Children with moderate traumatic brain injury (modTBI) (Glasgow Coma Scale (GCS) 9-13) may benefit from better stratification. We aimed to compare neurocritical care utilization and functional outcomes between children with high GCS modTBI (hmodTBI, GCS 11-13), low GCS modTBI (lmodTBI, GCS 9-10), and severe TBI (sTBI, GCS ≤ 8). We hypothesized that patients with lmodTBI have higher neurocritical care needs and worse outcomes than patients with hmodTBI and are similar to patients with sTBI. Prospective observational study from June 2018 to October 2022 in 28 pediatric intensive care units (PICU) in Asia, South America, and Europe. We included children (age < 18years) with modTBI and sTBI admitted to PICU and measured functional outcomes at 3months using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds, scale 1-8, 1 = upper good recovery, 8 = death). We analyzed 409 patients: 98 (24%) and 311 (76%) with modTBI and sTBI, respectively. Patients with lmodTBI (vs. hmodTBI) were more likely to have invasive ICP monitoring (32.3% vs. 4.5%, p < 0.001), longer PICU stay (days, median [IQR]; 5.00 [4.00, 9.75] vs 4.00 [2.00, 5.00], p = 0.007), and longer hospital stay (days, median [IQR]: 13.00 [8.00, 17.00] vs. 8.00 [5.00, 12, 25], p = 0.015). Median GOS-E Peds scores were significantly different (hmodTBI (1.00 [1.00, 3.00]), lmodTBI (3.00 [IQR 2.00, 5.75]), and sTBI (5.00 [IQR 1.00, 6.00]) (p < 0.001)). After adjusting for age, sex, presence of polytrauma and cerebral edema, lmodTBI, and sTBI remained significantly associated with higher GOS-E scores (adjusted coefficient (standard error): 1.24 (0.52), p = 0.018, and 1.27 (0.33), p < 0.001, respectively) compared with hmodTBI. Children with lmodTBI have higher rates of neurocritical care utilization and worse functional outcomes than those with hmodTBI but better than those with sTBI. Children with lmodTBI may benefit from guideline-based management similar to what is implemented in children with sTBI. This work was performed in hospitals within the PACCMAN and LARed networks. No reprints will be ordered.

Chronic kidney disease is a multifactorial process of a progressive and irreversible nature which frequently leads to a advanced state, and requires substitutive renal support therapies. The number of patients with end-stage renal disease is increasing worldwide, with an increasing demand for healthcare services. Being many of them candidates for palliative care, due to their chronic, advanced and life-limiting illness.Patients and their families need to make early decisions for the end of life from the moment of diagnosis of the advanced illness, through the advance directive document, adequacy of the therapeutic effort and palliative care, a decision that will be based on adequate dialogic information that recognizes autonomy and respects the dignity and fundamental rights of the patient expressed through informed consent seeking the best good and quality of life.Patients who opt for renal replacement support therapies know that their lives depend on the periodicity and compliance to hemodialysis, peritoneal dialysis or a successful kidney transplant, as well as the control of other pathologies associated with their disease. In order to know the bioethical aspects related to end-stage renal disease, a non-systematic review was carried out and rights, judgment values and proportionality for ethical decision-making were defined.The objective was to know the bioethics in advanced chronic renal patients with renal replacement support therapies: hemodialysis, peritoneal dialysis and transplants.

The use of glucocorticoids is the most frequent cause of osteoporosis and osteoporotic fractures. Considering that glucocorticoid-induced osteoporosis (GIOP) is an underestimated and generally untreated problem, the Bone Metabolism study group of the Colombian Association of Rheumatology decided to create this Clinical Practice Guideline (CPG) in order to support rheumatologists and other specialists in the country who use this type of medication to manage inflammatory and autoimmune conditions, with recommendations on prevention, diagnosis, and treatment of GIOP. The recommendations presented here were constructed following the GRADE-ADOLOPMENT methodology. The American College of Rheumatology guideline, Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis, was selected as the source for updating the literature searches. The development of this CPG also included the participation of clinical experts from different specialties, patients, and the EpiThink Health Consulting technical-methodological team.

Accurate and reliable noninvasive methods to estimate gas exchange are necessary to guide clinical decisions to avoid frequent blood samples in children with pediatric acute respiratory distress syndrome (PARDS). We aimed to investigate the correlation and agreement between end-tidal measured immediately after a 3-s inspiratory-hold (PLAT CO2 ) by capnometry and measured by arterial blood gases (ABG) in PARDS. Prospective cohort study. Seven-bed Pediatric Intensive Care Unit, Hospital El Carmen de Maipú, Chile. Thirteen mechanically ventilated patients aged ≤15 years old undergoing neuromuscular blockade as part of management for PARDS. None. All patients were in volume-controlled ventilation mode. The regular end-tidal (without the inspiratory hold) was registered immediately after the ABG sample. An inspiratory-hold of 3 s was performed for lung mechanics measurements, recording in the breath following the inspiratory-hold. (PLAT CO2 ). End-tidal alveolar dead space fraction (AVDSf) was calculated as and its surrogate (S)AVDSf as . Measurements of were considered the gold standard. We performed concordance correlation coefficient (ρc), Spearman's correlation (rho), and Bland-Altmann's analysis (mean difference ± SD [limits of agreement, LoA]). Eleven patients were included, with a median (interquartile range) age of 5 (2-11) months. Tidal volume was 5.8 (5.7-6.3) mL/kg, PEEP 8 (6-8), driving pressure 10 (8-11), and plateau pressure 17 (17-19) cm H2 O. Forty-one paired measurements were analyzed. was higher than (52 mmHg [48-54] vs. 42 mmHg [38-45], p < 0.01), and there were no significant differences with PLAT CO2 (50 mmHg [46-55], p > 0.99). The concordance correlation coefficient and Spearman's correlation between and PLAT CO2 were robust (ρc = 0.80 [95% confidence interval [CI]: 0.67-0.90]; and rho = 0.80, p < 0.001.), and for were weak and strong (ρc = 0.27 [95% CI: 0.15-0.38]; and rho = 0.63, p < 0.01). The bias between PLAT CO2 and was -0.4 ± 3.5 mmHg (LoA -7.2 to 6.4), and between and was -8.5 ± 4.1 mmHg (LoA -16.6 to -0.5). The correlation between AVDSf and (S)AVDSf was moderate (rho = 0.55, p < 0.01), and the mean difference was -0.5 ± 5.6% (LoA -11.5 to 10.5). This pilot study showed the feasibility of measuring end-tidal CO2 after a 3-s end-inspiratory breath hole in pediatric patients undergoing controlled ventilation for ARDS. Encouraging preliminary results warrant further study of this technique.

The neurocritical patient suffers from severe dysfunction of the central nervous system, generated by the alteration in his brain structure and function due to changes in his neuronal connections, neurotransmitters and autoregulation secondary to edema, ischemia or cerebral hemorrhage.Neurobioethics is a variant of personalistic ethics that sees the person as unique and exceptional, applying the principle of defense of physical life, which promotes the integral and dual brain-mind good. The attention of the neurocritical patient in Intensive Care depends on the bioethical conduct «moral improvement» of the person who assumes and performs it. It is the interaction of the doctor who is conscious and the patient who is unconscious without autonomy. That is, it will depend on the doctor-patient relationship, the medical act, professional autonomy, not so much on the autonomy of the patient.In order to carry out a critical reflection and a reflexive analysis for an argumentation based on the ethics and science of neurobioethics applied to the neurocritical patient in Intensive Care, a non-systematic review of neurobioethics, neuroscience and neuroethics applied to the patient was carried out. The objective is to raise ethical considerations of neurobioethics in the care of the neurocritical patient in Intensive Care.

Organ donation in brain or neurological death is an accepted scientific and ethical procedure, however, the demand for transplants exceeds the supply of organs, having to resort to other forms of donation. To the so-called non-heart-beating donors described in the literature as uncontrolled asystolic donors and controlled asystolic donors, detected inside and outside the intensive care units. This new way of obtaining organs is becoming an increasingly accepted method in the world, due to the favorable results obtained.The intensive care physician in end-of-life care requires knowledge of this new way of detecting donors in patients in imminent death with terminal catastrophic illness category Maastricht III. Where the vision of informed, subrogated consent, advance directives, autonomy, respect for dignity, rights, controlled withdrawal of life support, terminal extubation and circulatory arrest, must be taken into account before the decision of the patient or family member in their will to donate. To understand donors in controlled asystole, end-of-life care, and ethical issues in intensive care, a systematic review was performed using the ask Medline search tool in Medline/PubMed and three PICO questions related to the search were answered. Concepts of the terms used in end of life and DAC and ethical aspects and DAC were established according to the references.The objective of this review was to know what is related to organ donation in controlled asystole, end-of-life care and its ethical aspects in intensive care.

Medical professionals, health institutions, pharmacists and the civil community in general must be part of ethical discussions and not only scientific ones on the indiscriminate use of antibiotics, self-medication or self-prescription. Current bioethics emphasizes self-care and care for others and considers infectious and contagious diseases as a public health problem of the present and the future.Bioethics invites critical reflection on the daily practice of antibiotic prescription in the hospital and community environment with or without a prescription. It helps to understand that an inappropriate and irrational prescription of an antibiotic contributes to bacterial resistance. Resistance is produced when bacteria mutate in response to the indiscriminate use of these drugs; it is bacteria and not humans that become resistant to antibiotics through overuse.In order to know the relationship between bioethics, antibiotic prescription and bacterial resistance, a non-systematic bibliographic review of articles on basic bioethics, and normative ethics applied through ethical theories in Web Bioethics and in PubMed was carried out regarding bacterial resistance and prescription. of antibiotics. The objective of this article was to make a bioethical reflection on the medical prescription of antibiotics associated with bacterial resistance.

PurposeTo estimate the health-related quality of life (HRQOL) according to glycemic status, and its relationship with sociodemographic and clinical factors in a population at risk of developing type 2 diabetes (T2D).MethodsCross-sectional study, using cluster sampling. Data were collected from 1135 participants over 30 years of age, at risk of developing T2D from the PREDICOL project. Participants' glycemic status was defined using an oral glucose tolerance test (OGTT). Participants were divided into normoglycemic subjects (NGT), prediabetes and diabetics do not know they have diabetes (UT2D). HRQOL was assessed using the EQ-5D-3L questionnaire of the EuroQol group. Logistic regression and Tobit models were used to examine factors associated with EQ-5D scores for each glycemic group.ResultsThe mean age of participants was 55.6 ± 12.1 years, 76.4% were female, and one in four participants had prediabetes or unknown diabetes. Participants reported problems most frequently on the dimensions of Pain/Discomfort and Anxiety/Depression in the different glycemic groups. The mean EQ-5D score in NGT was 0.80 (95% CI 0.79–0.81), in prediabetes, 0.81 (95% CI 0.79–0.83), and in participants with UT2D of 0.79 (95% CI 0.76–0.82), respectively. Female sex, older age, city of residence, lower education, receiving treatment for hypertension, and marital status were significantly associated with lower levels of HRQOL in the Tobit regression analysis.ConclusionsHRQOL of NGT, prediabetes, and UT2D participants was statistically similar. However, factors such as gender, age. and place of residence were found to be significant predictors of HRQOL for each glycemic group.

For Colombia, it is important to adopt a standardized and structured quality management system for the continuous improvement of health care in intensive care units (ICU). The Colombian Association of Critical Medicine and Intensive Care (AMCI) developed this consensus document to offer recommendations on the different pillars of health quality that are necessary for practice within the units. It was built with a comprehensive approach, taking into account the accumulated experience of the actors who practice the discipline of critical medicine together with the analysis of the best available scientific evidence, but contextualized to the national perspective. This consensus seeks to guarantee and prioritize safety and quality conditions for critically ill patients in the units. In response to the variability in processes, systems, structure, and complexity in ICU throughout the national territory, the AMCI convened a multidisciplinary team of experts in critical medicine, clinicians, and methodologists to make a scientific statement using the consensus methodology. formally, mainly through the DELPHI method, about the quality standards necessary to guarantee efficiency and quality in intensive care services and that can be reflected in patient outcomes. It is intended to have a positive impact on the different levels of the health system, providers, administrators and insurers. It is also intended to establish work channels with the national government and its regulatory bodies, to provide arguments from the scientific society that can facilitate the formulation of policies in control and audit regulations. The consensus invites all intensive care units in the country to carry out a self-assessment of their specific conditions, taking into account the contents of this consensus, clarifying that it was developed in a scientific, academic and non-commercial context, focused on the continuous search for benefit for patients, but also for the human talent that works in the units. Each health institution must be a guarantor, through the leadership of the care coordination of the ICU, of having the best conditions to be able to develop the practice of critical medicine. This consensus document constitutes a source for improvement processes. This document has a national scope and its content is expected to be updated in no more than 4 years.