¿Qué es una UCI?


¿Qué es una UCI?

Introducción: Servicio de Medicina Intensiva

ICU Entrance

¿Como se define la especialidad?

MEDICINA INTENSIVA: La Medicina Intensiva, reconocida desde 1978 en España, es una especialidad multidisciplinaria y multiprofesional, que tiene como fundamento la práctica de la atención integral del enfermo cuya vida vida corre el riesgo de una evolución fatal por presentar un proceso fisiopatológico grave y potencialmente recuperable, y cuyo correcto tratamiento precisa de su atención en Áreas de Asistencia Especializada. Desarrolla el conocimiento de las bases fisiológicas de las vías de la muerte y la forma de como combatir para evitarlas.
Se entiende por atención integral a la actuación continuada y coordinada y al mismo tiempo unitaria que incluye, desde la detección del proceso, hasta la finalización de la situación crítica y el alta.

La especialidad nace y se desarrolla para la atención del Enfermo Crítico (EC), en todas sus vertientes. Pueden existir muchas enfermedades, pero fisiopatológicamente los hechos que conducen a la muerte suelen ser bastante homogéneos y requieren medios diagnósticos y terapéuticos similares.
Los Servicios de Medicina Intensiva están altamente desarrollados en cuanto a tecnología y su ubicación en el Hospital está bien definida y centralizada.

Determinantes científicos y tecnológicos que delimitan la especialidad.
La práctica de la Medicina Intensiva requiere poseer un determinado campo de conocimientos, dominar un conjunto de habilidades y disponer de actitudes psico-físicas y humanas adecuadas. Como punto de partida, la práctica de la medicina Intensiva requiere poseer una sólida base en medicina Interna, se trata de dominar la fase crítica de la Medicina Interna, con una clara proyección fisiopatológica; nuestro objetivo final es conocer los mecanismos por los que todas las enfermedades pueden conducir a una situación en que la vida esté amenazada, es decir las vías finales comunes (Fynn 1974): fracaso de la respiración, la circulación o los sistemas de mantenimiento del medio interno, lo que obliga al manejo de diagnósticos funcionales de los que dependen el soporte vital. Así mismo el intensivista necesita poseer ciertas nociones de bioingeniería, ya que ha de manejar dispositivos mecánicos y electrónicos que van a formar una unidad con el paciente; ello exige conocer los fundamentos físicos de los respiradores mecánicos, la tecnología de transductores y microprocesadores, manejo de gases etc.

Un Servicio de Medicina Intensiva, puede disponer de uno o varios tipos de UCIs. Los más comunes son las UCIs Polivalentes, otras son las UCI de Coronarias (llamadas UCC o Unidad de Cuidados Coronarios). Otras son UCIs postoperatorias, por ejemplo las de Cirugía Cardíaca! Dependiendo del nivel de Hospital podrá haber una o varias UCIs. Hay Hospitales con Áreas específicas como las Unidades de Cuidados Intermedios, que son Unidades donde el nivel de atención es menor y sirven como salida de pacientes graves a las Plantas de Hospitalización.

En América se denominan UTI (Unidades de Terapia Intensiva) y la especialidad (Medicina Crítica) suele ser una subespecialidades de otras como Medicina Interna, Neumología, Anestesiología, etc. que para acceder a ella, solo se requiere un entrenamiento durante un tiempo en Medicina Crítica.

En España desde 1978 (y desde hace unos años en Suiza, Australia, Nueva Zelanda y agunas Universidades Americanas) la especialidad es Primaria y se requieren 5 años de formación y entrenamiento. Esta formación es multidisciplinaria, quiere decir, que afronta el conocimiento de diferentes especialidades durante 2 años (Medicina Interna, Nefrología, Neumología, Cardiología, Anestesiología, etc …) y durante los ultimos 3 años en todo momento entrenándose en la UCI. Al final de los 5 años, el especialista está titulado y puede desarrollar su especialidad.

España se está calificando en la escena mundial como uno de los ejemplos mas determinantes de la excelencia en Medicina Intensiva, por su alta eficiencia. La calidad es muy elevada adoptando incluso normas que en otras partes de Europa y América observan como potencialmente aceptadas. Diversas compañias de Seguros Americanas, dada la alta eficacia de nuestras UCIs están intentando que se inicien Servicios Jerarquizados y con dotación exclusivamente de médicos intensivistas.

Al igual que en el apartado sobre la especialidad, la Medicina Intensiva es una especialidad desconocida para la ciudadanía, a diferencia de lo que ocurre con otras especialidades, ésta se confunde con otras especialidades por el hecho de ser una especialidad multidisciplinaria, pero …
Su importancia social es indiscutible por una triple razón:
• Valor añadido que genera: Alrededor de un 80-85% supervivencia.
• Alto coste de oportunidad
• Alto coste monetario: Del 15-18% del presupuesto de un Hospital y del 0.25-0.30 % del Producto interior bruto (PIB) en España (1.1 % en EEUU)

¿Como definiríamos la UCI?

“Es la concentración de conocimientos y de recursos de todo tipo necesarios para atender de una forma coordinada y continuada al paciente en una etapa de su enfermedad caracterizada por la gravedad real o potencial que pone en peligro su vida” (SEMICYUC, 1986)

Aunque inicialmente la Medicina Intensiva se inició desde un ámbito hospitalario demarcado a un Servicio Central, en un área conocida como Unidad de Cuidados Intensivos, la especialidad ha sabido ir acomodándose a las necesidades de la población objeto, donde debe de atender al EC independientemente de donde se encuentre.

El entorno de la Especialidad se extiende a Áreas de Asistencia Especializada, correspondiendo al ámbito hospitalario dentro de lo que se vá denominando el Hospital Progresivo de Agudos, apoyando al EC en cualquier zona del mismo (Unidades de Medicina Intensiva, Unidades Coronarias, Unidades de Cuidados Intermedios Semicríticos, Áreas de Urgencia, Consultas Externas, Salas de despertar, Salas de Planta, Actividad Indoor) y al ámbito extra hospitalario (Servicios de Emergencia Extra hospitalaria y Transporte interhospitalario).

La UCI, es el espacio relacionado a la enfermería y donde se situan los pacientes críticos.
Detrás de estas puertas, habitualmente cerradas a todo el personal no sanitario, hay otro mundo dentro del Hospital. Existe una diferente forma de trabajar que en el resto del Hospital, otros horarios de visita y una atención continuada durante 24 horas, siendo los pacientes ser dados de alta dependiendo de la situación que se encuentre la UCI en cualquier momento del día y la noche. Los pacientes habitualmente son trasladados a otras plantas de hospitalización general cuando son alta. Esto puede ocurrir en cualquier momento de las 24 horas del día y los 365 días del año.

La enfermería, auxiliares y celadores funciona por Turnos (3, Mañana, tarde y noche) de trabajo y los médicos (turno de mañana y los que se quedan de guardia 24 horas). En un día en nuestro Hospital (Cabueñes) hay alrededor de 56 personas trabajando para un máximo de 14 pacientes. Quiere decir que hay 4 personas trabajando por cada paciente y día de manera continuada. En momentos puntuales incluso puede estar varias enfermeras y médicos con un solo paciente, cuando las condiciones lo requieran.

Los Servicios de Medicina Intensiva, dado el personal que atiende a los pacientes, lo sofisticación de su material clínico y los soportes de vida son Este sistema de trabajo es reconocido como extremadamente eficaz, no solo por el personal que atiende al paciente, sino por que ha sido preciso una alta capacidad de adiestramiento, para el manejo del paciente y de los soportes de vida conectados a los mismos.

CITATION:

Herrero S. “¿Qué es una UCI?”  Journal of Pearls in Intensive Care Medicine; 2011 Volumen. 1. Nº 6

Link: http://wp.me/p19kQl-1d

J Pearls Int Care Med © 2011 ·Todos los derechos reservados

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Journal of Pearls in Intensive Care Medicine - Perlas en Medicina Intensiva

Herrero-Varon's MD Editors. Asturias (Gijón) and Houston (TX, USA). Languaje EN/ES 2011-2016

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