ABSTRACT
In view of the exceptional public health situation caused by the COVID-19 pandemic, a consensus work has been promoted from the ethics group of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC), with the objective of finding some answers from ethics to the crossroads between the increase of people with intensive care needs and the effective availability of means.In a very short period, the medical practice framework has been changed to a 'catastrophe medicine' scenario, with the consequent change in the decision-making parameters. In this context, the allocation of resources or the prioritization of treatment become crucial elements, and it is important to have an ethical reference framework to be able to make the necessary clinical decisions. For this, a process of narrative review of the evidence has been carried out, followed by a unsystematic consensus of experts, which has resulted in both the publication of a position paper and recommendations from SEMICYUC itself, and the consensus between 18 scientific societies and 5 institutes/chairs of bioethics and palliative care of a framework document of reference for general ethical recommendations in this context of crisis.
Subject(s)
Betacoronavirus , Clinical Decision-Making , Coronavirus Infections/epidemiology , Critical Care/ethics , Intensive Care Units , Pandemics , Pneumonia, Viral/epidemiology , COVID-19 , Coronavirus Infections/therapy , Critical Care/methods , Critical Care/psychology , Critical Care/standards , Ethics Committees , Health Services Needs and Demand , Hospital Bed Capacity , Humans , Pneumonia, Viral/therapy , Precision Medicine , Resource Allocation/ethics , Resource Allocation/standards , Respiration, Artificial , SARS-CoV-2 , Societies, Scientific , Spain/epidemiology , Triage/ethics , Triage/standardsABSTRACT
No disponible
Subject(s)
Humans , Intensive Care Units/ethics , Blood Transfusion/legislation & jurisprudence , Informed Consent/legislation & jurisprudence , Bioethics/trendsABSTRACT
Admission of a patient in the Intensive Care Unit (ICU) is justified when the critical situation can be reverted or relieved. In spite of this, there is high mortality in the ICU in regard to other hospital departments. End-of-life treatment of critical patients and attention to the needs of their relatives is far from being adequate for several reasons: society denies or hides the death, it is very difficult to predict it accurately, treatment is frequently fragmented between different specialists and there is insufficient palliative medicine training, including communication skills. There are frequent conflicts related to the decisions made regarding the critical patients who are in the end of their life, above all, with the limitation of life-sustaining treatments. Most are conflicts of values between the different parties involved: the patient, his relatives and/or representatives, health professionals, and the institution. The SEMICYUC Working Group of Bioethics elaborates these Recommendations of treatment at the end of the life of the critical patient in order to contribute to the improvement of our daily practice in such a difficult field. After analyzing the role of the agents involved in decision making (patient, familiar, professional, and health care institutions), of the ethical and legal foundations of withholding and withdrawal of treatments, guidelines regarding sedation in the end of the life and withdrawal of mechanical ventilation are recommended. The role of advance directives in intensive medicine is clarified and a written form that reflects the decisions made is proposed.
Subject(s)
Critical Care/methods , Critical Care/standards , Palliative Care/standards , Ethics, Clinical , Hospitalization , Humans , Palliative Care/methods , SpainABSTRACT
El ingreso de un paciente en la Unidad de Medicina Intensiva (UMI) está justificado cuando es posible revertir o paliar su situación crítica; a pesar de ello, en las UMI se produce una alta mortalidad con respecto a otros servicios hospitalarios. El tratamiento al final de la vida de los pacientes críticos y la atención a las necesidades de sus familiares están lejos de ser adecuados, por diversos motivos: la sociedad niega u oculta la muerte, es muy difícil predecirla con exactitud, con frecuencia el tratamiento está fragmentado entre diferentes especialistas y hay una insuficiente formación en medicina paliativa, incluyendo habilidades de comunicación. Se producen frecuentes conflictos relacionados con las decisiones que se toman en torno a los enfermos críticos que están en el final de su vida, especialmente con la limitación de tratamientos de soporte vital (LTSV). La mayoría son conflictos de valores entre las diversas partes implicadas: el paciente, sus familiares y/o representantes, los profesionales sanitarios y la institución. El Grupo de trabajo de Bioética de la SEMICYUC elabora estas Recomendaciones de tratamiento al final de la vida del paciente crítico con el propósito de contribuir a la mejora de nuestra práctica diaria en tan difícil campo. Tras el análisis del papel de los agentes implicados en la toma de decisiones (pacientes, familiares, profesionales e instituciones sanitarias) y de los fundamentos éticos y legales de la omisión y retirada de tratamientos, se aconsejan unas pautas de actuación en lo referente a la sedación en el final de la vida y la retirada de la ventilación mecánica, se matiza el papel de las instrucciones previas en medicina intensiva y se propone un formulario que refleje de forma escrita las decisiones adoptadas
Admission of a patient in the Intensive Care Unit (ICU) is justified when the critical situation can be reverted or relieved. In spite of this, there is high mortality in the ICU in regard to other hospital departments. End-of-life treatment of critical patients and attention to the needs of their relatives is far from being adequate for several reasons: society denies or hides the death, it is very difficult to predict it accurately, treatment is frequently fragmented between different specialists and there is insufficient palliative medicine training, including communication skills. There are frequent conflicts related to the decisions made regarding the critical patients who are in the end of their life, above all, with the limitation of life-sustaining treatments. Most are conflicts of values between the different parties involved: the patient, his relatives and/or representatives, health professionals, and the institution. The SEMICYUC Working Group of Bioethics elaborates these Recommendations of treatment at the end of the life of the critical patient in order to contribute to the improvement of our daily practice in such a difficult field. After analyzing the role of the agents involved in decision making (patient, familiar, professional, and health care institutions), of the ethical and legal foundations of withholding and withdrawal of treatments, guidelines regarding sedation in the end of the life and withdrawal of mechanical ventilation are recommended. The role of advance directives in intensive medicine is clarified and a written form that reflects the decisions made is proposed
Subject(s)
Humans , Critical Care/ethics , Terminal Care/ethics , Palliative Care/ethics , Advanced Cardiac Life Support , Living Wills/ethics , Intensive Care Units/ethics , Professional-Family Relations/ethics , Decision Making/ethics , Hypnotics and Sedatives/administration & dosage , Withholding Treatment/ethicsABSTRACT
No disponible
Subject(s)
Humans , Codes of Ethics , Critical Care/ethics , Practice Patterns, Physicians'/ethics , Patient Rights/ethics , Personal Autonomy , Right to Die/ethics , Confidentiality/ethics , Quality of Health Care/ethics , Tissue Donors/ethics , Informed Consent/ethicsABSTRACT
No disponible
Subject(s)
Humans , Magnetic Resonance Spectroscopy/instrumentation , Critical Care/methods , Ventilators, Mechanical , Manometry/instrumentation , Magnetic Resonance Spectroscopy/methodsABSTRACT
La relación asistencial debe basarse en el respeto del paciente como agente moral, teniendo en cuenta su derecho a participar en la toma de decisiones. Para preservar la autonomía del paciente cuando ya no sea competente para decidir por sí mismo se ha propuesto la planificación de tratamientos y cuidados (advance care planning) como el mejor modo de contar con los deseos del enfermo. Este proceso puede plasmarse de modo escrito a través de un documento de instrucciones previas (DIP), llamado también voluntades anticipadas o directrices previas o testamento vital. En este artículo se revisan sus fundamentos éticos y legales, las ventajas y limitaciones, así como unas consideraciones sobre su aplicación en la asistencia del paciente crítico (AU)
Subject(s)
Humans , Critical Care/legislation & jurisprudence , Informed Consent/legislation & jurisprudence , Mental Competency , Patient Advocacy/legislation & jurisprudence , Physician-Patient Relations , Critical Illness/therapyABSTRACT
No disponible
Subject(s)
Aged , Male , Humans , Ticlopidine , Platelet Aggregation Inhibitors , AgranulocytosisSubject(s)
Amphetamines/adverse effects , Myocardial Infarction/chemically induced , Adult , Humans , MaleABSTRACT
No disponible
Subject(s)
Adult , Male , Humans , Myocardial Infarction , Amphetamines , Hemochromatosis , HemochromatosisABSTRACT
BACKGROUND: The aim of this study was to evaluate the efficacy of an structured intervention based on a medical advice versus to the ordinary anti-tobacco advice in patients with miocardial infarction who are attended in an Intensive Care Unit (ICU). PATIENTS AND METHODS: 90 patients were randomly selected to receive either the specific intervention (intervention group) or the ordinary advice (control group). The medical advice was given during the ICU hospitalization and during the second, the third and the fourth week. One year later the smoking habit was evaluated. RESULTS: After one year 26 patients of the intervention group and 31 patients of the control group had stopped smoking (RR = 0.88 [CI 95% RR] 0.57 to 1.37). CONCLUSIONS: The percentage of patients who stop smoking after a miocardial infarction is high. The structured medical counselling was not effective to reduce the number of smokers at one year.
Subject(s)
Myocardial Infarction/prevention & control , Patient Education as Topic , Smoking Cessation , Female , Humans , Male , Middle AgedABSTRACT
No disponible
Subject(s)
Aged , Male , Humans , Myocardial Infarction/etiology , Anaphylaxis/complications , Insect Bites and Stings/complications , Hymenoptera/pathogenicity , Mast Cells/physiology , Coronary Vasospasm/physiopathology , Platelet Aggregation Inhibitors/therapeutic useABSTRACT
BACKGROUND: The aim of the study is to know whether the patients with acute myocardial infarction (AMI) who consulted an extrahospitalary physician before the hospital arrival delayed their admission to the critical care unit (CCU), and whether their probability to receive early thrombolytic therapy was smaller than that of the patients who cam directly to hospital. PATIENTS AND METHODS: A descriptive study in patients with AMI was performed during 1995. The following variables were studied: age, sex, town of residence, previous AMI, consultation to an extrahospitalary physician, delay time in the admission to the CCU, and whether thrombolytic treatment was performed. Comparison of proportions, Student-Fisher t-test, or Mann-Whitney U-test were used, according to the case. A multiple logistic regression was used to study the independent effect of the previous consult to an extrahospitalary physician on the chance for early thrombolytic treatment. RESULTS: A hundred and eighteen patients (79.7% males) were studied. The mean age was 63 years-old. Nine point five per cent of the patients had suffered a previous AMI and 54.2% received thrombolytic treatment. Delay to hospital arrival was the main exclusion reason to receive this treatment. The mean age of patients who consulted an extrahospitalary physician (n = 69) was 5 years older, their hospital arrival were 100 min later (difference of medians) (p < 0.001), were admitted to the CCU 124 min later (p < 0.02) and ran a higher risk to arrive to CCU after 3 hours from the onset of symptoms (odds ratio [OR]: 3.3; confidence interval [IC] 95%: 1.2 to 9.2) than those who cam directly to hospital. CONCLUSIONS: The patients with AMI who consult an extrahospitalary physician delay their admission to the CCU and have a less chance to receive early thrombolytic therapy in the first 3 hours of evolution.
Subject(s)
Emergency Medical Services , Fibrinolytic Agents/therapeutic use , Myocardial Infarction/drug therapy , Physician's Role , Aged , Female , Humans , Logistic Models , Male , Middle Aged , Prospective Studies , Time FactorsABSTRACT
Cases of severe acute carbon tetrachloride poisoning are sporadically described in Spain. We report the cases of three patients that inhaled toxic vapour of carbon tetrachloride that they used as a solvent during their working activity. They developed hepatic disfunction and one of them acute renal failure. The interval between the labour exposure and the medical care was higher than 24 hours. All the patients received N-acetylcysteine treatment (300 mg/kg) and oxygen. The patient ith renal failure recurred hemodialysis. The basic aspects of diagnosis and treatment are commented.
