Medicina intensiva
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The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. ⋯ The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.
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Patients with acute respiratory distress syndrome may require high positive end-expiratory pressure (PEEP) levels, though the optimum level remains to be established. Several clinical trials have compared high PEEP levels versus conventional PEEP. Overall, although high PEEP levels improve oxygenation and are safe, they do not result in a significant reduction of the mortality rates. ⋯ Five studies have explored this latter scenario. Unfortunately, all of them have small sample sizes and have used different means to determine optimum PEEP. It is therefore necessary to conduct studies of sufficient sample size to compare the treatment of patients with severe acute respiratory distress syndrome, using a protective ventilation strategy with high PEEP guided by the characteristics of lung mechanics and ventilation with the protocol proposed by the ARDS Network.
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Medicines reconciliation plays a key role in patient safety. However, there is limited data available on how this process affects critically ill patients. In this study, we evaluate a program of reconciliation in critically ill patients conducted by the Intensive Care Unit's (ICU) pharmacist. ⋯ The incidence and characteristics of reconciliation errors in ICU are similar to those published in non-critically ill patients, and they affect drugs with high clinical significance. Our data support the importance of the stablishment of medication reconciliation proceedings in critically ill patients. The ICU's pharmacist could carry out this procedure adequately.
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Letter Comparative Study
Not too much hyperextension: Airway positioning using magnetic resonance imaging.