Editorial
Surviving the Intensive Care Units looking through the family's eyes
Sobrevivir a las unidades de cuidados intensivos mirando a través de los ojos de la familia
Read
8230
Timeswas read the article
2630
Total PDF
5600
Total HTML
Share statistics
array:23 [ "pii" => "S2173572717301649" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.08.004" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1043" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2017;41:451-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2010 "formatos" => array:3 [ "EPUB" => 164 "HTML" => 1242 "PDF" => 604 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569117300657" "issn" => "02105691" "doi" => "10.1016/j.medin.2017.02.003" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1043" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2017;41:451-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 17238 "formatos" => array:3 [ "EPUB" => 252 "HTML" => 12720 "PDF" => 4266 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Sobrevivir a las unidades de cuidados intensivos mirando a través de los ojos de la familia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "451" "paginaFinal" => "453" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Surviving the Intensive Care Units looking through the family's eyes" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1781 "Ancho" => 2499 "Tamanyo" => 296281 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dirección General de Coordinación de la Atención al Ciudadano y Humanización de la Asistencia Sanitaria. Plan de Humanización de la Asistencia Sanitaria 2016-2019. Líneas estratégicas del Plan de Humanización de las Unidades de Cuidados Intensivos (UCI) de la Comunidad de Madrid. Disponible en: <span class="elsevierStyleInterRef" id="intr0005" href="http://www.madrid.org/bvirtual/BVCM017902.pdf">http://www.madrid.org/bvirtual/BVCM017902.pdf</span></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.C. Martín Delgado, A. García de Lorenzo y Mateos" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M.C." "apellidos" => "Martín Delgado" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "García de Lorenzo y Mateos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572717301649" "doi" => "10.1016/j.medine.2017.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717301649?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117300657?idApp=WMIE" "url" => "/02105691/0000004100000008/v1_201710301105/S0210569117300657/v1_201710301105/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572717301765" "issn" => "21735727" "doi" => "10.1016/j.medine.2016.12.003" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1019" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2017;41:454-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2126 "formatos" => array:3 [ "EPUB" => 165 "HTML" => 1167 "PDF" => 794 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "The impact of the patient post-intensive care syndrome components upon caregiver burden" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "454" "paginaFinal" => "460" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de los componentes del síndrome poscuidados intensivos del paciente en la sobrecarga de los cuidadores" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1754 "Ancho" => 2931 "Tamanyo" => 262064 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Flow chart of patient and caregiver enrolment (in attachment).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Torres, D. Carvalho, E. Molinos, C. Vales, A. Ferreira, C.C. Dias, R. Araújo, E. Gomes" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Torres" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Carvalho" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Molinos" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Vales" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Ferreira" ] 5 => array:2 [ "nombre" => "C.C." "apellidos" => "Dias" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Araújo" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Gomes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0210569117300049" "doi" => "10.1016/j.medin.2016.12.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117300049?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717301765?idApp=WMIE" "url" => "/21735727/0000004100000008/v1_201710301314/S2173572717301765/v1_201710301314/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Surviving the Intensive Care Units looking through the family's eyes" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "451" "paginaFinal" => "453" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.C. Martín Delgado, A. García de Lorenzo y Mateos" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M.C." "apellidos" => "Martín Delgado" "email" => array:1 [ 0 => "mcmartindelgado@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "García de Lorenzo y Mateos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III/IdiPAZ, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Miembro del Proyecto HU-CI, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sobrevivir a las unidades de cuidados intensivos mirando a través de los ojos de la familia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1781 "Ancho" => 2499 "Tamanyo" => 292522 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dirección General de Coordinación de la Atención al Ciudadano y Humanización de la Asistencia Sanitaria. Plan de Humanización de la Asistencia Sanitaria 2016–2019. Líneas estratégicas del Plan de Humanización de las Unidades de Cuidados Intensivos (UCI) de la Comunidad de Madrid. Available from: General Board of Citizen Care Coordination and Healthcare Humanization (<span class="elsevierStyleItalic">Dirección General de Coordinación de la Atención al Ciudadano y Humanización de la Asistencia Sanitaria</span>). Healthcare Humanization Plan 2016–2019. Strategic Lines of the Humanization Plan for Intensive Care Units (ICUs) in the Community of Madrid. Accessible at: <span class="elsevierStyleInterRef" id="intr0005" href="http://www.madrid.org/bvirtual/BVCM017902.pdf">http://www.madrid.org/bvirtual/BVCM017902.pdf</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A steadily increasing number of patients survive their stay in the Intensive Care Unit (ICU), and a significant percentage become chronic cases. Patient post-intensive care syndrome (PICS-P) is a recently described condition that affects an important number of patients (30–50%). It encompasses the physical (mainly respiratory and neuromuscular), cognitive (memory and attention) and psychological sequelae (depression, anxiety, stress and/or posttraumatic stress syndrome) at discharge from the ICU, and which have a negative impact upon patient quality of life.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This syndrome also affects the family of the patient (PICS-F). In effect, the patient relatives constitute a vulnerable and often forgotten group of individuals that nevertheless suffer negative physical, psychological and social effects that worsen their quality of life.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The relatives of critical patients often suffer anxiety (70%), depression (35%) and posttraumatic stress (35%) that can persist for years. In a recent study, 16% of the relatives had not reduced their level of depression one year after patient discharge.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Furthermore, they suffer physical symptoms such as fatigue and behavioral alterations that pose a risk for health, such as sleep disturbances, insufficient rest, lack of physical exercise, disrupted eating habits, and a lack of adherence to medical treatment. The burden of caring for a postcritical patient moreover affects personal aspects such as life plans and social and professional relationships, and favors the generation of family conflicts.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The concept of person-centered medicine recognizes the needs not only of the patient but also of the family during critical illness.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although several factors have been related to PICS-F,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> few studies have specifically addressed this syndrome to date. The study published by Torres et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> in the journal <span class="elsevierStyleSmallCaps">Medicina Intensiva</span> was carried out in a Portuguese medical-surgical ICU and offers relevant information in this regard. The authors evaluated the impact of the different components of PICS-P upon caregiver burden. Among the 186 relatives interviewed, the burden was found to be low in 34.5% of the cases and moderate-high in 15.5%. The main finding of the study was that the presence of psychological components of PICS-P (anxiety and depression) three months after discharge from the ICU had a negative impact upon caregiver burden. Neither the patient physical sequelae nor other variables studied (age, gender, SAPS II score or ICU stay) had a significant impact upon caregiver burden. Among the limitations of the study, the authors mentioned its single center design, and the fact that the sample size may have been too small to allow extrapolation of the results. Likewise, the lack of anonymity might have influenced sincerity in answering, and certain family-related variables considered in other studies were not examined. Lastly, the 31% of cases lost to follow-up could have altered the results.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Despite the interest and contributions of the study, which are particularly relevant in demonstrating the need to include the family in critical patient care and to offer them support over time, important gaps remain when it comes to defining the best strategy for dealing with these syndromes. Furthermore, validated tools are needed to allow homogeneous comparison of the results obtained.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The strategies designed to detect and prevent PICS require a structured and multidisciplinary approach implemented early after admission of the critical patient. The measures adopted must allow us to detect risk factors for the appearance of sequelae not only in the patient but also in the family. Many initiatives and recommendations have been defined to reduce the appearance of PICS-P in all its dimensions, and they are gradually being incorporated to the ICU as daily objectives. However, few strategies have demonstrated scientific evidence in reducing the negative impact of admission to the ICU upon the family, and even fewer Units have systematically incorporated such strategies to daily care.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The concept of “ICU Liberation”<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> constitutes a quality improvement initiative based on implementation of the ABCDEF series of measures, with high scientific evidence, and which when globally applied has been found to improve the outcomes and reduce the appearance of PICS. The control of pain, adequate sedation, the management of delirium, keeping the patients awake and under spontaneous breathing, early mobilization, and implication and participation of the family have been shown to lessen the impact not only in terms of patient survival but also as regards the sequelae for both the patients and their relatives at discharge from the ICU. The incorporation of these measures to clinical practice requires a change in culture and philosophy, adopting an integral approach to the patient and family in all dimensions, and ensuring optimum teamwork on the part of all the professionals implicated in critical patient care. If we really want to improve the outcomes, we must be able to recognize these needs. The success of some initiatives<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> should help overcome reluctance to change, adopting an open view allowing the gradual but effective reduction of avoidable damage associated to critical patient care.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The humanization of intensive care, which recently has gained relevance as a consequence of different projects such as the HU-CI initiative,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> favors specific actions destined to reduce this syndrome through the strategic lines included in the Humanization Plan for ICUs in the Community of Madrid (Spain) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The creation of monitoring units following ICU discharge will facilitate the continuity of management of the process and evaluation of the impact of these interventions. Intensive Care Units should consider expanding their range of services, offering this resource on a multidisciplinary basis with the aim of reintegrating the patients and their families to society after the critical episode, with the minimum physical, cognitive and psychological sequelae possible.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The relatives and caregivers of patients that survive their ICU stay constitute a crucial element of support for these individuals, and moreover absorb an important economical cost for the health system. We therefore can and must make sure that these people are not forgotten.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-30" "fechaAceptado" => "2017-02-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín Delgado MC, García de Lorenzo y Mateos A. Sobrevivir a las unidades de cuidados intensivos mirando a través de los ojos de la familia. Med Intensiva. 2017;41:451–453.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1781 "Ancho" => 2499 "Tamanyo" => 292522 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dirección General de Coordinación de la Atención al Ciudadano y Humanización de la Asistencia Sanitaria. Plan de Humanización de la Asistencia Sanitaria 2016–2019. Líneas estratégicas del Plan de Humanización de las Unidades de Cuidados Intensivos (UCI) de la Comunidad de Madrid. Available from: General Board of Citizen Care Coordination and Healthcare Humanization (<span class="elsevierStyleItalic">Dirección General de Coordinación de la Atención al Ciudadano y Humanización de la Asistencia Sanitaria</span>). Healthcare Humanization Plan 2016–2019. Strategic Lines of the Humanization Plan for Intensive Care Units (ICUs) in the Community of Madrid. Accessible at: <span class="elsevierStyleInterRef" id="intr0005" href="http://www.madrid.org/bvirtual/BVCM017902.pdf">http://www.madrid.org/bvirtual/BVCM017902.pdf</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.M. Needham" 1 => "J. Davidson" 2 => "H. Cohen" 3 => "R.O. Hopkins" 4 => "C. Weinert" 5 => "H. Wunsch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e318232da75" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "502" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21946660" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Having a loved one in the ICU: the forgotten family" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Schmidt" 1 => "E. Azoulay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0b013e328357f141" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "540" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22914431" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "RECOVER Program Investigators (Phase 1: towards RECOVER); Canadian Critical Care Trials Group. One-year outcomes in caregivers of critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.I. Cameron" 1 => "L.M. Chu" 2 => "A. Matte" 3 => "G. Tomlinson" 4 => "L. Chan" 5 => "C. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1511160" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2016" "volumen" => "374" "paginaInicial" => "1831" "paginaFinal" => "1841" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27168433" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reported burden on informal caregivers of ICU survivors: a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. van Beusekom" 1 => "F. Bakhshi-Raiez" 2 => "N.F. de Keizer" 3 => "D.A. Dongelmans" 4 => "M. van der Schaaf" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-016-1185-9" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2016" "volumen" => "20" "paginaInicial" => "16" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26792081" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Family response to critical illness: postintensive care syndrome-family" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Davidson" 1 => "C. Jones" 2 => "O.J. Bienvenu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e318236ebf9" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "618" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22080636" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[article in English, Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of the patient's post intensive care syndrome components on caregiver's burden" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Torres" 1 => "D. Carvalho" 2 => "E. Molinos" 3 => "C. Vales" 4 => "A. Ferreira" 5 => "C.C. Dias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "454" "paginaFinal" => "460" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ABCDEF bundle: science and philosophy of how ICU liberation serves patients and families" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.W. Ely" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000002175" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2017" "volumen" => "45" "paginaInicial" => "321" "paginaFinal" => "330" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28098628" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving hospital survival and reducing brain dysfunction at seven California Community Hospitals: implementing PAD guidelines via the ABCDEF bundle in 6,064 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Barnes-Daly" 1 => "G. Phillips" 2 => "E.W. Ely" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000002149" "Revista" => array:7 [ "tituloSerie" => "Crit Care Med" "fecha" => "2017" "volumen" => "45" "paginaInicial" => "171" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27861180" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0365669112003012" "estado" => "S300" "issn" => "03656691" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HUCI se escribe con H de HUMANO" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.H. La Calle" 1 => "C.Z. Lallemand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.enfi.2014.11.001" "Revista" => array:6 [ "tituloSerie" => "Enferm Intensiva" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "123" "paginaFinal" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25443599" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Añon JM. La consulta del síndrome Post-UCI ya es una realidad. Blog Humanizandoloscuidados intensivos. Available from: <a href="http://humanizandoloscuidadosintensivos.com/la-consulta-del-sindrome-post-uci-ya-es-una-realidad/">http://humanizandoloscuidadosintensivos.com/la-consulta-del-sindrome-post-uci-ya-es-una-realidad/</a> [accessed 15.6.17]." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004100000008/v1_201710301314/S2173572717301649/v1_201710301314/en/main.assets" "Apartado" => array:4 [ "identificador" => "406" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004100000008/v1_201710301314/S2173572717301649/v1_201710301314/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717301649?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 3 | 4 |
| 2024 October | 84 | 48 | 132 |
| 2024 September | 67 | 27 | 94 |
| 2024 August | 93 | 45 | 138 |
| 2024 July | 74 | 35 | 109 |
| 2024 June | 111 | 43 | 154 |
| 2024 May | 87 | 42 | 129 |
| 2024 April | 95 | 38 | 133 |
| 2024 March | 91 | 39 | 130 |
| 2024 February | 75 | 35 | 110 |
| 2024 January | 90 | 36 | 126 |
| 2023 December | 88 | 38 | 126 |
| 2023 November | 82 | 44 | 126 |
| 2023 October | 90 | 28 | 118 |
| 2023 September | 81 | 37 | 118 |
| 2023 August | 63 | 22 | 85 |
| 2023 July | 84 | 36 | 120 |
| 2023 June | 55 | 14 | 69 |
| 2023 May | 90 | 35 | 125 |
| 2023 April | 85 | 28 | 113 |
| 2023 March | 110 | 47 | 157 |
| 2023 February | 88 | 29 | 117 |
| 2023 January | 87 | 18 | 105 |
| 2022 December | 101 | 45 | 146 |
| 2022 November | 142 | 42 | 184 |
| 2022 October | 105 | 53 | 158 |
| 2022 September | 66 | 28 | 94 |
| 2022 August | 106 | 47 | 153 |
| 2022 July | 70 | 38 | 108 |
| 2022 June | 50 | 31 | 81 |
| 2022 May | 43 | 40 | 83 |
| 2022 April | 64 | 54 | 118 |
| 2022 March | 62 | 70 | 132 |
| 2022 February | 58 | 39 | 97 |
| 2022 January | 69 | 37 | 106 |
| 2021 December | 64 | 67 | 131 |
| 2021 November | 79 | 48 | 127 |
| 2021 October | 115 | 61 | 176 |
| 2021 September | 82 | 42 | 124 |
| 2021 August | 62 | 52 | 114 |
| 2021 July | 44 | 29 | 73 |
| 2021 June | 40 | 29 | 69 |
| 2021 May | 81 | 56 | 137 |
| 2021 April | 182 | 68 | 250 |
| 2021 March | 95 | 33 | 128 |
| 2021 February | 99 | 26 | 125 |
| 2021 January | 71 | 19 | 90 |
| 2020 December | 52 | 10 | 62 |
| 2020 November | 54 | 24 | 78 |
| 2020 October | 51 | 25 | 76 |
| 2020 September | 47 | 24 | 71 |
| 2020 August | 47 | 14 | 61 |
| 2020 July | 35 | 23 | 58 |
| 2020 June | 59 | 42 | 101 |
| 2020 May | 55 | 16 | 71 |
| 2020 April | 61 | 11 | 72 |
| 2020 March | 44 | 8 | 52 |
| 2020 February | 218 | 39 | 257 |
| 2020 January | 38 | 23 | 61 |
| 2019 December | 75 | 22 | 97 |
| 2019 November | 64 | 32 | 96 |
| 2019 October | 62 | 22 | 84 |
| 2019 September | 30 | 29 | 59 |
| 2019 August | 47 | 23 | 70 |
| 2019 July | 41 | 20 | 61 |
| 2019 June | 34 | 11 | 45 |
| 2019 May | 58 | 32 | 90 |
| 2019 April | 24 | 18 | 42 |
| 2019 March | 28 | 29 | 57 |
| 2019 February | 32 | 29 | 61 |
| 2019 January | 27 | 34 | 61 |
| 2018 December | 35 | 47 | 82 |
| 2018 November | 72 | 87 | 159 |
| 2018 October | 104 | 22 | 126 |
| 2018 September | 41 | 10 | 51 |
| 2018 August | 19 | 10 | 29 |
| 2018 July | 42 | 20 | 62 |
| 2018 June | 50 | 14 | 64 |
| 2018 May | 27 | 10 | 37 |
| 2018 April | 73 | 17 | 90 |
| 2018 March | 32 | 8 | 40 |
| 2017 December | 0 | 1 | 1 |
| 2017 November | 1 | 1 | 2 |
| 2017 September | 0 | 2 | 2 |
Show all
