Examinando por Autor "Nates, Joseph"

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    International multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach
    (John Wiley & Sons Ltd, 0004-08-26) Borges-Sa, Marcio; Giglio, Andrés; Martin-Loeches, Ignacio; Nates, Joseph; González del Castillo, Josemaría; Cárdenas, Yenny; Mergulhao, P.; Candel, F. J.; Zaragoza, R.; Larrosa-Escartin, M. N.; Vidal-Cortés, P.; Maseda, E.; Reina, R.; Paiva, J. A.; del Pozo, J. L.; Villegas, M. V.; Salavert, M.; Soriano, C.; Hidalgo, J.; Machuca, I.; Gonçalves-Pereira, J.; Manuel-Vázquez, A.; Lisboa, T.; Pichardo-Viñas, M.; Barberán, J.; Esparza, G.; Castillo-Abrego, G.; Estella, A.; Ortega, K.; Matos, A.; Raimondi, N.; Ferrer, R.; Sanchez, J. R.; Huelmo, I.; Gorordo-Delsol, L. A.; Campozano, V.; Soriano, A.; Perez, J.; Rodriguez, A.
    Background. Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high-income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs. Methods. A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as ≥70% agreement across three iterative rounds using Likert scales (Rounds 1–2) and binary format (Round 3). Results. Consensus was achieved for 40 statements. Strong endorsement (82%–95%) was reached for structured hospital sepsis programs, NEWS-2 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6 h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first-line vasopressor therapy. Experts also supported pharmacokinetic- and pharmacodynamic-guided antibiotic dosing, prolonged infusion of time-dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis-2, Sepsis-3, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy. Conclusions. These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high- and middle-income healthcare systems.
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    Mapping intensive care across Ibero-America: The FEPIMCTI multinational survey of bed capacity, workforce, and pandemic response
    (Elsevier, 0022-07-26) Matos, Alfredo; Giglio, Andrés; Pérez-Fernandez, Javier; Nates, Joseph; Cárdenas, Yenny; Raimondi, Nestor; Sánchez, Jorge; Hidalgo, Jorge; Rezende, Ederlon; Borges-Sa, Marcio
    Background: Intensive care resources are unequally distributed across Ibero-America, and reliable comparable data are scarce, hindering cross-national comparison and health-system planning. Methods: We conducted a cross-sectional survey of the 25 national critical care societies affiliated with FEPIMCTI. Presidents or designated representatives reported country-level data on ICU beds, intensivist and nursing workforce, organizational models, training pathways, and surge capacity before and during the COVID-19 pandemic. Resource density was summarized as the country-level median with IQR and as the population-weighted regional rate. Results: Twenty-one countries, including Spain and Portugal, participated, representing 693.6 million inhabitants. A total of 78,723 ICU beds were reported (country-level median 6.1 per 100,000, IQR 3.3–12.4; population-weighted rate 11.3), with public ICUs accounting for 51.6%. A total of 23,803 intensivists were identified (median 2.6 per 100,000, IQR 1.0–5.0), with five countries below 1 per 100,000. Nurse-to-patient ratios ranged from 1:1 to 1:7, and universal 24/7 intensivist coverage was reported in only a subset of countries. During the pandemic, ICU bed capacity rose 69%; among the 20 countries with data for both periods, physician involvement rose 32%, largely through redeployment of non-intensivists rather than growth of the certified workforce. Conclusions: Critical care capacity, workforce, and organization vary widely across Ibero-America, with many countries below high-income benchmarks and pandemic surges met largely through temporary redeployment. These findings provide the first coordinated regional benchmark to guide workforce development, standardized training, and organizational strengthening.