Prevención de la muerte en una UCI médica en un país en desarrollo.
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Preventability of death in a medical ICU in a developing country
Sunavala JD.
Indian J Crit Care Med [serial online] 2014 [cited 2014 Jan 30];18:59-61.
On November 15 th 1990, an Alitalia flight from Milan, crashed into a wooded hill while attempting to land at Zurich's Kloten airport. The plane was torn to shreds - various parts strewn all over the hilly terrain between the villages of Stadel and Weiach. There were 40 passengers and 6 crew on board and none of them survived. A few years later, I visited the site to pay my respects to a departed friend, who had boarded the ill-fated flight. As I gazed at the steep cliff, shorn of all vegetation, I turned to my companion, who happened to be a pilot, and asked if flying could ever be 100% safe. "Not as long as human beings are involved," he answered, explaining that most crashes are caused by human error. Even if the cutting edge technology may prevent all equipment failures, human beings would remain fallible. So despite many checks including counter checks and safety drills, the aviation industry-or in fact, any industry-will never be devoid of risk. To substantiate his observation-according to the 2013 International Civil Aviation Organization safety report, the number of worldwide accidents for that the specified year for the jet commercial aircrafts was 99 with 372 fatalities.
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Prevención de la muerte en UCI médica en un hospital universitario en un país en desarrollo
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Preventability of death in a medical intensive care unit at a university hospital in a developing country
Zeggwagh AA, Mouad H, Dendane T, Abidi K, Belayachi J, Madani N, Abouqal R.
Indian J Crit Care Med [serial online] 2014 [cited 2014 Jan 30];18:88-94.
Abstract
Objective: To determine the incidence and characteristics of preventable in-ICU deaths. Materials and Methods: A one-year observational study was conducted in a medical ICU of a teaching hospital. All patients who died in medical ICU beyond 24 h were analyzed and reviewed during daily medical meeting. A death was considered preventable when it would not have occurred if the patient had received ordinary standards of care appropriate for the time of study. Preventability of death was classified by using a 1-6 point preventability scale. The types of medical errors causing preventable in-ICU deaths and the contributory factors to deaths were identified. Results: 120 deaths (47 ± 19 years, 57 months-63 weeks) were analyzed (mortality: 23%; 95% confidence interval (CI):15-31%). At admission, Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18 ± 7.6 and Charlson comorbidity index was 1.3 ± 1.6. The main diagnosis was infectious disease (57%) and respiratory disease (23%). The median period between the ICU admission and death was 5 days. The rate of preventable in-ICU deaths was 14.1% (17/120). The most common medical errors related to occurrence of preventable in-ICU deaths were therapeutic error (52.9%) and inappropriate technical procedure (23.5%). The preventable in-ICU deaths were associated with inadequate training or supervision of clinical staff (58.8%), no protocol (47.1%), inadequate functioning of hospital departments (29.4%), unavailable equipment (23.5%), and inadequate communication (17.6%). Conclusion: According to our study, one to two in-ICU deaths would be preventable per month. Our results suggest that the implementation of supervision and protocols could improve outcomes for critically ill patients.
Keywords: Adverse events, intensive care unit, medical errors, patient safety, preventable mortality.
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Los principales temas para 2011 en anestesia cardiovascular y cuidados intensivos.
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Major themes for 2011 in cardiovascular anesthesia and intensive care.
Riha H, Patel P, Valentine E, Lane B, Augoustides JG.
HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(1):31-9.
Abstract
The past year has witnessed major advances in of cardiovascular anesthesia and intensive care. Perioperative interventions such as anesthetic design, inotrope choice, glycemic therapy, blood management, and noninvasive ventilation have significant potential to enhance perioperative outcomes even further.The major theme for 2011 is the international consensus conference that focused on ancillary interventions likely to reduce mortality in cardiac anesthesia and intensive care. This landmark conference prioritized volatile anesthetics, levosimendan, and insulin therapy for their promising life-saving perioperative potential. Although extensive evidence has demonstrated the cardioprotective effects of volatile anesthetics, levosimendan as well as glucose, insulin and potassium therapy, the clinical relevance of these beneficial effects remains to be fully elucidated. Furthermore, controversy still persists about how tight perioperative glucose control should be in adult cardiac surgery because of the risk of hypoglycemia.A second major theme in 2011 has been perioperative hemostasis with the release of multispecialty guidelines. Furthermore, hemostatic agents such as recombinant factor VIIa and tranexamic acid have been studied intensively, even in the setting of major non-cardiac surgery. This review then highlights the remaining two major themes for 2011, namely the expanding role of noninvasive ventilation in our specialty and the formation of the Roland Hetzer International Cardiothoracic and Vascular Surgery Society.In conclusion, it is time for large adequately powered multicenter trials to test whether prioritized perioperative interventions truly reduce mortality and morbidity in cardiac surgical patients. This essential paradigm shift represents a major clinical opportunity for the global cardiovascular anesthesia and critical care community.
KEYWORDS: cardiac anesthesia, cardiac surgery, intensive care, mortality, review
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org |
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