<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902025000301201</article-id>
<article-id pub-id-type="doi">10.29193/rmu.41.3.1</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Herramientas para la detección de necesidades paliativas en el paciente crítico]]></article-title>
<article-title xml:lang="en"><![CDATA[Assessment methods for palliative care needs in critically ill patients]]></article-title>
<article-title xml:lang="pt"><![CDATA[Ferramentas para a detecção de necessidades paliativas em pacientes críticos]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Canale]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Broli]]></surname>
<given-names><![CDATA[Fabiana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Mirtha]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Queirolo]]></surname>
<given-names><![CDATA[Claudia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fernández]]></surname>
<given-names><![CDATA[Claudia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Benedetti]]></surname>
<given-names><![CDATA[María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Castroman]]></surname>
<given-names><![CDATA[Cecilia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Noveri]]></surname>
<given-names><![CDATA[Sylvia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Pasteur  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Maciel  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>41</volume>
<numero>3</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902025000301201&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902025000301201&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902025000301201&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: Un enfoque paliativo es esencial para una atención integral de calidad en la Unidad de Cuidados intensivos (UCI). Las terapéuticas fútiles y no alineadas a preferencias del paciente o su familia han aumentado significativamente en los últimos 30 días de vida.  Objetivos: Identificar pacientes con necesidades paliativas en una UCI, sus características epidemiológicas, evolución al alta de la UCI y a un año del alta hospitalaria.  Metodología: Estudio prospectivo, descriptivo y longitudinal, realizado en una UCI polivalente de adultos durante un periodo de tres meses. Se utilizaron dos herramientas: 1) &#8220;triggers&#8221; críticos: Asistencia Ventilatoria Mecánica Invasiva (AVMI)&gt; 5 días, estadía en UCI &gt; 7 días, disfunción multiorgánica (DOM)&gt; a 3, entre otros); y 2) la herramienta NecPal (Necesidades de Cuidados Paliativos), CCOMS-ICO 3.1 (2017). Se realizó seguimiento telefónico hasta un año posterior al alta hospitalaria. Se aplicó análisis estadístico a variables cualitativas y cuantitativas, con significación estadística establecida p &lt; 0,05.  Resultados: Ingresaron 273 pacientes, de los cuales 118 fueron identificados con necesidades paliativas mediante ambas herramientas. Al alta, 88 pacientes (74,5 %) mantuvieron la necesidad paliativa NECPAL (+), mientras que 30 (25,4 %) fueron clasificados como NecPal (&#8722;). Al comparar ambos grupos, NecPal (+) vs. (&#8722;), no se observaron diferencias significativas en score APACHE II, el uso de AVMI ni en la presencia de DOM. Sin embargo, el grupo NecPal (+) fue de mayor edad (65 vs. 35 años; p= 0,00), tuvo mayor estadía en cuidados moderados (23,7 vs. 13,2 días; p &lt; 0,007), mayor frecuencia de limitación terapéutica (40 % vs. 0 %; p=0,00), y mayor mortalidad en UCI (28 % vs. 7 %; p = 0,001) y hospitalaria (44 % vs. 10 %; p = 0,002). La mortalidad al año entre los sobrevivientes fue del 39 %, con un alto índice de reingresos.  Conclusiones: Uno de cada tres pacientes presentó necesidades paliativas. Los disparadores clínicos y la herramienta NecPal permitieron una detección precoz y adecuada. Estos pacientes se caracterizaron por mayor edad, estadías hospitalarias prolongadas, alto uso de recursos y elevada mortalidad tanto intrahospitalaria como al año del alta.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: a palliative approach is essential for comprehensive, high-quality care in the Intensive Care Unit (ICU). The use of futile treatments and interventions misaligned with patient or family preferences has increased significantly during the last 30 days of life.  Objectives To identify patients with palliative care needs in an ICU, describe their epidemiological characteristics, and evaluate their outcomes at ICU discharge and one year after hospital discharge.  Methods: a prospective, descriptive, longitudinal study was conducted in an adult general ICU over a three-month period. Two assessment tools were used: (1) clinical triggers such as invasive mechanical ventilation (IMV) &gt; 5 days, ICU stay &gt; 7 days, and multiorgan dysfunction (MOD) &gt; 3, among others; and (2) the NecPal tool (Palliative Care Needs), CCOMS-ICO version 3.1 (2017). Follow-up was conducted by telephone up to one year after hospital discharge. Statistical analysis was performed on qualitative and quantitative variables, with statistical significance set at p &lt; 0.05.  Results: a total of 273 patients were admitted, of whom 118 were identified as having palliative care needs using both tools. At discharge, 88 patients (74.5%) remained NecPal-positive, while 30 (25.4%) were classified as NecPal-negative. When comparing both groups (NecPal [+] vs. [&#8722;]), no significant differences were found in APACHE II scores, use of IMV, or presence of MOD. However, the NecPal (+) group was older (65 vs. 35 years; p = 0.00), had longer stays in intermediate care (23.7 vs. 13.2 days; p &lt; 0.007), a higher frequency of treatment limitation decisions (40% vs. 0%; p = 0.00), and higher ICU mortality (28% vs. 7%; p = 0.001) and in-hospital mortality (44% vs. 10%; p = 0.002). One-year mortality among survivors was 39%, with a high readmission rate.  Conclusions: One in three patients presented palliative care needs. The use of clinical triggers and the NecPal tool allowed for early and appropriate identification. These patients were characterized by older age, prolonged hospital stays, high resource utilization, and elevated in-hospital and one-year mortality.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução: uma abordagem paliativa é essencial para um cuidado integral e de qualidade na Unidade de Terapia Intensiva (UTI). O uso de terapêuticas fúteis e não alinhadas às preferências do paciente ou da família aumentou significativamente nos últimos 30 dias de vida.  Objetivos: Identificar pacientes com necessidades de cuidados paliativos em uma UTI, descrever suas características epidemiológicas e avaliar sua evolução na alta da UTI e após um ano da alta hospitalar.  Metodologia: Estudo prospectivo, descritivo e longitudinal, realizado em uma UTI geral de adultos durante um período de três meses. Foram utilizadas duas ferramentas: (1) triggers clínicos, como ventilação mecânica invasiva (VMI) &gt; 5 dias, permanência na UTI &gt; 7 dias, e disfunção orgânica múltipla (DOM) &gt; 3, entre outros; e (2) a ferramenta NecPal (Necessidades de Cuidados Paliativos), CCOMS-ICO versão 3.1 (2017). O seguimento foi realizado por contato telefônico até um ano após a alta hospitalar. As variáveis qualitativas e quantitativas foram analisadas estatisticamente, considerando-se significância quando p &lt; 0,05.  Resultados: Foram admitidos 273 pacientes, dos quais 118 foram identificados com necessidades paliativas por ambas as ferramentas. Na alta, 88 pacientes (74,5%) mantiveram a condição NecPal positiva, enquanto 30 (25,4%) foram classificados como NecPal negativos. Ao comparar os grupos (NecPal [+] vs. [&#8722;]), não houve diferenças significativas nos escores APACHE II, uso de VMI ou presença de DOM. Entretanto, o grupo NecPal (+) era mais idoso (65 vs. 35 anos; p = 0,00), apresentou maior tempo de permanência em cuidados intermediários (23,7 vs. 13,2 dias; p &lt; 0,007), maior frequência de limitação terapêutica (40% vs. 0%; p = 0,00), e maior mortalidade na UTI (28% vs. 7%; p = 0,001) e hospitalar (44% vs. 10%; p = 0,002). A mortalidade em um ano entre os sobreviventes foi de 39%, com alta taxa de reinternações.  Conclusões: Um em cada três pacientes apresentou necessidades de cuidados paliativos. O uso de triggers clínicos e da ferramenta NecPal permitiu uma identificação precoce e adequada. Esses pacientes se caracterizaram por idade avançada, longa permanência hospitalar, alto consumo de recursos e elevada mortalidade intra-hospitalar e após um ano da alta.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Paciente crítico]]></kwd>
<kwd lng="es"><![CDATA[Necesidades paliativas]]></kwd>
<kwd lng="es"><![CDATA[NeCPal]]></kwd>
<kwd lng="es"><![CDATA[UCI]]></kwd>
<kwd lng="en"><![CDATA[Critically ill patient]]></kwd>
<kwd lng="en"><![CDATA[Palliative care needs]]></kwd>
<kwd lng="en"><![CDATA[NeCPal]]></kwd>
<kwd lng="en"><![CDATA[ICU]]></kwd>
<kwd lng="pt"><![CDATA[Paciente crítico]]></kwd>
<kwd lng="pt"><![CDATA[Necessidades paliativas]]></kwd>
<kwd lng="pt"><![CDATA[NeCPal]]></kwd>
<kwd lng="pt"><![CDATA[UTI]]></kwd>
</kwd-group>
</article-meta>
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