Pub Date : 2023-02-02Epub Date: 2022-12-15DOI: 10.5554/22562087.e1058
Roxanna M Garcia, Carlos Javier Shiraishi-Zapata, Ricardo César Zúñiga Vallejos, Dante Pool Gil Chiroque, Mario Alejandro Oyanguren Maldonado, Juan Carlos Paico Palacios, Ebella Estela Romero, Aldo Humberto Villarreal Álamo, Jaime Sergio Castillo Tovar, Salomón Jesús Aguirre Uribe, Renato Díaz Ruiz, Yovanky Miluska More Vilela
Introduction: Low and medium income countries face challenges in access and delivery of surgical care, resulting in a high number of deaths and disabled individuals.
Objective: To estimate the capacity to provide surgical and trauma care in public hospitals in the Piura region, Perú, a middle income country.
Methods: A survey was administered in public hospitals in the Peruvian region of Piura, which combined the Spanish versions of the PIPES and INTACT surveys, and the WHO situational analysis tool. The extent of the event was assessed based in the absolute differences between the medians of the scores estimated, and the Mann-Whitney bilateral tests, according to the geographical location and the level of hospital complexity.
Results: Seven public hospitals that perform surgeries in the Piura region were assessed. Three provinces (3/8) did not have any complexity healthcare institutions. The average hospital in the peripheral provinces tended to be smaller than in the capital province in INTACT (8.25 vs. 9.5, p = 0.04). Additionally, water supply issues were identified (2/7), lack of incinerator (3/7), lack of uninterrupted availability of a CT-scanner (5/7) and problems with working hours; in other words, the blood banks in two hospitals were not open 24 hours.
Conclusions: There is a significant inequality among the provinces in the region in terms of their trauma care capacities and several shortfalls in the public sector healthcare infrastructure. This information is required to conduct future research on capacity measurements in every public and private institution in the Peruvian region of Piura.
{"title":"Surgical care and trauma patients capacity in Piura, Perú - Cross-sectional study.","authors":"Roxanna M Garcia, Carlos Javier Shiraishi-Zapata, Ricardo César Zúñiga Vallejos, Dante Pool Gil Chiroque, Mario Alejandro Oyanguren Maldonado, Juan Carlos Paico Palacios, Ebella Estela Romero, Aldo Humberto Villarreal Álamo, Jaime Sergio Castillo Tovar, Salomón Jesús Aguirre Uribe, Renato Díaz Ruiz, Yovanky Miluska More Vilela","doi":"10.5554/22562087.e1058","DOIUrl":"10.5554/22562087.e1058","url":null,"abstract":"<p><strong>Introduction: </strong>Low and medium income countries face challenges in access and delivery of surgical care, resulting in a high number of deaths and disabled individuals.</p><p><strong>Objective: </strong>To estimate the capacity to provide surgical and trauma care in public hospitals in the Piura region, Perú, a middle income country.</p><p><strong>Methods: </strong>A survey was administered in public hospitals in the Peruvian region of Piura, which combined the Spanish versions of the PIPES and INTACT surveys, and the WHO situational analysis tool. The extent of the event was assessed based in the absolute differences between the medians of the scores estimated, and the Mann-Whitney bilateral tests, according to the geographical location and the level of hospital complexity.</p><p><strong>Results: </strong>Seven public hospitals that perform surgeries in the Piura region were assessed. Three provinces (3/8) did not have any complexity healthcare institutions. The average hospital in the peripheral provinces tended to be smaller than in the capital province in INTACT (8.25 vs. 9.5, p = 0.04). Additionally, water supply issues were identified (2/7), lack of incinerator (3/7), lack of uninterrupted availability of a CT-scanner (5/7) and problems with working hours; in other words, the blood banks in two hospitals were not open 24 hours.</p><p><strong>Conclusions: </strong>There is a significant inequality among the provinces in the region in terms of their trauma care capacities and several shortfalls in the public sector healthcare infrastructure. This information is required to conduct future research on capacity measurements in every public and private institution in the Peruvian region of Piura.</p>","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47889816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Escobar syndrome is a rare, autosomal recessive disease of unknown incidence. It is characterized by multiple skeletal, genitourinary and orofacial abnormalities. The multiple malformations (mainly orofacial) and restricted mobility of these patients pose a challenge to the anesthesia team, especially as regards airway management. We describe the clinical case of a pediatric patient diagnosed with Escobar syndrome who underwent two consecutive anesthesia interventions, with evidence of progressive airway anomalies that characterize this syndrome. The case required adaptation, according to the clinical stage of the disease, of the current algorithms used to approach an anticipated difficult airway in pediatrics, and the incorporation of new devices, not described so far in patients with this pathology, as part of the planning and execution phases.
{"title":"Escobar syndrome, difficult airway management in pediatrics: A case report","authors":"Angelina Lippi Quiñones, Nathalie López Jaque, Verónica Maureira Moreno","doi":"10.5554/22562087.e1057","DOIUrl":"https://doi.org/10.5554/22562087.e1057","url":null,"abstract":"Escobar syndrome is a rare, autosomal recessive disease of unknown incidence. It is characterized by multiple skeletal, genitourinary and orofacial abnormalities. The multiple malformations (mainly orofacial) and restricted mobility of these patients pose a challenge to the anesthesia team, especially as regards airway management. We describe the clinical case of a pediatric patient diagnosed with Escobar syndrome who underwent two consecutive anesthesia interventions, with evidence of progressive airway anomalies that characterize this syndrome. The case required adaptation, according to the clinical stage of the disease, of the current algorithms used to approach an anticipated difficult airway in pediatrics, and the incorporation of new devices, not described so far in patients with this pathology, as part of the planning and execution phases.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46058635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. H. González Cárdenas, Daniel Santiago Benítez Ávila, Wilson Javier Gómez Barajas, Mario Alexander Tamayo Reina, Igor Leonardo Pinzón Villazón, José Luis Cuervo Pulgarín, William Sneyder Díaz Díaz, Ivonne Alejandra Martínez
Introduction: Pediatric postoperative delirium is a frequent complication for which preventive pharmacological measures have been suggested. The use of midazolam as a prophylactic strategy has not yet been thoroughly assessed. Notwithstanding the fact that it is used in pediatric presurgical separation anxiety, its role in delirium is yet to be established. Objective: To quantify the incidence of pediatric postoperative delirium in patients undergoing low risk surgical interventions, exposed to oral midazolam-based premedication and to explore the protective and risk factors associated with the development of delirium. Materials and methods: Prospective, analytical observational study with a cohort design. Children were conveniently selected in accordance with the daily list of surgical procedures in the operating rooms. The inclusion criteria were children between 2 and 10 years old, ASA I-II, undergoing low risk surgeries. Concurrent and longitudinal follow-up was then conducted upon admission to the post-anesthesia care unit (PACU) for the first hour. Results: A total of 518 children were included. The overall incidence of delirium was 14.4 % (95 % CI: 11.4 %-17.5 %). In the subgroup exposed to midazolam, 178 children were analyzed, with an incidence of delirium of 16.2% (95% CI of 10,8 %-21,7). These patients exhibited a higher tendency to delirium with the use of sevoflurane or fentanyl, and/or when presenting with severe postoperative pain. Patients exposed to propofol and/or remifentanil showed lower incidences. Conclusions: No reduction in the incidence of emergency pediatric delirium associated with the use of pre-surgical oral midazolam in low risk surgical procedures. Prospective controlled trials and additional research are required to study the effectiveness and safety of this intervention.
{"title":"Premedication with midazolam in low-risk surgery in children does not reduce the incidence of postoperative delirium. Cohort study","authors":"V. H. González Cárdenas, Daniel Santiago Benítez Ávila, Wilson Javier Gómez Barajas, Mario Alexander Tamayo Reina, Igor Leonardo Pinzón Villazón, José Luis Cuervo Pulgarín, William Sneyder Díaz Díaz, Ivonne Alejandra Martínez","doi":"10.5554/22562087.e1055","DOIUrl":"https://doi.org/10.5554/22562087.e1055","url":null,"abstract":"Introduction: Pediatric postoperative delirium is a frequent complication for which preventive pharmacological measures have been suggested. The use of midazolam as a prophylactic strategy has not yet been thoroughly assessed. Notwithstanding the fact that it is used in pediatric presurgical separation anxiety, its role in delirium is yet to be established. \u0000Objective: To quantify the incidence of pediatric postoperative delirium in patients undergoing low risk surgical interventions, exposed to oral midazolam-based premedication and to explore the protective and risk factors associated with the development of delirium. \u0000Materials and methods: Prospective, analytical observational study with a cohort design. Children were conveniently selected in accordance with the daily list of surgical procedures in the operating rooms. The inclusion criteria were children between 2 and 10 years old, ASA I-II, undergoing low risk surgeries. Concurrent and longitudinal follow-up was then conducted upon admission to the post-anesthesia care unit (PACU) for the first hour. \u0000Results: A total of 518 children were included. The overall incidence of delirium was 14.4 % (95 % CI: 11.4 %-17.5 %). In the subgroup exposed to midazolam, 178 children were analyzed, with an incidence of delirium of 16.2% (95% CI of 10,8 %-21,7). These patients exhibited a higher tendency to delirium with the use of sevoflurane or fentanyl, and/or when presenting with severe postoperative pain. Patients exposed to propofol and/or remifentanil showed lower incidences. \u0000Conclusions: No reduction in the incidence of emergency pediatric delirium associated with the use of pre-surgical oral midazolam in low risk surgical procedures. Prospective controlled trials and additional research are required to study the effectiveness and safety of this intervention.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41476870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Gregorio, A. Mafra, J. Fonseca, Elisabete Valente
Source: Authors. The accompanying images exhibit a large round, subcutaneous fat mass protruding from the posterior cervical area and also several other masses along the back, in a patient with Madelung disease (Image 1). From an anterior view, it is also possible to see big bulky cheeks and another fat mass on the anterior neck (Image 2). Madelung’s disease, also known as multiple symmetric lipomatosis or Launois–Bensaude syndrome is a rare lipid metabolic disorder characterized by diffuse, progressive growth of encapsulated subcutaneous adipose tissue, in the neck, shoulder and other areas, as can be seen in the image. The exact cause of Madelung’s disease has not yet been fully understood, but there’s one theory that argues that a defect in the adrenergic-stimulated fat breakdown (lipolysis) process could result in improper fat deposits. Madelung’s disease affects more males than females (ratio of 15-30:1) and is usually diagnose between 30-70 years of age. For unclear reasons, this disorder appears to be more prevalent in Mediterranean and European population as compared to others regions in the world. (1) As described, the characteristics of Madelung’s disease imposes a careful anaesthetic approach because it makes
{"title":"Why is Madelung’s disease a challenge for the anaesthesiologist?","authors":"M. Gregorio, A. Mafra, J. Fonseca, Elisabete Valente","doi":"10.5554/22562087.e1051","DOIUrl":"https://doi.org/10.5554/22562087.e1051","url":null,"abstract":"Source: Authors. The accompanying images exhibit a large round, subcutaneous fat mass protruding from the posterior cervical area and also several other masses along the back, in a patient with Madelung disease (Image 1). From an anterior view, it is also possible to see big bulky cheeks and another fat mass on the anterior neck (Image 2). Madelung’s disease, also known as multiple symmetric lipomatosis or Launois–Bensaude syndrome is a rare lipid metabolic disorder characterized by diffuse, progressive growth of encapsulated subcutaneous adipose tissue, in the neck, shoulder and other areas, as can be seen in the image. The exact cause of Madelung’s disease has not yet been fully understood, but there’s one theory that argues that a defect in the adrenergic-stimulated fat breakdown (lipolysis) process could result in improper fat deposits. Madelung’s disease affects more males than females (ratio of 15-30:1) and is usually diagnose between 30-70 years of age. For unclear reasons, this disorder appears to be more prevalent in Mediterranean and European population as compared to others regions in the world. (1) As described, the characteristics of Madelung’s disease imposes a careful anaesthetic approach because it makes","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41537197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Khanna, R. Richardson, Carlos Trombetta, Roshni Sreedharan
a Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. b Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. c Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. d Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. Correspondence: Department of Cardiothoracic Anesthesiology, Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, E3-108, Cleveland Clinic Foundation, Cleveland, Ohio 44122, USA. Email: khannas@ccf.org OPEN
a克利夫兰诊所基金会麻醉研究所心胸麻醉科。美国克利夫兰。b克利夫兰临床基金会麻醉研究所全身麻醉科。美国克利夫兰。c克利夫兰临床基金会麻醉学研究所结果研究部。美国克利夫兰。d克利夫兰临床基金会麻醉学研究所重症监护与复苏科。美国克利夫兰。通讯:克利夫兰诊所基金会麻醉研究所，欧几里得大道9500号，E3-108，克利夫兰诊所基金会，俄亥俄州克利夫兰44122，美国，心肺麻醉科，全身麻醉科和结局研究部。邮箱:khannas@ccf.org OPEN
{"title":"Anterolateral papillary muscle rupture in acute myocardial infarction","authors":"S. Khanna, R. Richardson, Carlos Trombetta, Roshni Sreedharan","doi":"10.5554/22562087.e1052","DOIUrl":"https://doi.org/10.5554/22562087.e1052","url":null,"abstract":"a Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. b Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. c Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. d Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic Foundation. Cleveland, USA. Correspondence: Department of Cardiothoracic Anesthesiology, Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, E3-108, Cleveland Clinic Foundation, Cleveland, Ohio 44122, USA. Email: khannas@ccf.org OPEN","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43148749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos Eduardo Laverde-Sabogal, Carmelo José Espinosa-Almanza, D. Patiño-Hernández, Horacio Rodríguez-Escallón, Juan Camilo Aguado-Valderrama, P. Lara-Monsalve
Introduction: Acute respiratory failure remains one of the three leading causes of admission to the intensive care unit (ICU). Self-extubation is an adverse outcome requiring reintubation in 50% of cases. Objective: To assess for determinants (risk factors) of self-extubation and mortality in the ICU by using a generalized estimation equation model (GEE). Methods: The data was collected from a retrospective cohort study from 2017-2020 including all patients admitted to the ICU with mechanical ventilation. Univariate and bivariate analyses were performed. Then, a GEE model was conducted to predict the risk of self-extubation and mortality. Results: A total of 857 subjects were included, with a mean age of 60.5 +/- 17 years-old. Most of the subjects were males (55.2%). An 8.99-fold risk (95%CI 3.83-21.1, p<0.01) of self-extubation was identified in patients with agitation. Exposure to infusion of neuromuscular blockade was also found to increase the risk of self-extubation 3.37 times (95%CI 1.31-8.68, p=0.01). No associations were identified between immobilization and self-extubation (OR 1.38 95%CI 0.76-2.51, p=0.29). Finally, light sedation according to the Richmond Sedation Scale (RASS) between 0 to -2 rather than moderate (RASS-3) reduces the risk of mortality (OR 0.57, 95%CI 0.38-0.83, p<0.01). Conclusions: The main factors resulting in self-extubation were: agitation, delirium, and infusion of neuromuscular blocking agents. An association was found between light sedation and a lower risk of mortality. No association was found between the use of physical restraint and the desired outcome.
{"title":"Risk factors of self-extubation in intensive care. Retrospective cohort study","authors":"Carlos Eduardo Laverde-Sabogal, Carmelo José Espinosa-Almanza, D. Patiño-Hernández, Horacio Rodríguez-Escallón, Juan Camilo Aguado-Valderrama, P. Lara-Monsalve","doi":"10.5554/22562087.e1050","DOIUrl":"https://doi.org/10.5554/22562087.e1050","url":null,"abstract":"Introduction: Acute respiratory failure remains one of the three leading causes of admission to the intensive care unit (ICU). Self-extubation is an adverse outcome requiring reintubation in 50% of cases. \u0000Objective: To assess for determinants (risk factors) of self-extubation and mortality in the ICU by using a generalized estimation equation model (GEE). \u0000Methods: The data was collected from a retrospective cohort study from 2017-2020 including all patients admitted to the ICU with mechanical ventilation. Univariate and bivariate analyses were performed. Then, a GEE model was conducted to predict the risk of self-extubation and mortality. \u0000Results: A total of 857 subjects were included, with a mean age of 60.5 +/- 17 years-old. Most of the subjects were males (55.2%). An 8.99-fold risk (95%CI 3.83-21.1, p<0.01) of self-extubation was identified in patients with agitation. Exposure to infusion of neuromuscular blockade was also found to increase the risk of self-extubation 3.37 times (95%CI 1.31-8.68, p=0.01). No associations were identified between immobilization and self-extubation (OR 1.38 95%CI 0.76-2.51, p=0.29). Finally, light sedation according to the Richmond Sedation Scale (RASS) between 0 to -2 rather than moderate (RASS-3) reduces the risk of mortality (OR 0.57, 95%CI 0.38-0.83, p<0.01). \u0000Conclusions: The main factors resulting in self-extubation were: agitation, delirium, and infusion of neuromuscular blocking agents. An association was found between light sedation and a lower risk of mortality. No association was found between the use of physical restraint and the desired outcome.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44681476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Choosing Wisely","authors":"Wendy Levinson, M. Giraldo","doi":"10.5554/22562087.e1047","DOIUrl":"https://doi.org/10.5554/22562087.e1047","url":null,"abstract":"","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42417648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Milena Álvarez Acuña, Julián Camilo Riaño Moreno, Jhonatan López Neira, Ómar Fernando Gomezese Ribero
Introduction. The Advanced Directives Document (ADD) is an efficient tool to plan for future medical care in case of a potential loss of autonomy. Ethical dilemmas arise in end-of-life care, including the principle of respect for autonomy and potential beneficence involved in health care, leading to moral distress of practitioners. Objective. To identify the ethical principles and dilemmas arising from the discourse of healthcare practitioners involved with end-of-life care based on the ADD. Methodology. Qualitative study with a hermeneutics approach based on 253 answers to the following exploratory question: Are you willing to respect the ADD of an unconscious patient when you think that the patient may benefit otherwise? Results. Most practitioners acknowledge their respect for the ADD as an ethical obligation, whilst a minority consider it a legal right. For the large majority of practitioners, the ethical principles of respect for the ADD are recognized under the ethical theory of liberal individualism. Respect for autonomy is associated with the principle of non-maleficence and the value of human dignity. The principle of beneficence and the quality of life concept were presented as genuine moral dilemmas. A reversible clinical condition, the request for euthanasia, the family and the legibility of anticipated directives were submitted as apparent moral dilemmas. Conclusions. During the end-of-life decision making process, there are other valid ethical considerations beyond principlism. The dilemmas identified show the ethical complexity healthcare practitioners face based on the ADD.
{"title":"Ethical principles and dilemmas in the discourse of healthcare practitioners involved with end-of-life care based on the Advanced Directives Document","authors":"Ana Milena Álvarez Acuña, Julián Camilo Riaño Moreno, Jhonatan López Neira, Ómar Fernando Gomezese Ribero","doi":"10.5554/22562087.e1046","DOIUrl":"https://doi.org/10.5554/22562087.e1046","url":null,"abstract":"Introduction. The Advanced Directives Document (ADD) is an efficient tool to plan for future medical care in case of a potential loss of autonomy. Ethical dilemmas arise in end-of-life care, including the principle of respect for autonomy and potential beneficence involved in health care, leading to moral distress of practitioners. \u0000Objective. To identify the ethical principles and dilemmas arising from the discourse of healthcare practitioners involved with end-of-life care based on the ADD. \u0000Methodology. Qualitative study with a hermeneutics approach based on 253 answers to the following exploratory question: Are you willing to respect the ADD of an unconscious patient when you think that the patient may benefit otherwise? \u0000Results. Most practitioners acknowledge their respect for the ADD as an ethical obligation, whilst a minority consider it a legal right. For the large majority of practitioners, the ethical principles of respect for the ADD are recognized under the ethical theory of liberal individualism. Respect for autonomy is associated with the principle of non-maleficence and the value of human dignity. The principle of beneficence and the quality of life concept were presented as genuine moral dilemmas. A reversible clinical condition, the request for euthanasia, the family and the legibility of anticipated directives were submitted as apparent moral dilemmas. \u0000Conclusions. During the end-of-life decision making process, there are other valid ethical considerations beyond principlism. The dilemmas identified show the ethical complexity healthcare practitioners face based on the ADD.","PeriodicalId":36529,"journal":{"name":"Colombian Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46641140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. H. González Cárdenas, Ilia Marcela Jáuregui Romero, Yonny Mena Méndez, Paola Nathaly Silva Enríquez, Andrés Soler Sandoval
Introduction: Determining perioperative risk is part of the strategies implemented with the aim of reducing morbidity and mortality in the surgical population in the world. Although there is no established definition, high perioperative risk is associated with the group of patients with the highest disease burden. Objective: To determine postoperative mortality and its associated factors in patients with high perioperative risk. Methods: Analytical observational cohort study of high perioperative risk patients included in the database (n = 843) of the anesthesia program in a high complexity hospital in Colombia, between January 2011 and April 2018. Pre and postoperative variables were analyzed using uni and multivariate logistic regression per protocol. Overall and stratified mortality were estimated and factors associated with their occurrence were analyzed. Finally, survival was analyzed, the primary outcome being overall cohort mortality and stratified high cardiovascular risk mortality. Results: Cumulative 7-day mortality was 3.68% (95% CI 2.40-4.95%) and 30-day mortality was 10.08% (95% CI 8.05-12.12%). Perioperative mortality in the high cardiovascular risk group in the first 7 days was 3.60% (95% CI 1.13-6.07%) and 14.86% (95% CI 10.15-19.58%) at 30 days. The following preoperative variables were associated with mortality: chronic obstructive pulmonary disease, chronic kidney disease, limited functional class and abdominal aortic aneurysm. A strong association was observed between postoperative complications and a significant increase in mortality rate; the most relevant complications were cerebrovascular events and cardiogenic shock. Conclusions: In this group of high perioperative risk patients, and in the subgroup of high cardiovascular risk patients, overall mortality at 7 and at 30 days was estimated to be above values reported in various countries. Mortality was significantly increased by the presence of preoperative factors and postoperative complications.
前言:确定围手术期风险是世界范围内降低手术人群发病率和死亡率的战略实施的一部分。虽然没有明确的定义，但围手术期高风险与疾病负担最高的患者群体相关。目的:探讨围手术期高危患者的术后死亡率及其相关因素。方法:2011年1月至2018年4月，对哥伦比亚一家高复杂性医院麻醉项目数据库中的高危患者(n = 843)进行分析性观察队列研究。每个方案使用单变量和多变量逻辑回归分析术前和术后变量。估计总体死亡率和分层死亡率，并分析其发生的相关因素。最后，对生存率进行分析，主要结局是总队列死亡率和分层心血管高危死亡率。结果:累计7天死亡率为3.68% (95% CI 2.40 ~ 4.95%)， 30天死亡率为10.08% (95% CI 8.05 ~ 12.12%)。高危组围手术期前7天死亡率为3.60% (95% CI 1.13-6.07%)， 30天死亡率为14.86% (95% CI 10.15-19.58%)。以下术前变量与死亡率相关:慢性阻塞性肺疾病、慢性肾脏疾病、功能受限分类和腹主动脉瘤。观察到术后并发症与死亡率显著增加之间存在密切关联;最相关的并发症是脑血管事件和心源性休克。结论:在这组围手术期高危患者和心血管高危患者亚组中，7天和30天的总死亡率估计高于各国报告的值。由于术前因素和术后并发症的存在，死亡率明显增加。
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