seen in our DICM, with a decrease in the patients admitted to the conventional ICU. Patients now admitted to the ICU are more seriously ill, require a greater level of intervention, and give rise to an increase in the mean duration of stay in the ICU.
Asunto(s)
Cuidados Críticos/normas , Departamentos de Hospitales/organización & administración , Modelos Organizacionales , Estudios de Cohortes , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Induced hypothermia in neurocritical patients is one of the most promising neuroprotective therapies in the last decade. Unfortunately, the promising results obtained in experimental studies have had an unequal reflection in the different diseases that affect the neurocritical patient. The use of therapeutic hypothermia is clearly established in patients with neurological deterioration after cardiac arrest. On the contrary, its use in patients with traumatic brain injury is highly controversial. There is not enough evidence in stroke and hemorrhagic patients to support its use except in clinical trials. Nowadays, the greater understanding of the pathophysiology of secondary brain damage, the go od clinical results obtained in randomized clinical trials in patients with cerebral anoxia after ventricular fibrillation and the new cooling methods that have appeared have improved the interest of hypothermia in neurocritical patients. Induced hypothermia has a role in the intensive care unit. Critical care physicians should be familiar with the physiologic effects, current indications, techniques, and complications of induced hypothermia. This review elaborates on the clinical implications of hypothermia research in traumatic brain injury, anoxic, brain injury, stroke and intracerebral hemorrhage.