Medicina intensiva
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Ischemia and infarct after surgical revascularization are a relatively frequent complication, with high morbidity and mortality. Early diagnosis is essential. ⋯ The objectives of this study have been 1. To show the diagnostic criteria for perioperative infarct and ischemia. 2. to show the different therapeutic options available. 3. to propose a treatment algorithm that includes the differential diagnosis, how to control vasospasm, implantation of balloon counterpulsation, and the possible revascularization strategies (percutaneous coronary intervention vs reoperation).
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The Health System is in crisis and critical care (from transport systems to the ICU) cannot escape from that. Lack of integration between ambulances and reference Hospitals, a deep shortage of critical care specialists and assigned economical resources that increase less than critical care demand are the cornerstones of the problem. Moreover, the analysis of the situation anticipated that the problem will be worse in the future. "Closed" ICUs in which critical care specialists direct patient care outperform "open" ones in which primary admitting physicians direct patient care in consultation with critical care specialists. ⋯ Current information technology and networking capabilities should be fully exploited to improve both the extent and quality of intensivist coverage. Far to be a replacement of the existing model Telemedicine might be a complimentary tool. In fact, to centralize medical data into servers has many additional advantages that could even improve the way in which critical care physicians take care of their patients under the traditional system.
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To adapt the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the diagnosis of delirium to the language and culture of Spain and to validate the adapted version. ⋯ The Spanish version of the CAM-ICU is a valid, reliable, and reproducible instrument that can be satisfactorily applied to diagnose delirium in Spanish-speaking ICU patients.
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To validate the Spanish version of the CAM-ICU. ⋯ The Spanish version of the CAM-ICU is reliable. Its sensitivity, specificity and predictive values should be considered good.