Originales
Encuesta de ética en las unidades de cuidados intensivos pediátricos españolas
Ethical attitudes in spanish pediatric critical care units
A. Hernández Gonzáleza,
, M.ªT. Hermana Tezanosb, R. Hernández Rastrolloc, F.J. Cambra Lasaosad, A. Rodríguez Núñeze, I. Faildef, Grupo de Ética de la SECIP
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.
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.
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
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Badajoz" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos. Hospital Clínic-Sant Joan de Déu. Unidad Integrada de Pediatría. Esplugues de Llobregat. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos. Hospital Clínico Universitario de Santiago de Compostela. Pontevedra" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] 5 => array:3 [ "entidad" => "Servicio de Medicina Preventiva. Hospital Universitario Puerta del Mar. Cádiz. España" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff6" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "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." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ethical attitudes in spanish pediatric critical care units" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-03-31" "fechaAceptado" => "2006-01-31" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186339" "palabras" => array:5 [ 0 => "Ética" 1 => "Limitación terapéutica" 2 => "Tratamiento de soporte vital" 3 => "Unidades de cuidados intensivos" 4 => "Eutanasia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec186340" "palabras" => array:5 [ 0 => "Ethics" 1 => "End-of-life decision" 2 => "Life support care" 3 => "Intensive care units" 4 => "Euthanasia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se enviaron encuestas a las 43 UCIP existentes en nuestro país, con 20 cuestiones relacionadas con los objetivos del trabajo.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To asses physicians’ awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units (PICUs).</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.</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. 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.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ethicus Study Group. End of life practices in European intensive care units: The Ethicus Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.L. Sprung" 1 => "S.I. Cohen" 2 => "L. Simon" 3 => "P. Sjokvist" 4 => "M. Baras" 5 => "H.H. 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Información del artículo
ISSN: 16954033Idioma original: Español
DOI:10.1157/13089919
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| 2024 Julio | 43 | 44 | 87 |
| 2024 Junio | 62 | 33 | 95 |
| 2024 Mayo | 63 | 43 | 106 |
| 2024 Abril | 57 | 44 | 101 |
| 2024 Marzo | 47 | 46 | 93 |
| 2024 Febrero | 62 | 33 | 95 |
| 2024 Enero | 38 | 34 | 72 |
| 2023 Diciembre | 49 | 23 | 72 |
| 2023 Noviembre | 33 | 30 | 63 |
| 2023 Octubre | 22 | 27 | 49 |
| 2023 Septiembre | 24 | 24 | 48 |
| 2023 Agosto | 28 | 33 | 61 |
| 2023 Julio | 27 | 38 | 65 |
| 2023 Junio | 31 | 35 | 66 |
| 2023 Mayo | 30 | 24 | 54 |
| 2023 Abril | 19 | 21 | 40 |
| 2023 Marzo | 24 | 35 | 59 |
| 2023 Febrero | 22 | 23 | 45 |
| 2023 Enero | 18 | 30 | 48 |
| 2022 Diciembre | 36 | 37 | 73 |
| 2022 Noviembre | 41 | 37 | 78 |
| 2022 Octubre | 25 | 48 | 73 |
| 2022 Septiembre | 25 | 44 | 69 |
| 2022 Agosto | 36 | 71 | 107 |
| 2022 Julio | 25 | 50 | 75 |
| 2022 Junio | 15 | 54 | 69 |
| 2022 Mayo | 24 | 40 | 64 |
| 2022 Abril | 34 | 43 | 77 |
| 2022 Marzo | 22 | 48 | 70 |
| 2022 Febrero | 29 | 53 | 82 |
| 2022 Enero | 42 | 52 | 94 |
| 2021 Diciembre | 25 | 61 | 86 |
| 2021 Noviembre | 31 | 67 | 98 |
| 2021 Octubre | 38 | 74 | 112 |
| 2021 Septiembre | 37 | 58 | 95 |
| 2021 Agosto | 29 | 46 | 75 |
| 2021 Julio | 65 | 46 | 111 |
| 2021 Junio | 29 | 47 | 76 |
| 2021 Mayo | 57 | 38 | 95 |
| 2021 Abril | 136 | 96 | 232 |
| 2021 Marzo | 99 | 52 | 151 |
| 2021 Febrero | 72 | 16 | 88 |
| 2021 Enero | 53 | 36 | 89 |
| 2020 Diciembre | 50 | 10 | 60 |
| 2020 Noviembre | 24 | 27 | 51 |
| 2020 Octubre | 13 | 13 | 26 |
| 2020 Septiembre | 16 | 14 | 30 |
| 2020 Agosto | 27 | 10 | 37 |
| 2020 Julio | 26 | 10 | 36 |
| 2020 Junio | 32 | 15 | 47 |
| 2020 Mayo | 44 | 24 | 68 |
| 2020 Abril | 23 | 16 | 39 |
| 2020 Marzo | 29 | 14 | 43 |
| 2020 Febrero | 33 | 16 | 49 |
| 2020 Enero | 45 | 14 | 59 |
| 2019 Diciembre | 54 | 20 | 74 |
| 2019 Noviembre | 18 | 10 | 28 |
| 2019 Octubre | 16 | 15 | 31 |
| 2019 Septiembre | 16 | 13 | 29 |
| 2019 Agosto | 27 | 14 | 41 |
| 2019 Julio | 28 | 20 | 48 |
| 2019 Junio | 40 | 39 | 79 |
| 2019 Mayo | 43 | 42 | 85 |
| 2019 Abril | 44 | 30 | 74 |
| 2019 Marzo | 25 | 28 | 53 |
| 2019 Febrero | 22 | 21 | 43 |
| 2019 Enero | 16 | 36 | 52 |
| 2018 Diciembre | 13 | 28 | 41 |
| 2018 Noviembre | 40 | 27 | 67 |
| 2018 Octubre | 44 | 27 | 71 |
| 2018 Septiembre | 9 | 8 | 17 |
| 2018 Agosto | 2 | 0 | 2 |
| 2018 Julio | 1 | 1 | 2 |
| 2018 Junio | 3 | 0 | 3 |
| 2018 Mayo | 3 | 0 | 3 |
| 2018 Abril | 8 | 0 | 8 |
| 2018 Marzo | 6 | 0 | 6 |
| 2018 Febrero | 10 | 0 | 10 |
| 2018 Enero | 10 | 0 | 10 |
| 2017 Diciembre | 5 | 0 | 5 |
| 2017 Noviembre | 16 | 0 | 16 |
| 2017 Octubre | 9 | 0 | 9 |
| 2017 Septiembre | 8 | 0 | 8 |
| 2017 Agosto | 6 | 0 | 6 |
| 2017 Julio | 9 | 0 | 9 |
| 2017 Junio | 18 | 13 | 31 |
| 2017 Mayo | 17 | 17 | 34 |
| 2017 Abril | 13 | 11 | 24 |
| 2017 Marzo | 16 | 13 | 29 |
| 2017 Febrero | 11 | 9 | 20 |
| 2017 Enero | 13 | 5 | 18 |
| 2016 Diciembre | 14 | 10 | 24 |
| 2016 Noviembre | 44 | 6 | 50 |
| 2016 Octubre | 34 | 15 | 49 |
| 2016 Septiembre | 25 | 10 | 35 |
| 2016 Agosto | 18 | 4 | 22 |
| 2016 Julio | 15 | 7 | 22 |
| 2016 Abril | 1 | 0 | 1 |
| 2015 Diciembre | 1 | 0 | 1 |
| 2015 Agosto | 1 | 0 | 1 |
| 2015 Julio | 22 | 0 | 22 |
| 2015 Junio | 15 | 0 | 15 |
| 2015 Mayo | 14 | 0 | 14 |
| 2015 Abril | 16 | 0 | 16 |
| 2015 Marzo | 16 | 0 | 16 |
| 2015 Febrero | 12 | 0 | 12 |
| 2015 Enero | 13 | 0 | 13 |
| 2014 Diciembre | 19 | 1 | 20 |
| 2014 Noviembre | 18 | 0 | 18 |
| 2014 Octubre | 17 | 0 | 17 |
| 2014 Septiembre | 18 | 3 | 21 |
| 2014 Agosto | 29 | 2 | 31 |
| 2014 Julio | 34 | 1 | 35 |
| 2014 Junio | 42 | 1 | 43 |
| 2014 Mayo | 66 | 4 | 70 |
| 2014 Abril | 46 | 1 | 47 |
| 2014 Marzo | 51 | 5 | 56 |
| 2014 Febrero | 44 | 5 | 49 |
| 2014 Enero | 41 | 7 | 48 |
| 2013 Diciembre | 63 | 11 | 74 |
| 2013 Noviembre | 51 | 5 | 56 |
| 2013 Octubre | 58 | 8 | 66 |
| 2013 Septiembre | 50 | 8 | 58 |
| 2013 Agosto | 53 | 6 | 59 |
| 2013 Julio | 40 | 9 | 49 |
| 2013 Junio | 6 | 1 | 7 |
| 2013 Mayo | 11 | 3 | 14 |
| 2013 Abril | 10 | 1 | 11 |
| 2013 Marzo | 11 | 2 | 13 |
| 2013 Febrero | 23 | 1 | 24 |
| 2013 Enero | 20 | 1 | 21 |
| 2012 Diciembre | 10 | 0 | 10 |
| 2012 Noviembre | 14 | 2 | 16 |
| 2012 Octubre | 4 | 2 | 6 |
| 2012 Septiembre | 3 | 1 | 4 |
| 2006 Mayo | 2969 | 0 | 2969 |
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