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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Evaluar la percepci&#243;n y experiencia que tienen los m&#233;dicos que trabajan en las unidades de cuidados intensivos pedi&#225;tricos &#40;UCIP&#41; acerca de los problemas &#233;ticos que se generan en la atenci&#243;n al ni&#241;o cr&#237;tico&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se enviaron encuestas a las 43 UCIP existentes en nuestro pa&#237;s&#44; con 20 cuestiones relacionadas con los objetivos del trabajo&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron 95 encuestas contestadas por medicos &#40;24 residentes y 71 m&#233;dicos de plantilla&#41; de 21 UCIP&#46; El 96&#44;8 &#37; reconocieron que en su UCIP se presentaban problemas de &#233;tica asistencial&#46; El consenso m&#233;dico es el procedimiento m&#225;s frecuente para resolver estos problemas &#40;80 &#37;&#41;&#44; mientras que la participaci&#243;n familiar en la toma de decisiones es muy variable&#46; El 95&#44;8 &#37; refieren que en su UCIP se toman decisiones de limitaci&#243;n terap&#233;utica&#44; aunque s&#243;lo un tercio de los casos se hacen constar en la historia cl&#237;nica&#46; La decisi&#243;n de no reanimar es la forma m&#225;s frecuente de limitaci&#243;n&#46; El 32&#44;6 &#37; consideraron que exist&#237;an diferencias &#233;ticas entre no instaurar o retirar un determinado tratamiento&#46; La experiencia pr&#225;ctica en limitaci&#243;n terap&#233;utica es mayor entre los m&#233;dicos de plantilla que entre los residentes&#44; aunque sus opiniones al respecto son muy similares&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La problem&#225;tica &#233;tica asistencial es com&#250;n en las UCIP&#46; En este entorno&#44; las decisiones de limitaci&#243;n terap&#233;utica son frecuentes aunque muchos m&#233;dicos reconocen no tener las ideas claras sobre este y otros aspectos de &#233;tica cl&#237;nica&#46; La participaci&#243;n familiar en la toma de decisiones es insuficiente en nuestro medio&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To asses physicians&#8217; awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units &#40;PICUs&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Questionnaires containing 20 questions about ethical dilemmas and attitudes related to the care of children admitted to PICUs were mailed to 43 PICUs in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Ninety-five responses corresponding to 24 residents and 71 attending physicians were received from 21 PICUs&#46; The occurrence of ethical dilemmas in the PICU was recognized by 96&#46;8 &#37; of the respondents&#46; The most frequent method of solving these problems was through medical consensus &#40;80 &#37;&#41;&#44; while family participation in the decision making process was highly variable&#46; A total of 95&#46;8 &#37; of respondents stated that decisions to limit therapy were made in their PICU&#44; although only one third of these decisions were written in the medical record&#46; The most frequent form of therapeutic limitation was the do not resuscitate order&#46; One third &#40;32&#46;6 &#37;&#41; of participants considered there were ethical differences between withdrawal and withholding of treatment&#46; Attending physicians had greater experience of therapeutic limitation than did residents&#44; but their opinions on the subject were similar&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Ethical dilemmas are common in the PICU&#46; In this setting&#44; decisions about limitation of therapy are frequent&#44; although many physicians admit to not being clear on this issue or on other aspects of clinical ethics&#46; Family members&#8217; participation in the decision making process is insufficient in Spanish PICUs&#46;</p>"
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Vol. 64. Núm. 6.
Páginas 542-549 (junio 2006)
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Vol. 64. Núm. 6.
Páginas 542-549 (junio 2006)
Originales
Acceso a texto completo
Encuesta de ética en las unidades de cuidados intensivos pediátricos españolas
Ethical attitudes in spanish pediatric critical care units
Visitas
9776
A. Hernández Gonzáleza,
Autor para correspondencia
artucadiz@ono.com

Correspondencia: Dr. A. Hernández González. Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario Puerta del Mar de Cádiz. Avda. Ana de Viya, 21. 11009 Cádiz. España.
, M.ªT. Hermana Tezanosb, R. Hernández Rastrolloc, F.J. Cambra Lasaosad, A. Rodríguez Núñeze, I. Faildef, Grupo de Ética de la SECIP
a Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario Puerta del Mar. Cádiz
b Unidad de Cuidados Intensivos Pediátricos. Hospital de Cruces. Baracaldo. Bilbao
c Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario Infanta Cristina. Badajoz
d Unidad de Cuidados Intensivos Pediátricos. Hospital Clínic-Sant Joan de Déu. Unidad Integrada de Pediatría. Esplugues de Llobregat. Barcelona
e Unidad de Cuidados Intensivos Pediátricos. Hospital Clínico Universitario de Santiago de Compostela. Pontevedra
f Servicio de Medicina Preventiva. Hospital Universitario Puerta del Mar. Cádiz. España
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
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Estadísticas
Objetivos

Evaluar la percepción y experiencia que tienen los médicos que trabajan en las unidades de cuidados intensivos pediátricos (UCIP) acerca de los problemas éticos que se generan en la atención al niño crítico.

Material y métodos

Se enviaron encuestas a las 43 UCIP existentes en nuestro país, con 20 cuestiones relacionadas con los objetivos del trabajo.

Resultados

Se obtuvieron 95 encuestas contestadas por medicos (24 residentes y 71 médicos de plantilla) de 21 UCIP. El 96,8 % reconocieron que en su UCIP se presentaban problemas de ética asistencial. El consenso médico es el procedimiento más frecuente para resolver estos problemas (80 %), mientras que la participación familiar en la toma de decisiones es muy variable. El 95,8 % refieren que en su UCIP se toman decisiones de limitación terapéutica, aunque sólo un tercio de los casos se hacen constar en la historia clínica. La decisión de no reanimar es la forma más frecuente de limitación. El 32,6 % consideraron que existían diferencias éticas entre no instaurar o retirar un determinado tratamiento. La experiencia práctica en limitación terapéutica es mayor entre los médicos de plantilla que entre los residentes, aunque sus opiniones al respecto son muy similares.

Conclusiones

La problemática ética asistencial es común en las UCIP. En este entorno, las decisiones de limitación terapéutica son frecuentes aunque muchos médicos reconocen no tener las ideas claras sobre este y otros aspectos de ética clínica. La participación familiar en la toma de decisiones es insuficiente en nuestro medio.

Palabras clave:
Ética
Limitación terapéutica
Tratamiento de soporte vital
Unidades de cuidados intensivos
Eutanasia
Objectives

To asses physicians’ awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units (PICUs).

Material and methods

Questionnaires containing 20 questions about ethical dilemmas and attitudes related to the care of children admitted to PICUs were mailed to 43 PICUs in Spain.

Results

Ninety-five responses corresponding to 24 residents and 71 attending physicians were received from 21 PICUs. The occurrence of ethical dilemmas in the PICU was recognized by 96.8 % of the respondents. The most frequent method of solving these problems was through medical consensus (80 %), while family participation in the decision making process was highly variable. A total of 95.8 % of respondents stated that decisions to limit therapy were made in their PICU, although only one third of these decisions were written in the medical record. The most frequent form of therapeutic limitation was the do not resuscitate order. One third (32.6 %) of participants considered there were ethical differences between withdrawal and withholding of treatment. Attending physicians had greater experience of therapeutic limitation than did residents, but their opinions on the subject were similar.

Conclusions

Ethical dilemmas are common in the PICU. In this setting, decisions about limitation of therapy are frequent, although many physicians admit to not being clear on this issue or on other aspects of clinical ethics. Family members’ participation in the decision making process is insufficient in Spanish PICUs.

Key words:
Ethics
End-of-life decision
Life support care
Intensive care units
Euthanasia
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