We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
ECMO is a technique used in critical patients suffering from extremely serious respiratory and/or cardiovascular diseases where conventional life support is insufficient. The machine temporarily replaces lung or heart function, enabling the organs to rest while the underlying illness is treated.
The machine removes blood through a thick tube inserted into a major vein and transfers it to a centrifugal pump. The pump pushes it through an oxygenator, where oxygen is added and carbon dioxide removed. Subsequently, it is reintroduced into the patient’s body. If this is done through another vein, it is known as veno-venous (VV) ECMO and provides respiratory support. Where it is done via an artery, this is known as veno-arterial (VA) ECMO and provides support for both the heart and lungs.
ECMO is not a treatment per se but rather a support mechanism. It optimises organ recovery but does not resolve the underlying problem. In fact, one of the reasons to use the procedure is its reversibility for patients. The system is highly effective in replacing vital organ function. However, it is currently a last option for a specific patient group given its complex nature and associated risks, such as bleeding, thrombosis and infection.
Regardless of the support strategy chosen, this is a highly complex technique associated with a high risk of serious complications. That is why, in order to ensure excellent care, a well-organised programme is required, with optimal material and sufficient numbers of properly trained staff. Cases need to be clustered at leading centres and units with the necessary resources and material to ensure effectiveness, as well as a highly trained multidisciplinary team.
The Extracorporeal Life Support Organization (ELSO) is the benchmark international scientific association for ECMO. It establishes care and organisational guidelines, coordinates teaching activities and promotes research in the field. The organisation has a multi-centre database with information on over 200,000 patients. Although patients receive optimal care through ECMO with excellent survival rates, they often have later side effects due to the seriousness of their illness and the intense nature of their care, both during ECMO and with prior treatment.
Vall d’Hebron is home to two ECMO programmes. One is for adult patients and led by Dr Jordi Riera, and the other is for children and new-born patients, led by Dr Joan Balcells.
Our programmes follow ELSO guidelines at all levels, from lifelong, multidisciplinary and skill-based training for ECMO teams to filling in records for continuous assessment, as well as optimised protocols that align with our context and setting.
Our programmes take a long-term outlook, focused on getting patients back to their daily lives with maximum functional recovery. In this sense, we prioritise minimal deep sedation and safe early physical rehabilitation, even where recovery of the failed organ is still ongoing. ECMO support makes this possible by substituting heart and lung functions. Moreover, patients are able to directly interact with professionals and family members.
Veno-Arterial (VA) and Veno-Venous (VV):
The VA option provides heart and lung support by taking over organ functions. It is used when there is a cardiorespiratory problem, such as a heart attack or myocarditis (inflammation). The VV option is used to provide respiratory support and takes over lung function. It is used where there is a breathing issue, such as pneumonia or an acute blockage in the airways.
Peripheral or central line:
Patients are normally connected to an ECMO machine through cannulae (thick tubes) in the neck or groin. This is known as a peripheral line. At times, the machine needs to be directly connected to a patient’s heart or very close to the heart through the chest. This is known as a central line.
Special scenarios:
ECMO is an effective system but can pose major risks for patients. In terms of frequency and potential seriousness, these risks include bleeding and infection.
Bleeding is due to the fact that patients are often treated with blood thinners. Infection is due to receiving highly invasive therapy and the severity of the illness.
In order to minimise these risks, it is essential to have a properly trained multidisciplinary ECMO team, cluster ECMO cases and resources, and ensure robust records comparable to other consolidated external records.
Our mission is to restore the health of all critical or potentially critical hospital patients using advanced monitoring and support systems. Our work with patients is carried out both within the Intensive Care Unit and outside it, 24 hours a day, every day of the year. We have the knowledge and technical means to treat the most complex patients.
The Intensive Care Unit (ICU) treats 1,200 of the most complex critical patients every year. Additionally, the Department supports other serious patients not in the ICU but who require assessment from specialists in intensive care medicine.
The Intensive Care Medicine Department leads many hospital programmes, such as: Code Sepsis, care for cardiorespiratory disease and the ECMO programme, and collaborates actively in the Organ Donation and Transplant Programme.
Intensive care medicine is the speciality that cares for critically-ill patients, those who are in a life-threatening condition and who are susceptible to recovery. This provides us with a wide-ranging perspective of all kinds of patients and pathologies and makes us one of the most cross-cutting specialities in our current health system. In addition to the General Hospital's Intensive Care Unit, the Intensive Care Medicine Teaching Unit includes the Traumatology ICU, the Cardiac Surgery Post-operative Unit and the General and Traumatology Semi-critical areas.
Our Intensive Care Medicine is a leading service for pathologies such as lung transplants, ECMO, neurocritical care, spinal cord injuries, oncohematology patients, burns and pregnancies, among others. This differentiates us from other centres, as we have access to nearly all critical pathologies, and are consequently able to provide excellent training.
Intensive Care Training Itinerary
The intensive care medicine resident doctors undertake training in various areas: emergencies, medical specialities, surgery and, mainly, high-acuity areas, such as the General Intensive Care Unit and the Traumatology and Burns.
Its caring activities are characterised by a constant presence in high-acuity areas, as well as hospital duty shifts throughout the residency. Residents are therefore familiarised with intensive care medicine and acquire the ability to address the problems of critical patients and carry out necessary therapies from the first day of their residencies. They learn the basics of haemodynamics, mechanical ventilation, extracorporeal treatment, the pharmacological management of vasoactive drugs and antibiotics, among other things. Furthermore, they are an essential part of the cardiorespiratory arrest emergency and care team.
The acquisition of the speciality's specific skills is complemented by training in cross-cutting abilities, such as communication, teamwork and leadership, which allows residents to progressively acquire autonomy, always under the supervision of the appropriate specialists.
We are a teaching unit with various research groups, including the Respiratory Pathology, Sepsis, Haemodynamics, Infections, Neurocritical Patients, Renal Medicine, Polytrauma and Burns Group. In the Vall d'Hebron Research Institute (VHIR), we are represented by the SODIR (Shock, Organic Dysfunction and Resuscitation) Group, which is very active in a wide range of projects and clinical trials. Furthermore, we are part of the UNINN (Neurotraumatology and Neurosurgery Research Unit) and with the Plastic Surgery and Burns group, which are worldwide pioneers in achieving the first full-face transplant and the treatment of burns with enzymatic debridement.
The Department promotes and facilitates the presentation of communications in congresses concerning the speciality and the drafting of articles for the sector's most influential journals, activities which lay the foundations for developing the doctoral theses of their members.
The Hospital Radiophysics Teaching Unit is made up of hospital radiophysics specialists and senior technicians specialising in radiotherapy and/or radiodiagnosis.
Itinerario formativo en Radiofísica hospitalaria
The Medical Physics and Radiation Protection Department was accredited as a teaching unit in 1995 and is one of the first to receive accreditation in Spain. Some of our former residents now hold important positions in hospitals throughout Spain. Being part of Catalonia’s biggest hospital, with a technology park that is updated constantly, allows us to offer state-of-the-art training in all the areas of the speciality: radiotherapy, nuclear medicine, radiodiagnosis, and radiation protection in healthcare. It is unique, thanks to its extensive experience in advanced radiation oncology techniques in adult and paediatric patients, along with the scope of the radiation protection operations it carries out within the hospital, in both clinical and research facilities. The department has a laboratory where the hospital’s radiation detectors can be calibrated.
Additionally, the Vall d'Hebron Campus offers the possibility of actively participating in national and international research projects and clinical trials linked to its two research institutions, the Vall d'Hebron Institute of Oncology and the Vall d'Hebron Research Institute.
Why specialise at Vall d’Hebron?
The Urology Teaching Unit is led by the Vall d’Hebron Urology Department, with participation from other specialisations such as General Surgery, Nephrology, Intensive Care Medicine, and Paediatric Urology.
Urology training itinerary
Urology deals with the study, diagnosis and treatment of medical-surgical conditions associated with the urinary and retroperitoneal system of both sexes. It also includes the male reproductive system of any age group, that may have congenital, metabolic, obstructive or oncological disorders, or injuries due to trauma.
Sepsis is a potentially fatal condition that occurs when the body responds to an infection and attacks its own tissue and organs. On some occasions it produces organic dysfunction (for example, hypertension), which produces an anomalous response to infection and translates into a very serious medical condition.
Septic shock occurs when abnormalities in the circulation, cells or metabolism are so severe that they increase the risk of mortality. This can be identified by persistent hypertension that requires vasopressors to maintain arterial pressure and serum lactate levels. With these criteria, and even with the necessary volume replenishment, hospital mortality rates are over 40%.
Sepsis arises from an infection which changes the body and unleashes signs that may be associated with organic dysfunction or systemic hypoperfusion. These symptoms are:
Every year there are on average 212.7 sepsis patients for every 100,000 citizens in the Catalan healthcare system. To be precise, between 2008 and 2012, 82,300 people were diagnosed with severe sepsis and in 2012 there were 20,228 recorded cases.
At Vall d’Hebron, 232 patients were admitted to Intensive Care with this condition in 2010, amounting to 25.2% of all admissions to this department.
The following diagnostic tests are used for sepsis:
Early treatment can improve prognosis. Sepsis Coding is used for this reason:
To prevent this condition, early detection of patients with a history suggestive of infection and organic dysfunction is vital. In some cases, vaccination is necessary.
Intensive Care Medicine, General Hospital
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