The degree and direction of change in ICU patients' HRQOL 1 year after discharge depends considerably on diagnostic category. Proxy responses can be reliably used with the EQ-5D when measuring change in HRQOL.

IntroductionWe investigated the potential benefits of early tracheotomy performed before day eight of mechanical ventilation (MV) compared with late tracheotomy (from day 14 if it still indicated) in reducing mortality, days of MV, days of sedation and ICU length of stay (LOS).MethodsRandomized controlled trial (RCT) including all-consecutive ICU admitted patients requiring seven or more days of MV. Between days five to seven of MV, before randomization, the attending physician (AP) was consulted about the expected duration of MV and acceptance of tracheotomy according to randomization. Only accepted patients received tracheotomy as result of randomization. An intention to treat analysis was performed including patients accepted for the AP and those rejected without exclusion criteria.ResultsA total of 489 patients were included in the RCT. Of 245 patients randomized to the early group, the procedure was performed for 167 patients (68.2%) whereas in the 244 patients randomized to the late group was performed for 135 patients (55.3%) (P <0.004). Mortality at day 90 was similar in both groups (25.7% versus 29.9%), but duration of sedation was shorter in the early tracheotomy group median 11 days (range 2 to 92) days compared to 14 days (range 0 to 79) in the late group (P <0.02). The AP accepted the protocol of randomization in 205 cases (42%), 101 were included in early group and 104 in the late group. In these subgroup of patients (per-protocol analysis) no differences existed in mortality at day 90 between the two groups, but the early group had more ventilator-free days, less duration of sedation and less LOS, than the late group.ConclusionsThis study shows that early tracheotomy reduces the days of sedation in patients undergoing MV, but was underpowered to prove any other benefit. In those patients selected by their attending physicians as potential candidates for a tracheotomy, an early procedure can lessen the days of MV, the days of sedation and LOS. However, the imprecision of physicians to select patients who will require prolonged MV challenges the potential benefits of early tracheotomy.Trial registrationControlled-Trials.com ISRCTN22208087. Registered 27 March 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0585-y) contains supplementary material, which is available to authorized users.

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The PHS of critically ill patients varied according to admission category. Given the instruments used and population studied, there was no association between PHS and hospital outcome.

Institut Pla Marcell (Cardedeu) L'ensenyament de les matemàtiques implica l'adquisició d'habilitats de planificació matemàtica i la capacitat d'identificar les matemàtiques en els contexts. En aquest sentit, l'Aprenentatge Basat en Projectes és una oportunitat perquè les matemàtiques recuperin aquest paper de motor. En aquest article es descriuen quatre propostes didàctiques al voltant de diverses temàtiques (superfícies i volums, construcció de formes geomètriques, Teorema de Thales, Estadística, Diagrames de Voronoi) en connexió amb diversos contextos del món real que fan rellevant el procés d'aprenentatge de les matemàtiques (disseny d'envasos, distribució de serveis municipals, efectes cinematogràfics, creació de formes artístiques). Es discuteix l'aportació d'aquest tipus d'activitats i es proporcionen orientacions per al seu desenvolupament.