Los cuidados intensivos pediátricos en Latinoamérica

doi:10.1016/j.medin.2011.07.004

Medicina Intensiva

Volume 36, Issue 1, January–February 2012, Pages 3-10

https://doi.org/10.1016/j.medin.2011.07.004 Get rights and content

Resumen

Objetivo

Conocer cómo es la práctica de los cuidados intensivos pediátricos en Latinoamérica en comparación con 2 países europeos.

Diseño

Recopilación y análisis de los datos presentados por los países miembros de la Sociedad Latinoamericana de Cuidado Intensivo Pediátrico (SLACIP), España y Portugal, en el Simposio de Intensivistas Pediátricos de Habla Española y Portuguesa realizado durante el V Congreso Mundial de Cuidado Intensivo Pediátrico.

Ámbito

Unidades de cuidado intensivo pediátrico.

Participantes

Intensivistas pediátricos representantes de los países que conforman la SLACIP, España y Portugal.

Intervenciones

Ninguna.

Variables de interés general

Se recolectaron, de cada país, indicadores de salud infantil, características de las instituciones de salud dedicadas al cuidado de los niños, unidades de cuidados intensivos pediátricos (UCIP), intensivistas pediátricos, procesos de certificación dentro de la especialidad, equipamiento de las diferentes unidades, casuística, cifras de mortalidad y principales problemas que requieren solución en cada uno de los países participantes.

Resultados

Se analizaron los datos de 11 países, 9 latinoamericanos (Argentina, Colombia, Cuba, Chile, Ecuador, Honduras, México, República Dominicana y Uruguay) y 2 europeos (España y Portugal). Los datos de Bolivia y Guatemala fueron considerados solo parcialmente. Se identificaron diferencias poblacionales, institucionales y operativas entre los diferentes países. La mortalidad promedio fue 13,29% en las UCIP latinoamericanas y 5% en las UCIP europeas (p = 0,005). La mortalidad se correlacionó de forma inversa con la disponibilidad de UCIP, número de intensivistas pediátricos, número de camas y número de centros pediátricos de especialidad. Limitaciones logísticas y financieras, deficiencias en las disciplinas de apoyo, estado general precario de los pacientes por desnutrición, retraso en su ingreso y tratamientos iniciales inadecuados, pueden ser contribuyentes significativos a la mortalidad al menos en algunos de estos países.

Conclusión

Abstract

Objective

To describe the practice of pediatric intensive care in Latin America and compare it with two European countries.

Design

Analysis of data presented by member countries of the Sociedad Latinoamericana de Cuidado Intensivo Pediátrico (SLACIP), Spain and Portugal, in the context of a Symposium of Spanish and Portuguese – speaking pediatric intensivists during the Fifth World Congress on Pediatric Intensive Care.

Setting

Pediatric intensive care units (PICUs).

Participants

Pediatric intensivists in representation of each member country of the SLACIP, Spain and Portugal.

Interventions

None.

Variables of interest

Each country presented its data on child health, medical facilities for children, pediatric intensive care units, pediatric intensivists, certification procedures, equipment, morbidity, mortality, and issues requiring intervention in each participating country.

Results

Data from 11 countries was analyzed. Nine countries were from Latin America (Argentina, Colombia, Cuba, Chile, Ecuador, Honduras, México, Dominican Republic and Uruguay), and two from Europe (Spain and Portugal). Data from Bolivia and Guatemala were partially considered. Populational, institutional, and operative differences were identified. Mean PICU mortality was 13.29% in Latin America and 5% in the European countries (P = 0.005). There was an inverse relationship between mortality and availability of pediatric intensive care units, pediatric intensivists, number of beds, and number of pediatric specialty centers. Financial and logistic limitations, as well as deficiencies in support disciplines, severity of diseases, malnutrition, late admissions, and inadequate initial treatments could be important contributors to mortality at least in some of these countries.

Conclusion

There are important differences in population, morbidity and mortality in critically ill children among the participating countries. Mortality shows an inverse correlation to the availability of pediatric intensive care units, intensive care beds, pediatric intensivists, and pediatric subspecialty centers.

Section snippets

Introducción

En el año 2000, la Organización Mundial de la Salud (OMS) se fijó las «Metas del Milenio» con el propósito de mejorar las condiciones de vida de la humanidad hasta el año 2015¹. Dentro de estas destaca, por ser de interés para los pediatras, la meta 4: «reducir la mortalidad en los niños menores de 5 años en dos tercios hasta el año 2015». Alcanzar esta meta significaría evitar más de 6 millones de muertes cada año².

La estrategia diseñada para alcanzar las «Metas del Milenio» se basa

Pacientes y métodos

Seis meses antes del V Congreso Mundial de CIP, se envió a los presidentes de las sociedades nacionales de la especialidad en cada país de Latinoamérica, España y Portugal, una invitación para participar con un póster en el Simposio de Intensivistas Pediátricos de Habla Española y Portuguesa. En el caso de no conocer al representante oficial de cada país, se contactó con líderes reconocidos de la especialidad de acuerdo a los registros de la SLACIP. En el póster debían constar los siguientes

Resultados

Participaron 11 países, 9 latinoamericanos (Argentina, Colombia, Cuba, Chile, Ecuador, Honduras, México, República Dominicana y Uruguay) y 2 europeos (España y Portugal). Bolivia y Guatemala enviaron datos incompletos, los cuales fueron considerados solo parcialmente.

Discusión

Este reporte presenta una perspectiva regional de los datos poblacionales y de morbimortalidad de 9 países latinoamericanos y 2 europeos relacionándolos con la infraestructura hospitalaria, recursos humanos y tecnológicos, y con la práctica de los CIP en cada uno de ellos. Entre estos datos destacan la significancia de la población de menores de 18 años en la mayoría de países latinoamericanos y la mortalidad en éstos preferentemente asociada a infecciones, insuficiencia respiratoria,

Conclusión

Existen diferencias significativas en términos poblacionales y de morbimortalidad entre los países estudiados. La mortalidad se correlaciona de forma inversa con la disponibilidad de UCIP, número de intensivistas pediátricos, número de camas y número de centros pediátricos de especialidad. Limitaciones logísticas y financieras, deficiencias en las disciplinas de apoyo (laboratorio, imagen, cirugía, otras subespecialidades), estado general precario de los pacientes por enfermedad avanzada o

Financiación

Ninguna.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

Agradecimientos

A los profesionales que colaboraron con los datos para la realización del presente reporte: L. Albano, D. Rufach, S. Santos y L. Saligari (Argentina); C. de Villegas (Bolivia); L.C. Maya, B. Giraldo y G. Cassalett (Colombia); B.L. Castro, M. Machado y L. Ibargollen (Cuba); C. Valdevenito (Chile); L. Eguiguren, E. Quiñones, S. Morales, F. Aguinaga y D. Granda (Ecuador); A. Palomeque y C. Rey (España); L. Moya (Guatemala); W: Moncada y M. Matamoros (Honduras); M. Correa y A. Román (México); A.

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OriginalLos cuidados intensivos pediátricos en LatinoaméricaPediatric intensive care in Latin America

Resumen

Objetivo

Diseño

Ámbito

Participantes

Intervenciones

Variables de interés general

Resultados

Conclusión

Abstract

Objective

Design

Setting

Participants

Interventions

Variables of interest

Results

Conclusion

Section snippets

Introducción

Pacientes y métodos

Resultados

Discusión

Conclusión

Financiación

Conflicto de intereses

Agradecimientos

Lancet

Lancet

Curr Probl Adolesc Health Care

Lancet

Crit Care Clin

Lancet

Lancet

Pediatric emergency and critical care in low-income countries

Pediatr Anaesth

Original
Los cuidados intensivos pediátricos en LatinoaméricaPediatric intensive care in Latin America