Intensive Care | ICS Girona

Servei Assistencial

Presentació

The Intensiv Care ,also known as ICU (intensive care unit), is a hospital unit where are the human and technological resources and knowledge needed to care , coordinated and continous, critical patients, in a vital stage characterized by a serious actual or potencial life threatening . Usually, patients admitted in ICU are in serious or critical situation, or postoperative complex surgeries. The ICU of Trueta, with 16 beds, is the unit of intensive care referral of the Health Region Girona. Is located on the first floor of the Hospital. The space occupied by each bed is called box, is individualand is equiped with specific equipment and technological services . All patients in the unit are connected to devices needed to ensure strict control of their disease during their stay in the service .

Visiting time and clinical information

Morning : from 7:15 to 7:45 AM
Noon : from 1 to 2 PM
Evening : from 8 to 9 PM

This unit allows the visit while of two relatives per patient . Before entering they should dress a green dressing gown with number of patient's box.
During the relatives visit at noon (1 to 2 pm) it will give information on patient's clinical situation. Evening, night and weekends doctors on duty take care of the patients and the information may be shorter .

Safety programme / Pneumonía Zero.
The Intensive Care Service of Hospital Trueta is attached to the National Program of pneumonía Zero (NZ)with Security Programa included . There is a working group that implements the program and discusses security issues on a regular basis.

Cartera de serveis

Cardiorespiratory arrest care with cardiopulmonary resuscitation (CPR) basic and advanced

o Cardiac massage

o Defibrillation and cardioversion

o Airway management

o Use of vasoactive drugs and antiarrhytmic

o Placing of external pacemakers

Monitoring and assisted in hospital transport

o Hemodynamic monitoring

o Mechanical ventilation assisted

Monitoring and treatment of cardiovascular disordres

o Monitoring cardiac and hemodynamics

§ Monitoring electrocardiography

Cardiac frequency
Electrocardiogram

§ Monitoring pressures

Invasiva and non invasive blood pressure
Central venous pressure
Pulmonary pressure and enclave (Swan-Ganz^®)

§ Mixed venous saturation (SvO₂) and central venous saturation (SvcO₂)

§ SvcO2 with continous measurement by catheter with infrared light:

Catheter Presep^®

Catheter Swan-Ganz, Vigilance^®

§ Cardiac output by thermo-dilution (Swan-Ganz®)

§ Cardiac output continous:

Swan-Ganz catheter (Vigilance^®)
PiCCO^®/Lung water
Flotrac^® (Vigileo^®)

o Cardioversion and defibrillation

o Handling of rhytm and driving disorders

§ Diagnosis and treatment

§ Placement of temporary pacemaker

Assistance postoperative cardiac surgery
Monitoring and treatment of respiratory disorders

o Estabishment , management and control of artificial airway

o Artificial ventilation

         Assisted techniques/controlled conventional
        CPAP and assisted proportional
        “Weaning” and withdrawal of mechanical ventilation i retirada de la ventilació mecànica
        Non invasive mechanical ventilation

o Monitoring respiratory function and interchange of gases

                         Respiratory frequency and arterial blood gases and central venous
                         Pulse oximetry
                         Capnography

o Tracheotomy care and implementation

Percutaneous puncture tracheotomy performed at bedside of patient with a set made by ORL in surgery

o Therapeutic brobronchoscopy

Nutrition and metabolism

o Prescription and control of enteral nutrition

o Prescription and control of parenteral nutrition

o Diagnosis and treatment of severe disordres

          Acid-base balance and electrolyte
          Endocrinopathies
          Strict control of blood glucose

Diagnosis and treatment of poisonning
- Medicines, drugs and external agents
Techniques continous of extrarenal debugging

o Continous veno-venous hemofiltration, MARS^®, plasmapheresis and others .

o Other conventional dyalise techniques

Multiple trauma patient care

o Coordinated and immediate care to multiple trauma patient in the emergency following the “Code politrauma”.

o Continuing care to multiple trauma in ICU

o Neurotrauma care

Placing and monitoring of SO₂ bulb jugular
Placing and monitoring intracranial pressure (Camino^® i Codman^®) and cerebral perfusion pressure
Prescription and control of barbiturate coma (with BIS^®)
Eco-Doppler transcranial

o Acute spinal cord injury care

Pharmacological dose corticosteroids and stabilitation till transfer

o Other techniques

Puncture and thoracic and pericardial drainage
Arterial and venous catheterization

Control of postoperative high risk surgery
Control of postoperative hepatectomy
Control of postoperataive esophagectomy
Control of postoperative digestive surgery risk based
Control of postoperative craniotomy and resection
Emergency care
Care in the ICU with multiorgan support measures
Coordination, detection and maintenance of the potential donor
- Diagnosis of brain death
- Eco-Doppler transcranial
- Mantenance to organ removal
Venous catheters placement with “Bacteriemia Zero” procedure in surgery of ICU with previor programming
Assistance to patient with sepsis
Assistance to organ trasplantation
Placement of central venous catheters in patients of Hematology

Equip

During the stay in ICU the patient is given care 24 hours a day by a medical team of doctors, nurses,nursing asistants, porters and cleaning staff.Each patient receives individual care .The work is divided into three shifts (morning,afternoon and evening). This team is lead by departament head and supervisor of nursing .

Dr. Josep-Maria Sirvent. Head of Service
Sra. Susanna Martin. Nursing Supervisora .

Docència

Results of teaching Service Intensive Care (ICU)
Specífics results of teching (Specialized training MIR), are presented in the memories of tutorials teaching
Cal destacar que tots els residents llevat dels de primer any, han començat un projecte d’investigació sota el grup d’estudi de la sèpsia. Aquest projectes són vàlids per tal d’obtenir la suficiència investigadora.

Recerca

Recerca del Servei de Medicia Intensiva dels tres últims anys

Publicacions 2011

AUTORS: O. Rodríguez Colomo, F. Alvarez Lerma, M.I. Gonzalez Pérez, J.M. Sirvent, M. Garcia Simón. Study Group of Infection in Critical Patients
TÍTOL: Impact of administrationa of vancomycin or linezolid to critically ill patients with impaired renal function
REVISTA : Eur J Clin Microbol Infect Dis DOI 10.1007s10096-010-1133-6

AUTORS: Teodoro Grau, Alfonso Bonet, Eduardo Miñambres, Laura Piñeiro, José Antonio Iries, Angel Robles, José Acosta, Ignacio Herrero, Venancio Palacios, Jorge López, Antonio Blesa, Pilar martínez; for the Metabolism, Nutrition Working Group, SEMICYUC, Spain
TÍTOL: The effect of L-alanyl-L-glutamine dpeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients
REVISTA: Crit Care Med 2011 Vol. 39, N. 6

AUTORS: Jordi vallès, Francisco Alvarez-Lerma, Mercedes Palomar, Armando Blanco, Ana Escoresca, Fernando Armestar, José Maria Sirvent, Carina Balasini, Rafael Zaragoza, María Marín and the Study Group of Infectious Diseases of the Spanish Society of Critical Care Medicine.
TÍTOL: Health-care-Associated Bloodstream Infections and Admission to the ICU.
REVISTA: Chest 2011; 139 (4): 810-815

AUTORS: C. Murcia-Gubianes, L. Valls-Masot, G. Rognoni-Amrein.
TÍTOL: Resonancia magnética cerebral en el golpe de calor.
REVISTA: XXXX

AUTORS: L. Bordejé Laguna; C. Lorencio Cárdenas i J. Acosta Escribano.
TÍTOL: Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Severe acute pancreatitis,
REVISTA: NUTRICION HOSPITALARIA. Nutr Hosp 2011; 26 (Supl. 2): 32-36

AUTORS: L. Bordejé Laguna; C. Lorencio Cárdenas i J. Acosta Escribano.
TÍTOL: Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consense SEMICYUC-SENPE: Pacreatitis aguda grave.
REVISTA: Med Intensiva, 2011; 35 (supl 1): 33-37

Comunicacions i ponències a congressos 2011:

Importància de la HDFVVC en el tractament de l’acidosi làctica associada a l’administració de metformina. 32 Reunió de la Societat Catalana Medicina Intensiva i crítica. Sant Fruitós del Bages Abril 2011.

Servei ampliat de Medicina Intensiva. Implantació de l’Equip de resposta ràpida al nostre Hospital. A. Garcia Fragua, C. Lorencio, I. Riera Riera, A. Baró Serra, C. Ferri Riera, J.M. Sirvent, C. Murcia Gubianes, G. Rognoni Amrein, S. Herranz Ulldemolins, C. Pedrós Mas. 32 Reunió de la Societat Catalana Medicina Intensiva i crítica. Sant Fruitós del Bages Abril 2011.

Avaluació d’una cohort de pacients crítics amb infecció del SNC. Correlació del Glasgow, la TC de crani inicial i les seqüeles neurològiques. C.Murcia Gubianas, G.RognoniAmrein, JM.Sirvent, S.HerranzUlldemolins, C.Ferri Riera, A. Béjar Delgado, A.Baró Serra, C.Pedrós Mas, M.Dupatrocinio Granados, A.Garcia Fragua. 32 Reunió de la Societat Catalana Medicina Intensiva i crítica. Sant Fruitós del Bages Abril 2011.

Comportament dinàmic dels valors de procalcitonina quantitativa com a factor pronòstic de supervivència a la sèpsia. G.Rognoni Amrein, C.Murcia Gubianas, JM.Sirvent, S.Herranz Ulldemolins, C.Ferri Riera, P.Ortiz Ballujera, C.Pedrós Mas, A.Baró Serra, M.Dupatrocinio Granados, A.Garcia Fragua 32 Reunió de la Societat Catalana Medicina Intensiva i crítica. Sant Fruitós del Bages Abril 2011.

Necessitat de Suport Ventilatori en Pacients amb Crisis Miastènica. XXVII Jornada de Cloenda Curs 2010-2011 Pablo Pujol Valverde*. Nuria Garcia Fabre*. Anna Baro Serra†. Gina Rognoni Amrein‡. Melina Dupatrocinio Granados•. Patricia Ortiz Ballujera.

Garcia Febrer, Núria; Pujol Valverde, Pablo; Garcia Fragua, Anna; Ferri Riera, Cristina; Murcia Gubianas, Cristina; Ortiz Ballujera, Patricia. Craniectomia Descompressiva precoç en el tractament d’un pacient amb hipertersión intracranial secundària a traumatisme cranioencefàlic greu. XXVII Jornada de Cloenda Curs 2010-2011.

Servicio ampliado de Medicina Intensiva. Implantación del Equipo de respuesta rápida en nuestro Hospital. A. Garcia Fragua, C. Lorencio, I. Riera Riera, A. Baró Serra, C. Ferri Riera, J.M. Sirvent, C. Murcia Gubianes, G. Rognoni Amrein, S. Herranz Ulldemolins, C. Pedrós Mas. XLVII Congreso Nacional de la SEMICYUC Bilbao junio 2011.

Comportamiento dinámico de los valores de procalcitonina cuantitativa como factor pronóstico de supervivencia en la sepsis. G.Rognoni Amrein, C.Murcia Gubianas, JM.Sirvent, S.Herranz Ulldemolins, C.Ferri Riera, P.Ortiz Ballujera, C.Pedrós Mas, A.Baró Serra, M.Dupatrocinio Granados, A.Garcia Fragua. XLVII Congreso Nacional de la SEMICYUC Bilbao junio 2011.

Variabilidad de la precisión de monitores continuos de glucosa en pacientes críticos dependiendo de su situación hemodinámica. Carol Lorencio, Yenny Leal, Alfonso Bonet, Josep Vehí, Jorge Bondia, Abdo Taché, Cesar C. Palerm, JM Sirvent. XLVII Congreso Nacional de la SEMICYUC Bilbao junio 2011.

Accuracy Assessment of subcutaneous continuous glucosa monitoring in an Intensive Care Unit according to the septic Shock State.. C. Lorencio, Y. Leal , A. Bonet, J. Vehi, J. Bondia, C.C. Palerm, A. Tache. 24th ESICM Annual Congress- Berlin October 2011.

Molins, C.Ferri Riera, P.Ortiz Ballujera, C.Pedrós Mas, A.Baró Serra, M.Dupatrocinio Granados, A.Garcia Fragua. XLVII Congreso Nacional de la SEMICYUC Bilbao junio 2011.

Publicacions 2012

AUTORS: A. Rodriguez, L. Alvarez-Rocha, J. M. Sirvent, R. Zaragoza, M. Nieto, A. Arenzana, P. Luque, L. Socías, M. Martin, D. Navarro, J. Camarea, L. Lorente, S. Trefler, L. Vidaur, J. Solé –Violán, F. Barcenilla, A. Pobo, J. Vallés, C. Ferri, I. Martin.Loeches, E. Díaz, D. López, M. J. López-Pueyo, F- Gordo, F. Del Nogal, A. Marqués, S. Tormo, M. P. Fuset, F. Pérez, J. Bonastre, B. Suberviola, E. Navas, C. Léon y GETGAG
TÍTOL: Recomendaciones del Grupo de Trabajo Enfermedades Infecciosas (GTEI) de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias y del Grupp de Estudio de Infecciones en el Pacients Crítico (GEIPC) de la Sociedad Española de Enfermedades Infecciosas y Microbriología clínica (SEIMC) para el diagnóstico y tratamiento de la gripe A/H1N1 en pacientes adultos graves hospitalizados en la Unidades de Cuidados Intensivos.
REVISTA: Med. Intensiva. 2012; 36 (2): 103-137

AUTORS: Carol Lorencio, Yenny Leal, Alfonso bonet, Jorge Bondia, Cesar C. Palerm, Abdó Tache, Josep Maria Sirvent i Josep Vehí.
TÍTOL: Real-Time Continuous Glucose Monitoring in an Intensive Care Unit: Better Accuracy in Patients with Septic Shock.
REVISTA: Diabetes Technology & Therapeutics. Volum 14, Number 7, 2012

AUTORS: C. Lorencio i J.M. Sirvent
TÍTOL: Ventilación no invasiva: ¿cuándo, cómo y dónde?
REVISTA: Med. Intensiva, 2012; 36 (9): 601-603

AUTORS: Anna Baró Serra, Bernat Guasch Aragay, Nàdia Martín Alemany, Josep M. Sirvent, Martí Vallès Prats.
TÍTOL: The importance of early haemodiafiltration in the treatment of lactic acidosis associated with the administration of metformin.
REVISTA: Revista Nefrologia. Nefrologia 2012; 32(5):664-9

AUTORS: C. Murcia Gubianes, L. Valls Massot i G. Rognoni Amrein
TÍTOL: Resonancia magnética cerebral en el golpe de calor.
REVISTA: Med. Intensiva, 2012; 36(7):526

Comunicacions i ponències a congressos 2012:

Clínica i imatges de la ressonància magnètica en les infeccions greus per Listeria monocytogenes. XXVIII Jornada de Cloenda Curs 2011-2012. Juliana Gonzalez Londoño, Miquel Morales Pedrosa, Cristina Ferri Riera, Anna Baró Serra, Sebastian Remollo, Antoni Alvarez.

MR-Proadenomedullin as prognostic biomarker in severe sepsis and septic shock. Anna Baró, Gina Rognoni, Cristina Murcia, Patricia Tejerina, Anna Garcia, Carol Lorencio, Abdo taché, Josep-Maria Sirvent. 25th ESICM Annual Congress-Lisbon October 2012.

High sensitivity Troponin-T as prognostic biomarker and relation with myocardial disfunction in severe sepsis and septic shock. Cristina Murcia, Gina Rognoni, Anna BAró, Anna Ochagavia, Cristina Ferri, Cristina Pedrós, Antoni Alvarez, Josep-Mari Sirvent. 25th ESICM Annual Congress-Lisbon October 2012.

Participació a la II Jornada Tècnica per a Coordinadors del Projecte i Gerents. Pneumònia Zero a Catalunya. 27 de setembre de 2012

Participació a la II Jornada del Pla de Salut de Catalunya 2011-2015 organitzada pel Departament de Salut i realitzada a Sitges. 30 de novembre, 1 de desembre de 2012.

Projectes científics en curs:

- Elaboració protocol de pancreatitis aguda col•laboratiu amb cirurgia. Dra. C Lorencio.
- Assaig clínic CIGMA 982. Dr. Sirvent, Dra. Carol Lorencio i Dr. Abdo Tache.
- Assaig clínic BHR, Synapse. Dr MA Arruego; Dra. C Lorencio, Dr. Abdo Taché.
- Registre ABISS-EDUSEPSIS.Dr. Pablo Pujol, Dra. Nuria García.
- Estudi Ecocardio en la sepsis. “TecoSepsis” Dra C. Murcia.
- Estudi ENVIN. Dr. JM Sirvent, Dra. C Ferri.
- Estudi Neumonia Zero. Dr. Sirvent, Dra C Ferri, Lupe García, MA Galvany, N Bisbe.
- Estudi pro-ADM. Dra. Baro i A. Garcia.
- Recollida sortides Equip de Resposta Ràpida/Codi sèpsia greu. Dra. Anna Garcia.

Projectes en curs d’infermeria:

- Tesi doctoral: “Limitació del esforç terapèutic a la UCI”. DUI Carme Majó.
- Estudi d’analgèsia en el postoperatori de cirurgia cardíaca. DUI Aaron Castanera.
- Estudi randomitzat sondes Bactiguard® en pacients postoperats de cirurgia cardíaca. DUI Manuela Rebollo, Marta Barbero, Isabel Hidalgo i Maria A Planas.

Participació i realització d’assaigs clínics.

-Assaig clínic PHOENIX. Va començar el 2010 i s’han estudiat 17 pacients. Quarta posició en el ranking. Ja acabat. Drets de publicació.

-Assaig BHR, “Synapse”, Progesterona en el TCE. 3 pacient inclòs. Encara en curs.

-Assaig CIGMA. Immunoglobulines en la pneumònia. 3 pacients inclosos. Encara en curs.

-Assaig MK 756. Randomized. Pendent d’iniciar.

-EQUIPS formats pels investigadors principals, metges i infermeria col•laboradors.

Àmbit:

Hospital

GTranslate

Search form

Servei Assistencial

Àmbit: