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Blanco P, Abdo-Cuza A, Palomares EA, Díaz CM, Gutiérrez VF. Ultrasonography and procedures in intensive care medicine. Med Intensiva 2023; 47:717-732. [PMID: 38035918 DOI: 10.1016/j.medine.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/20/2023] [Indexed: 12/02/2023]
Abstract
The use of point-of-care ultrasonography (POCUS) is not limited to the diagnosis and/or monitoring of critically ill patients. Further, ultrasound guidance is of paramount relevance to aid in successfully and safely performing several procedures in the intensive care unit (ICU). In this article, we review the role of POCUS as a procedural guidance in the ICU. Core procedures include, but are not limited to, vascular cannulation, pericardiocentesis, thoracentesis, paracentesis, aspiration of soft-tissue collections/arthrocentesis and lumbar puncture. With time, the procedures performed by intensivists may extend beyond the core competencies depicted in this review. Ultrasound guidance should be part of the intensivist's competencies, for which appropriate training should be achieved.
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Affiliation(s)
- Pablo Blanco
- High Dependency Unit, Hospital "Dr. Emilio Ferreyra", Necochea, Argentina.
| | | | | | - Cristina Martínez Díaz
- Intensive Care Unit, Hospital Universitario "Príncipe de Asturias Alcalá de Henares", Madrid, Spain
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Arias-Rivera S, Sánchez-Sánchez MM, Romero de-San-Pío E, Santana-Padilla YG, Juncos-Gozalo M, Via-Clavero G, Moro-Tejedor MN, Raurell-Torredà M, Andreu-Vázquez C. Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00060-5. [PMID: 38001020 DOI: 10.1016/j.enfie.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge. OBJECTIVES To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge. METHODOLOGY Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. VARIABLES pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. STATISTICS descriptive and multivariate analysis. RESULTS 254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge. CONCLUSIONS CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.
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Affiliation(s)
- S Arias-Rivera
- Investigación de Enfermería, Hospital Universitario de Getafe, Madrid, Spain
| | - M M Sánchez-Sánchez
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, Spain
| | - E Romero de-San-Pío
- Unidad de Cuidados Intensivos, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Y G Santana-Padilla
- Unidad de Cuidados Intensivos, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - M Juncos-Gozalo
- Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Via-Clavero
- Unidad de Cuidados Intensivos, Hospital Universitario de Bellvitge, Barcelona, Spain, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Grupo de Investigación en Enfermería (GRIN-IDIBELL), Barcelona, Spain
| | - M N Moro-Tejedor
- Unidad de Apoyo a la Investigación en Enfermería, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Escuela Universitaria de Enfermería de la Cruz Roja, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Raurell-Torredà
- Departamento de Enfermería Fundamental y Médico Quirúrgica, Universidad de Barcelona, Barcelona, Spain.
| | - C Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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Valls-Matarín J, Peradejordi-Torres RM, Del Cotillo-Fuente M. Dependency-related skin lesions in the prone critical patient. Incidence study. Enferm Clin (Engl Ed) 2023; 33:424-431. [PMID: 37898167 DOI: 10.1016/j.enfcle.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. METHOD Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. RESULTS Forty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 [61.8-71.3] vs. 64 [43-71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1-149.4] vs. 38.2 [18.8-57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01-1.05) and PVD (OR=8.9; 95%CI:1.3-58.9) as predisposing factors for developing DRSL. CONCLUSIONS There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.
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Affiliation(s)
- Josefa Valls-Matarín
- Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
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Pérez-Juan E, Maqueda-Palau M, Feliu-Roig C, Gómez-Arroyo JM, Sáez-Romero D, Ortiz-Monjo A. Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19. Enferm Intensiva (Engl Ed) 2023; 34:176-185. [PMID: 37248133 PMCID: PMC10201329 DOI: 10.1016/j.enfie.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/20/2022] [Indexed: 05/31/2023]
Abstract
The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.
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Affiliation(s)
- E Pérez-Juan
- Unidad de Cuidados Intensivos, Hospital Comarcal de Manacor, Manacor, Spain; Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain.
| | - M Maqueda-Palau
- Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain; Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Spain
| | | | | | - D Sáez-Romero
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
| | - A Ortiz-Monjo
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
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Martí-Hereu L, Navarra-Ventura G, Navas-Pérez AM, Férnandez-Gonzalo S, Pérez-López F, de Haro-López C, Gomà-Fernández G. Usage of immersive virtual reality as a relaxation method in an intensive care unit. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00048-4. [PMID: 37648599 DOI: 10.1016/j.enfie.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The usage of immersive virtual reality (iVR) in the context of an intensive care unit (ICU) is scarce. Our objective was to assess the feasibility of the usage of iVR in critical patients with or without mechanical ventilation (MV) and to determine the anxiety degree before and after each session. METHODS Analytical, descriptive, prospective, and cross-sectional research. Pilot test with 20 patients from a polyvalent ICU of a tertiary hospital. Adult patients were included, either connected or not to MV, watchful and calmed (RASS -1/+1) and without delirium (negative CAM-ICU). Oculus Go (Facebook Technologies, LLC) iVR glasses were the model used. The relaxation strategy consisted in the visualization of an experience of 15 min with scenes related to nature and fantasy, relaxing music with a plot. The sessions were individual, with the patient monitored in a fowler position or seated. The anxiety degree before and after each session was evaluated following a reduced version of the Spanish "Cuestionario de Ansiedad Estado-Rasgo (STAI-e)" and they were analysed using T samples coupled (statistical significance when p-value was <0.05). RESULTS Incorporation of 20 patients with an average age of 63.9 years old (60% men). A total of 34 sessions of iVR were conducted. 32% patients mechanically ventilated, 32% high-flow oxygen therapy, 36% other breathing supports. 80% of the sessions were completed without serious side effects. A significant decrease in the anxiety degree was observed after each iVR session: first session mean change -2.68 (SD = 2.75), p = 0.000; second session mean change -1.86 (SD = 1.57), p = 0.021; third session mean change -1.67 (SD = 1.63), p = 0.054. CONCLUSION The usage of iVR in the context of an ICU is feasible, even with patients mechanically ventilated. iVR reduces the anxiety degree in the critic patient, which suggests that "digital therapies" can be effective to improve the emotional state during their stay in the ICU.
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Affiliation(s)
- L Martí-Hereu
- Área de Críticos, Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, Spain.
| | | | - A M Navas-Pérez
- Área de Críticos, Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | | | - F Pérez-López
- Área de Metodología, Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - C de Haro-López
- Área de Críticos, Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - G Gomà-Fernández
- Área de Críticos, Consorcio Corporación Sanitaria Parc Taulí, I3PT, Fundación Parc Taulí, Sabadell, Barcelona, Spain
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Álvaro-Sánchez E. Nursing care in the postoperative period after Glenn surgery. A case report. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00047-2. [PMID: 37648600 DOI: 10.1016/j.enfie.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 09/01/2023]
Abstract
Glenn surgery is used as a palliative procedure in children with Hypoplastic Left Heart Syndrome (HLHS) and its objective is to partially redirect the systemic venous return. An individualized care plan is presented for a 7-month-old infant, admitted to the Pediatric Intensive Care Unit (PICU), after undergoing Glenn procedure. And is shown her evolution during admission. Marjorie Gordon's 11 functional health patterns are used for the nursing assessment, highlighting among the altered patterns, the nutritional-metabolic and the activity-exercise, due to their implication in hemodynamic changes derived from the surgery. Due to their association with the most common postoperative complications in this type of surgery, 8 diagnoses were prioritised according to NANDA-I taxonomy: risk for infection, excess fluid volume, risk for shock, risk for bleeding, risk for decreased cardiac output, impaired gas exchange, ineffective airway clearance and risk for ineffective cerebral tissue perfusion. In each of them, expected patient outcomes and nursing interventions, were selected using the NOC and NIC taxonomies, respectively. Outcome criteria scores showed a favourable evolution after 7 days from admission, only 3 of the diagnoses selected at the beginning remain active. The development and reassessment of the nursing care plan has made it possible to make an effective monitoring of patient's postoperative evolution and to standardize nursing care, ensuring safe and quality health care. The lack of similar case reports in available bibliography has prevented us from comparing actions, therefore it has been necessary to disclose these scientific articles to guarantee best evidence-based practice.
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Affiliation(s)
- Ester Álvaro-Sánchez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Reina Sofía, Córdoba, Spain.
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Santa Cruz Hernando AS, Nieves-Alonso JM, Mjertan A, Gutiérrez Martínez D, Planas Roca A. In-hospital cardiac arrest: Incidence, prognostic factors and results. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:373-380. [PMID: 36940853 DOI: 10.1016/j.redare.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/28/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA. PATIENTS AND METHODS Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year. RESULTS Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm. CONCLUSIONS These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.
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Affiliation(s)
- Alvar Santa Santa Cruz Hernando
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Clínico San Carlos, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Jesús Manuel Nieves-Alonso
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Amadea Mjertan
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Gutiérrez Martínez
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario Puerta de Hierro, Hospital Universitario de La Princesa, Madrid, Spain
| | - Antonio Planas Roca
- Servicio de Anestesiología y Reanimación, Jefe de Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
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Vergara C, Del Pozo P, Niklitschek J, Le Roy C. Nutritional support in the critical ill patient: Requirements, prescription and adherence. An Pediatr (Barc) 2023; 99:94-101. [PMID: 37537114 DOI: 10.1016/j.anpede.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/22/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION In critically ill patients, nutritional support is a challenge in terms of both estimating their requirements and ensuring adherence to the prescribed treatment. OBJECTIVE To assess the association between requirements, prescription and adherence to energy and protein supplementation based on the phase of disease in critically ill patients. SAMPLE AND METHODS We conducted a prospective, observational and analytical study in patients aged 0-18 years admitted to the paediatric intensive or intermediate care unit in 2020-2021. We collected data on demographic and anthropometric characteristics and the phase of disease (acute phase [AP] vs. non-acute phase [nAP]), in addition to prescribing (P) (indication of nutritional support), basal metabolic rate (BMR, Schofield equation), adherence to nutritional support (A) and protein requirements (R), and calculated the following ratios: P/BMR, P/R, A/BMR, A/R, and A/P. RESULTS The sample included 131 participants with a median age of 16 (4.5) months, of who 128 (97.7%) had comorbidities and 13 (9.9%) were in the AP. Comparing the phases of disease (AP vs. nAP), the median values for energy supplementation were P/BMR, 0.5 (IQR, 0.1-1.4) vs. 1.3 (IQR, 0.9-1.8) (P = 0.0054); A/BMR, 0.4 (IQR, 0-0.6) vs. 1.2 (IQR, 0.8-1.7) (P = 0.0005); A/P, 0.7 (IQR, 0-0.9) vs. 1 (IQR, 0.8-1) (P = 0.002), and for protein were P/R, 0.7 (IQR, 0-1.1) vs. 1.2 (0.9-1.6) (P = 0.0009); A/R 0.3 (IQR, 0-0.6) vs. 1.1 (IQR, 0.8-1.5) (P = 0.0002); A/P 0.7 (IQR, 0-1) vs. 1(IQR, 0.8-1) (P = 0.002). We found AP/nAP ratios greater than 110% for energy in the P/BMR (4 patients [30.8%]/72 patients [61%]; P = 0.007), A/BMR (3 [23%]/63 [53.4%]; P = 0.009) and A/P (1 [7%]/3 [2.5%]; P = 0.007). As for protein, more than 1.5 g/kg/day was prescribed in 3 patients (23.1%) in the AP and 71 (60.1%) in the nAP. We found adherence to the prescribed intake in 2 (15.4%) patients in the AP and 66 (56%) in the nAP. We found a correlation coefficient of 0.6 between the energy P/R and the protein P/R. Prescribed support was discontinued in 7 patients (53.8%) in the AP and 31 (26.3%) in the nAP (P = 0.002). CONCLUSIONS The proportion of adherence to prescribed nutritional support was high in patients in the nAP of the disease. Overfeeding was frequent, more so in the nAP. We identified difficulties in adhering to prescribed support, chief of which was the discontinuation of feeding.
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Affiliation(s)
- Camila Vergara
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Del Pozo
- Unidad Académica de Cuidados Intensivos Pediátricos, Departamento de Pediatría, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jessie Niklitschek
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Le Roy
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Pediatría y Cirugía Infantil, Campus Centro, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Alós Zaragozá L, Cobo Del Prado Ciurlizza I, Solis Albamonte P, Gandía Llopis J, Rosselló Chornet M, Romero García CS. The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:387-394. [PMID: 37553014 DOI: 10.1016/j.redare.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 11/27/2022] [Indexed: 08/10/2023]
Abstract
INTRODUCTION The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. OBJECTIVE To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. MATERIAL AND METHODS Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. RESULTS Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance» 75% (n=6) were discharged and 25% died (n=2), compared to the group with «bad compliance» where 53% (n=8) were discharged and 47% (n=7) died (Chi square test, p-value=0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission=14, IQR=10-16 and median days of admission=22, IQR=13-39, p-value=0.025). CONCLUSIONS Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
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Affiliation(s)
- L Alós Zaragozá
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - I Cobo Del Prado Ciurlizza
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Solis Albamonte
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J Gandía Llopis
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M Rosselló Chornet
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C S Romero García
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Narváez-Martínez MA, Henao-Castaño ÁM. Severity classification and influencing variables of the Postintensive Care Syndrome. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00042-3. [PMID: 37517880 DOI: 10.1016/j.enfie.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The study aims to characterise Postintensive Care Syndrome by classifying the severity of the disease and identifying the variables of influence in two highly complex intensive care units for adults in Colombia. METHODS A descriptive, cross-sectional, prospective study was carried out to characterise survivors of critical illness using the Healthy Aging Brain Care -Monitor in a sample of 135 patients. Postintensive Care Syndrome severity was classified using Gaussian Mixture Models for clustering, and the most influencing variables were identified through ordinal logistic regression. RESULTS Clustering based on Gaussian Mixture Models allowed the classification of Postintensive Care Syndrome severity into mild, moderate, and severe classes, with an Akaike Information Criterion of 308 and an area under the curve of 0.80, which indicates a good fit; Thus, the mild class was characterised by a score on the HABC-M Total scale ≤9; the moderate class for a HABC-M Total score ≥10 and ≤42 and the severe class for a HABC-M Total score ≥43. Regarding the most influencing variables, the probability of belonging to the moderate or severe classes was related to male sex (91%), APACHE II score (22.5%), age (13%), intensive care units days of stay (10.6%), the use of sedation, analgesia and neuromuscular blockers. CONCLUSION Intensive care units survivors were characterised using the Healthy Aging Brain Care-Monitor scale, which made it possible to classify Postintensive Care Syndrome through Gaussian Mixture Models clustering into mild, moderate, and severe and to identify variables that had the major influence on the presentation of Postintensive Care Syndrome.
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Affiliation(s)
- M A Narváez-Martínez
- Universidad Nacional de Colombia, Bogotá, Colombia; Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia.
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Armas-Navarro LP, Santana-Padilla YG, Mendoza-Segura L, Ramos-Díaz M, Santana-López BN, Alcaraz-Jiménez JA, Rico-Rodríguez J, Santana-Cabrera L. Dysphagia in intensive care, a real problem: analysis of risk factors. Enferm Intensiva (Engl Ed) 2023; 34:115-125. [PMID: 36935305 DOI: 10.1016/j.enfie.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/08/2022] [Indexed: 03/19/2023]
Abstract
AIMS To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.
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Affiliation(s)
- L P Armas-Navarro
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - Y G Santana-Padilla
- Area Quirúrgica del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - L Mendoza-Segura
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - M Ramos-Díaz
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - B N Santana-López
- Unidad de Medicina Intensiva del Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain
| | - J A Alcaraz-Jiménez
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - J Rico-Rodríguez
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - L Santana-Cabrera
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain.
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12
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Morán-Pozo C, Luna-Castaño P. Shift change handovers between nurses in Critical Care Units. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00012-5. [PMID: 36934076 DOI: 10.1016/j.enfie.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 03/18/2023]
Abstract
AIM To know the characteristics of the handover performed by nurses working in Critical Care Units in Spain. METHODS Descriptive and cross-sectional study, whose population was nurses working in Critical Care Units in Spain. An ad hoc questionnaire was used to explore the characteristics of the process, the training received, the information forgotten and the influence of this activity on patient care. The questionnaire was online and dissemination was done through social networks. The sample was selected by convenience. A descriptive analysis was performed according to the nature of the variables and comparison of groups through ANOVA with R software version 4.0.3 (R Project for Statistical Computing). RESULTS The sample was 420 nurses. Most of them answered that (79,5%) perform this activity in an individual way, from outgoing nurse to incoming nurse. Location varied according to the size of the unit (p<0,05). Interdisciplinary handover was rare (p<0.05). In the last month, with regard to the time of data collection, 29,5% had to contact the unit due to forgetting relevant information, using WhatsApp as the first channel to transmit this information. CONCLUSIONS There is a lack of standardization in the handoff between shifts, in terms of the physical space where it is done, tools to structure the information, participation of other professionals and the use of unofficial communication channels to contact for omitted information during the handover. Shift change was identified as a vital process to ensure continuity of care and patient safety, so further researchs are important for patients handoffs.
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Affiliation(s)
- C Morán-Pozo
- Responsable de Investigación de Enfermería, Hospital Central Cruz Roja, Madrid, Spain.
| | - P Luna-Castaño
- Supervisora de Investigación en Cuidados, Hospital Universitario La Paz, Madrid, Spain
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Mora-Boga R, Vázquez Muíños O, Pértega Díaz S, Meijide-Faílde RM, Rodríguez-Sotillo A, Ferreiro-Velasco ME, Salvador-de la Barrera S, Montoto-Marqués A. Prognostic value of early magnetic resonance imaging in the morbidity and mortality of traumatic spinal cord injury. Med Intensiva 2023; 47:157-164. [PMID: 36068148 DOI: 10.1016/j.medine.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). DESIGN Retrospective study. SETTING Third-level hospital, Spinal Cord Injury Unit and ICU. PATIENTS Individuals with acute TSCI between 2010 and 2019. INTERVENTION Analysis of MRI performed in the first 72 h. VARIABLES OF INTEREST Admission to ICU and mortality. RESULTS 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013). CONCLUSIONS The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Olalla Vázquez Muíños
- Unidad de Neurorradiología, Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Sonia Pértega Díaz
- Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Rosa María Meijide-Faílde
- Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
| | | | | | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidade de A Coruña (UDC), A Coruña, Spain
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14
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Lampreia-Raposo C, Rodrigues-Correia P, Caldeira-Berenguer S, Mascarenhas-Rabiais I, Madureira-Mendes M. Critical care nurses' emotional intelligence: A scoping review. Enferm Clin (Engl Ed) 2023; 33:68-71. [PMID: 35597426 DOI: 10.1016/j.enfcle.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/02/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Emotional intelligence is often described as the ability to know own emotions and to be aware of other emotions. The emotional intelligence of critical care nurses is a necessary competence for work performance. The aim of this review is to map the evidence on emotional intelligence of nurses working in this specific context. METHODS Scoping review based on Joanna Briggs Institute (JBI) guidance. Nurses as a population (P), critical care as a context (C) and emotional intelligence as a concept (C) were considered. Search was conducted using databases and electronic platforms such as CINAHL Complete, MEDLINE complete, Cochrane Central Register of Controlled Trials, Nursing & Allied Health Collection: Comprehensive (via EBSCOhost), MedLine (via PubMed), SCOPUS and Web of Science. From a total of 40 citations, nine articles have been included in the review. RESULTS The 9 articles emphasise the relevance of emotional intelligence in the professional experience, in emotional exhaustion and burnout prevention, in enhancing the safety culture of the sick, in contributing to organisational citizenship behaviour, and in resilience. CONCLUSION Emotional intelligence is a core competency of critical care nurses, with professional, personal and organisational implications.
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Affiliation(s)
- Cátia Lampreia-Raposo
- Enfermera del servicio de hospitalización de oncología médico-quirúrgica, Fundação Champalimaud, Máster en Enfermería en el área de especialización de enfermería médico-quirúrgica: persona en estado crítico, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, Portugal.
| | - Pedro Rodrigues-Correia
- Enfermera de Cuidados Intensivos y Recuperación, Fundação Champalimaud, Máster en Enfermería en el área de especialización de enfermería médico-quirúrgica: persona en estado crítico, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Silvia Caldeira-Berenguer
- Doctorado en enfermería, Máster en Bioética, Enfermera, Profesora adjunta visitante, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Isabel Mascarenhas-Rabiais
- Doctorado en enfermería, Máster en Ciencias de la Educación, Enfermera, Profesora Adjunta, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Manuela Madureira-Mendes
- Doctorado en enfermería, Máster en Cuidados Paliativos, Enfermera, Profesora Adjunta, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, Portugal
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Ródenas Monteagudo MÁ, Albero Roselló I, Del Mazo Carrasco Á, Carmona García P, Zarragoikoetxea Jauregui I. Update on the use of ultrasound in the diagnosis and monitoring of the critical patient. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:567-577. [PMID: 36253286 DOI: 10.1016/j.redare.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/07/2022] [Indexed: 06/16/2023]
Abstract
Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.
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Narváez-Martínez MA, Gómez Tovar LO, Henao-Castaño ÁM. Scales to measure post intensive care syndrome, a scoping review. Enferm Clin (Engl Ed) 2022; 32:440-450. [PMID: 36049644 DOI: 10.1016/j.enfcle.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/28/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Post Intensive Care Syndrome is a recently studied syndrome that affects between 50% and 70% of patients admitted to the ICU, its detection is complex due to the great variety of affected components. OBJECTIVE To determine the most widely used assessment instruments for the detection of post-intensive care syndrome, according to the evidence in the last 5 years. METHODOLOGY A scoping review was carried out in the databases: Academic Search, ScienceDirect, Scielo, Biblioteca Virtual en Salud, Medline, and Springer Link, with terms «Postintensive care syndrome» and «Post-intensive care syndrome». This review included 22 articles that met the criteria of: research or review typology, English, Spanish or Portuguese language, with access to the full text and published between 2015 and 2020. CONCLUSIONS Most of the instruments used to measure post-intensive care syndrome are divided according to the components of physical affectation (the Medical Research Council scale, the Katz index and the Barthel index); cognitive (Repeatable Battery for the Assessment of Neuropsychological Status, and the Montreal Cognitive Assessment test); and mental (Hospital Anxiety and Depression Scale, Beck's anxiety test, Depression Inventory Second Edition scale and Post Traumatic Stress Syndrome-14 scale). In addition, two tools were found that measure the event in its entirety with its three components, such as the Healthy Aging Brain Care Monitor and the Post-Intensive Care Syndrome Questionnaire.
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González-Pizarro P, Álvarez Bartolomé A, García Fernández J. Peripheral VA-ECMO left ventricular dysfunction: A combined biventricular assistance two case-report. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:583-586. [PMID: 36241508 DOI: 10.1016/j.redare.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/07/2021] [Indexed: 06/16/2023]
Abstract
We report 2 patients with cardiogenic shock that developed severe left ventricular dysfunction due to a non-opening aortic valve while on peripheral VA-ECMO (Veno-Arterial Extracorporeal Membrane Oxygenator). Patients were managed combining a LV (Left Ventricle) mechanical assist device, and central VA - ECMO to support the right ventricle, thus providing full circulatory and respiratory assistance. Patients were able to bridge to cardiac transplantation. We therefore recommend such combination in patients with severe LV dysfunction while on p-ECMO (peripheral ECMO) support.
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Affiliation(s)
- P González-Pizarro
- Servicio de Anestesiología, Cuidados Críticos y Dolor, Hospital Universitario La Paz, Madrid, Spain.
| | - A Álvarez Bartolomé
- Servicio de Anestesiología, Cuidados Críticos y Dolor, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J García Fernández
- Servicio de Anestesiología, Cuidados Críticos y Dolor, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma, Madrid, Spain
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18
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Acevedo-Nuevo M, Martín-Arribas MC, González-Gil MT, Solís-Muñoz M, Arias-Rivera S, Royuela-Vicente A. The use of mechanical restraint in critical care units: Characterisation, application standards and related factors. Results of a multicentre study. Enferm Intensiva (Engl Ed) 2022; 33:212-224. [PMID: 36369124 DOI: 10.1016/j.enfie.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement. METHOD Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals). RESULTS A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = -.431) and in the subgroup of patients with ETT (r = -.521). CONCLUSIONS Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.
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Affiliation(s)
- M Acevedo-Nuevo
- Organización Nacional de Trasplantes, Madrid, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain.
| | - M C Martín-Arribas
- Subdirección General de Investigación en Terapia Celular y Medicina Regenerativa, Instituto de Salud Carlos III, Madrid, Spain
| | - M T González-Gil
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - M Solís-Muñoz
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - S Arias-Rivera
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - A Royuela-Vicente
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Unidad de Bioestadística, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Pabón-Martínez BA, Rodríguez-Pulido LI, Henao-Castaño AM. The family in preventing delirium in the intensive care unit: Scoping review. Enferm Intensiva (Engl Ed) 2022; 33:33-43. [PMID: 35144905 DOI: 10.1016/j.enfie.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/26/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.
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Affiliation(s)
- B A Pabón-Martínez
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá D.C., Colombia.
| | | | - A M Henao-Castaño
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá D.C., Colombia
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Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future. An Pediatr (Barc) 2021; 95:485.e1-485.e10. [PMID: 34857500 DOI: 10.1016/j.anpede.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and therefore is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
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Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, Spain; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, Spain; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, Spain; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, Spain
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, Spain; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, Spain; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, Spain; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Raquerl Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, Spain
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21
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Vaquero-Roncero LM, Sánchez-Barrado E, Escobar-Macias D, Arribas-Pérez P, González de Castro R, González-Porras JR, Sánchez-Hernandez MV. C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:513-522. [PMID: 34743905 PMCID: PMC8568297 DOI: 10.1016/j.redare.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/20/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MATERIAL AND METHODS An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score. MEASUREMENTS AND MAIN RESULTS Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P = 0.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P < 0.0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P < 0.05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P > 0.05 vs AUC-ROC development). CONCLUSION Patients COVID-19 presenting at admission SOFA score ≥ 2 combined with CRP ≥ 9.1 mg/mL could be at high risk to require critical care.
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Affiliation(s)
- L M Vaquero-Roncero
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - E Sánchez-Barrado
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain.
| | - D Escobar-Macias
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - P Arribas-Pérez
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - R González de Castro
- Departamento de Anestesiología y Reanimación, Hospital Universitario de León, Universidad de León, León, Spain
| | - J R González-Porras
- Departamento de Hematología, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - M V Sánchez-Hernandez
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
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22
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2021; 45:470-476. [PMID: 34456175 DOI: 10.1016/j.medine.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/24/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, Spain
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
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23
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Taboada M, Baluja A, Park SH, Otero P, Gude C, Bolón A, Ferreiroa E, Tubio A, Cariñena A, Caruezo V, Alvarez J, Atanassoff PG. Complications during repeated tracheal intubation in the Intensive Care Unit. A prospective, observational study comparing the first intubation and the reintubation. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:384-391. [PMID: 34353767 DOI: 10.1016/j.redare.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/02/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND GOAL OF THE STUDY The goal of the study was to compare the incidence of complications, technical difficulty of intubation and physiologic pre-intubation status between the first intubation and reintubation performed on the same patient in an ICU. MATERIALS AND METHODS The study was approved by the ethics committee of Galicia (Santiago-Lugo, code No. 2015-012). Due to the observational, noninterventional, and noninvasive design of this study, the need for written consent was waived by the ethics committee of Galicia. Patients requiring tracheal intubation and reintubation in the ICU were included in this prospective observational study. Main endpoint was to compare the incidence of complications, physiologic pre-intubation status, and the rate of technical difficulty of intubation between the first intubation and reintubation performed on the same patient in an ICU. RESULTS AND DISCUSSION 504 patients were intubated in our ICU during the study period, and 82 (16%) required reintubation. There was no difference between the first intubation and reintubation regarding number of total complication (35% vs 33%; P = ,86), hypotension (24% vs 24%; P = 1), hypoxia (26% vs 26%; P = 1), esophageal intubation (1% vs 1%; P = 1), and bronchoaspiration (2% vs 1%; P = ,86). Physiologic pre-intubation status and technical difficulty of intubation did not differ between the first intubation and reintubation. CONCLUSIONS In our ICU patients requiring tracheal reintubation, incidence of complications, physiologic pre-intubation status, and technical difficulty of intubation did not differ between the first intubation and reintubation.
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Affiliation(s)
- M Taboada
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
| | - A Baluja
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - S H Park
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - P Otero
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - C Gude
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Bolón
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ferreiroa
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Tubio
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Cariñena
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - V Caruezo
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - J Alvarez
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. [Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00221-6. [PMID: 34304986 DOI: 10.1016/j.anpedi.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they would be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high-quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and, therefore, is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
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Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, España; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, España; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, España; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, España
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, España; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, España; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, España; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Raquel Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, España
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25
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González-Pizarro P, Álvarez Bartolomé A, García Fernández J. Peripheral VA-ECMO left ventricular dysfunction: A combined biventricular assistance two case-report. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00167-5. [PMID: 34187687 DOI: 10.1016/j.redar.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
We report 2patients with cardiogenic shock that developed severe left ventricular dysfunction due to a non-opening aortic valve while on peripheral VA-ECMO (Veno-Arterial Extracorporeal Membrane Oxygenator). Patients were managed combining a LV (Left Ventricle) mechanical assist device, and central VA - ECMO to support the right ventricle, thus providing full circulatory and respiratory assistance. Patients were able to bridge to cardiac transplantation. We therefore recommend such combination in patients with severe LV dysfunction while on p-ECMO (peripheral ECMO) support.
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Affiliation(s)
- P González-Pizarro
- Servicio de Anestesiología, Cuidados Críticos y Dolor. Hospital Universitario La Paz, Madrid, España.
| | - A Álvarez Bartolomé
- Servicio de Anestesiología, Cuidados Críticos y Dolor. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J García Fernández
- Servicio de Anestesiología, Cuidados Críticos y Dolor. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma, Madrid, España
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26
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Pabón-Martínez BA, Rodríguez-Pulido LI, Henao-Castaño AM. The family in preventing delirium in the intensive care unit: Scoping review. Enferm Intensiva (Engl Ed) 2021; 33:S1130-2399(21)00033-X. [PMID: 33888425 DOI: 10.1016/j.enfi.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/02/2021] [Accepted: 01/26/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.
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Affiliation(s)
- B A Pabón-Martínez
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá D.C., Colombia.
| | | | - A M Henao-Castaño
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá D.C., Colombia
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27
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Solla-Buceta M, González-Vílchez F, Almenar-Bonet L, Lambert-Rodríguez JL, Segovia-Cubero J, González-Costello J, Delgado JF, Pérez-Villa F, Crespo-Leiro MG, Rangel-Sousa D, Martínez-Sellés M, Rábago-Juan-Aracil G, De-la-Fuente-Galán L, Blasco-Peiró T, Hervás-Sotomayor D, Garrido-Bravo IP, Mirabet-Pérez S, Muñiz J, Barge-Caballero E. Infectious complications associated with short-term mechanical circulatory support in urgent heart transplant candidates. ACTA ACUST UNITED AC 2021; 75:141-149. [PMID: 33648882 DOI: 10.1016/j.rec.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Short-term mechanical circulatory support is frequently used as a bridge to heart transplant in Spain. The epidemiology and prognostic impact of infectious complications in these patients are unknown. METHODS Systematic description of the epidemiology of infectious complications and analysis of their prognostic impact in a multicenter, retrospective registry of patients treated with short-term mechanical devices as a bridge to urgent heart transplant from 2010 to 2015 in 16 Spanish hospitals. RESULTS We studied 249 patients, of which 87 (34.9%) had a total of 102 infections. The most frequent site was the respiratory tract (n=47; 46.1%). Microbiological confirmation was obtained in 78 (76.5%) episodes, with a total of 100 causative agents, showing a predominance of gram-negative bacteria (n=58, 58%). Compared with patients without infection, those with infectious complications showed higher mortality during the support period (25.3% vs 12.3%, P=.009) and a lower probability of receiving a transplant (73.6% vs 85.2%, P=.025). In-hospital posttransplant mortality was similar in the 2 groups (with infection: 28.3%; without infection: 23.4%; P=.471). CONCLUSIONS Patients supported with temporary devices as a bridge to heart transplant are exposed to a high risk of infectious complications, which are associated with higher mortality during the organ waiting period.
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Affiliation(s)
- Miguel Solla-Buceta
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | | | - Luis Almenar-Bonet
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Universitat de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José Luis Lambert-Rodríguez
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José González-Costello
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Fundación de Investigación I+12, Madrid, Spain; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Félix Pérez-Villa
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - María G Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Diego Rangel-Sousa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | | | | | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Iris P Garrido-Bravo
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Sonia Mirabet-Pérez
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Ciencias de la Salud, Universidade da Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
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Tejerina Álvarez EE, Gómez Mediavilla KA, Rodríguez Solís C, Valero González N, Lorente Balanza JÁ. Risk factors for readmission to ICU and analysis of intra-hospital mortality. Med Clin (Barc) 2021:S0025-7753(20)30883-6. [PMID: 33516522 DOI: 10.1016/j.medcli.2020.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Critical patients, despite initial recovery in the intensive care unit (ICU), may require readmission to the ICU or even die in the same hospital episode. The objectives are to determine the incidence and to identify risk factors for ICU readmission, and to determine hospital mortality. METHODS Observational cohort study of all patients admitted consecutively for more than 24hours to the ICU of the University Hospital of Getafe between April 1, 2018 and September 30, 2018 and discharged alive from their first ICU admission. RESULTS Of the 164 patients alive at ICU discharge, 14 (8.5%) were readmitted to ICU (2.4% at≤48hours). The adjusted risk of ICU readmission was higher in patients with disabling neurological deficits prior to ICU admission [odds ratio (OR) 7.96, 95% confidence interval (CI) 1.55-40.92] or who received vasoactive drugs (OR 5.07, 95% CI 1.41-18.29) during their ICU stay. Readmitted patients had higher hospital mortality (4 of 14 [29%] versus 5 of 150 [3%], P<.001) and longer hospital stay (74.5 [37.5-99.75] days versus 16 [9-34] days, median [interquartile range], P=.001). CONCLUSIONS Patients with disabling neurological deficits prior to hospital admission or who received vasoactive drugs during their ICU stay have a higher risk of readmission to the ICU, which increases hospital stay and mortality.
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Vaquero-Roncero LM, Sánchez-Barrado E, Escobar-Macias D, Arribas-Pérez P, González de Castro R, González-Porras JR, Sánchez-Hernandez MV. C-Reactive protein and SOFA scale: A simple score as early predictor of critical care requirement in patients with COVID-19 pneumonia in Spain. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(20)30327-3. [PMID: 34247837 PMCID: PMC7833846 DOI: 10.1016/j.redar.2020.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MATERIAL AND METHODS An approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score. MEASUREMENTS AND MAIN RESULTS Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P=.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P<.0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P<.05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P>0.05 vs AUC-ROC development). CONCLUSION Patients COVID-19 presenting at admission SOFA score ≥2 combined with CRP ≥9,1mg/mL could be at high risk to require critical care.
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Affiliation(s)
- L M Vaquero-Roncero
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, España
| | - E Sánchez-Barrado
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, España.
| | - D Escobar-Macias
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, España
| | - P Arribas-Pérez
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, España
| | - R González de Castro
- Departamento de Anestesiología y Reanimación, Hospital Universitario de León, Universidad de León, León, España
| | - J R González-Porras
- Departamento de Hematología, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, España
| | - M V Sánchez-Hernandez
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Salamanca-IBSAL, Departamento de Medicina, Universidad de Salamanca, Salamanca, España
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Nieves Alonso JM, Méndez Hernández RM, Ramasco Rueda F, Planas Roca A. Lung pulse visualized through pleural effusion as a diagnostic sign of complete obstructive atelectasis of the left lung in a critical patient with respiratory failure. ACTA ACUST UNITED AC 2020; 67:400-3. [PMID: 32616357 DOI: 10.1016/j.redar.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/23/2022]
Abstract
Complete obstructive atelectasis occurs when mucous or a foreign body obstruct one of the main bronchi. Several lung ultrasound signs have been associated with this entity. We describe the case of a patient admitted to the surgical critical care unit in whom lung ultrasound led to a diagnosis of complete obstructive atelectasis, and the presence of pleural effusion provided direct visualization of lung pulse, a sign that has only previously been described by interpreting ultrasound artifacts.
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López-Sánchez R, Jiménez-García E, Osorio-Álvarez S, Riestra-Rodríguez MR, Oltra-Rodríguez E, García-Pozo AM. Suitability of therapeutic effort in paediatric intensive care units: Opinion and attitude of professionals. Enferm Intensiva (Engl Ed) 2020; 31:184-191. [PMID: 32527609 DOI: 10.1016/j.enfi.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/06/2020] [Accepted: 02/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the opinion and describe the attitude of different health professionals on suitability of therapeutic effort. METHOD Multi-centre, cross-sectional observational study carried out with nurses and doctors who work in the paediatric intensive care units of four hospitals in the Madrid region. A self-administered questionnaire, previously piloted to assess its viability, was used and a sealed box was set up at the nursing station to hand it in. The analysis was performed using SPSS 21.0 software. RESULTS The 98.9% of the respondents were in favour of suitability of therapeutic effort. Doctors consider that the decision is made with the agreement of the multidisciplinary staff and the child's parents (48.8%). Of the nurses, 51.1% believe that the decision is made by agreement with the doctors and parents. Of the nurses, 65.5% state that they are never asked about decision-making for their patients. Of the doctors, 75% are always or almost always asked. Fifty-seven percent of the nurses and 83% of the doctors feel capable of making decisions about suitability of therapeutic effort. Of the professionals, 77.2% believe that suitability is used less often than required. CONCLUSIONS There are differences between doctors and nurses both in the perception of the decision-making model and in the way to proceed. Professionals seem not to follow any protocols or circuits in the decision-making process.
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Affiliation(s)
- R López-Sánchez
- Facultad de Enfermería de Gijón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Gijón, Asturias, España.
| | | | | | | | | | - A M García-Pozo
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
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Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Miguelena Hycka J, Claraco Vega LM, Gurpegui Puente M. Influence of frailty in the outcome of surgical patients over 70 years old with admission criteria in ICU. Cir Esp 2020; 99:41-48. [PMID: 32507310 DOI: 10.1016/j.ciresp.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Frailty degree can influence more than age or severity in the outcome of patients older than 70 years undergoing surgery of the digestive system that require immediate postoperative control in the ICU. METHODS A prospective and observational study of patients over 70 years of age who were admitted to the surgical ICU of a third level hospital immediately after an elective or emergent surgical intervention on the digestive system from June 1, 2018 until June 1, 2019. The variables age, frailty Clinical Frailty Scale (CFS), and modified Frailty Index (mFI), severity (APACHE II), type of surgery, surgical pathology were recorded upon admission. A bivariate analysis was performed to assess the influence of frailty and severity on hospital morbidity and mortality and baseline situation of the patient (in terms of dependence) at 6 months. RESULTS A total of 90 patients were recruited, 54.4% of whom were reoperated; 74.4% were initially discharged from the ICU, with 28.4% of readmission and directly associated to frailty (CFS and mFI: P<0.01). The overall mortality at 6 months was 44.5% being CFS (OR = 64.3; P<0.05, 95% CI: 12.3-333.9) and APACHE II (OR = 1.17; P<0.05; 95% CI: 1.04-1.32) the covariates that best related. CONCLUSIONS The estimation of frailty by CSF and mFI is directly associated to the surgical morbidity and readmission of elderly and severe patients admitted to the ICU. In addition, CFS and mFI has been efficient as a predictive of mortality at 6 months.
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2020; 45:S0210-5691(20)30114-5. [PMID: 32482371 DOI: 10.1016/j.medin.2020.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, España
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
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Andrade-Méndez B, Arias-Torres DO, Gómez-Tovar LO. Alarm Fatigue in the Intensive Care Unit: Relevance and Response Time. Enferm Intensiva (Engl Ed) 2020; 31:147-153. [PMID: 32349945 DOI: 10.1016/j.enfi.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/11/2019] [Accepted: 11/23/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To establish the presence of alarm fatigue, the clinical relevance of alarms and the stimulus-response time of the health team in an Adult Intensive Care Unit. METHOD Descriptive, quantitative, observational study, developed in the Multipurpose Adult Intensive Care Unit. Population made up of health personnel and the ICU teams. The method used was non-participant observation. Follow-up was carried out over 120 hours in three months. The variables studied were number of alarms activated, time elapsed between the alert sound of the blood pressure parameter, heart rate and oximetry and the response of the health personnel who attended the alarm. A descriptive statistical analysis was carried out. RESULTS 5,147 alarms were detected, on average 43 alarms / hour, of these 52.8% corresponded to multiparameter monitors and the rest to other equipment. Of those generated by multiparameter monitors, 37.3% were blood pressure, 33.4% oximetry and 29.3% heart rate. The clinical relevance was low in 42.7%, medium in 49.8% and high in 7.5%. The stimulus response time was between 0 and 60 seconds for 37% of the alarms; however, 42.5% had no response, which is why they are considered fatigued. A statistically significant relationship was found between the response time and the clinical relevance of the alarms (p = .000). CONCLUSIONS The presence of alarm fatigue was evident; with predominance of clinical relevance in the middle and low ranges. The health personnel responded within the time established for timely attention to the non-fatigued alarms.
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Affiliation(s)
- B Andrade-Méndez
- Enfermero, Especialista en cuidado crítico, Magister en Enfermería, Docente asociado del programa de Enfermería, Coordinador de la especialización en Enfermería en Cuidado Crítico, estudiante doctorado en ciencias de la salud. Universidad Surcolombiana, Huila, Colombia
| | - D O Arias-Torres
- Enfermera, Magister en Educación y Desarrollo Comunitario, Doctora en Ciencias de la Salud, Postdoctora / Estancia postdoctoral Universidade Federal do Estado do Rio de Janeiro. Docente titular, Coordinadora de Doctorado en Ciencias de la Salud, Coordinadora del grupo de investigación Cuidar. Universidad Surcolombiana, Huila, Colombia
| | - L O Gómez-Tovar
- Enfermera, Magister en Enfermería, Docente asociada del programa de Enfermería, Estudiante de doctorado en Enfermería. Universidad Surcolombiana, Huila, Colombia.
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Silva DDJN, Casimiro LGG, Oliveira MISD, Ferreira LBDC, Abelha FJPA. [The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes]. Rev Bras Anestesiol 2020; 70:3-8. [PMID: 32164996 DOI: 10.1016/j.bjan.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 10/15/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient. METHODS Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65-85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis. RESULTS The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012). CONCLUSION We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.
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Affiliation(s)
| | | | | | | | - Fernando José Pereira Alves Abelha
- Centro Hospitalar Universitário São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Departamento de Cirurgia e Fisiologia, Porto, Portugal.
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Garrido Casas J, Menéndez Llaneza C, Pico Gómez-Pavón P, Cal López MÁDL, Bozalongo S, Torrado Val E. Hospital care for adolescents with cancer in Spain: Needs, resources and organisational model. Enferm Clin (Engl Ed) 2019; 31:227-233. [PMID: 34243910 DOI: 10.1016/j.enfcle.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/21/2019] [Indexed: 11/17/2022]
Abstract
In Spain, adolescents with cancer are treated in Pediatric Onco-Hematology Units or in Adult Oncology Units. For this reason, the Spanish Federation of Parents of Children with Cancer carried out two surveys in 2013 and 2014 to know the differences in provision of psico-social services to the patients and their relatives among both types of Units. Twenty eight Pediatric and 18 Adult Units provided information. The results showed that the Pediatric Units were better adapted to the needs of the adolescent and family patients and to Spanish Health Authorities recommendations: more appropriate environment, resources for education and leisure, facilities to parents and relatives. Specialized Psycosocial care by psychologists and social workers is insufficient in both cases and the compliance with national and international recommendations is weak. However, specific adolescents' Units are starting to be created in Spain, following the experiences in other countries that define the new role of nurse as an essential linchpin in the care team.
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Affiliation(s)
| | | | | | | | - Silvia Bozalongo
- Asociación Riojana de Familiares y Amigos de Niños con Cáncer, Logroño, La Rioja, Spain
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Ruíz-González KJ, Pacheco-Pérez LA, García-Bencomo MI, Gutiérrez Diez MC, Guevara-Valtier MC. Mobbing perception among Intensive Care Unit nurses. Enferm Intensiva (Engl Ed) 2019; 31:113-119. [PMID: 31735507 DOI: 10.1016/j.enfi.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 11/30/2022]
Abstract
AIM to determine the perception of intensive care unit nursing staff on mobbing. METHOD qualitative approach study, Grounded Theory was used, 12intensive care unit nurses of 2public hospitals in our country during December 2017. RESULTS female sex predominated with an average age of 41.33 years old, mostly married, on night shift and trained a nursing technicians; 4categories emerged: general knowledge about mobbing, the origin of mobbing and its main actors, experiences of mobbing as a victim and as a spectator and the implications of mobbing in working life. DISCUSSION issues of workplace harassment are sensitive for most health workers, since they deal with private situations and lack of support from superiors when they have been victims of harassment. The evidence shows that one of the reasons why mobbing can be perceived in different ways is because little is known about the real concept, it can be associated with multiple forms of violence and there is heterogeneity in the use of the term. CONCLUSION the majority of intensive care unit nursing staff have been victims and witnesses of mobbing behaviour, with negative repercussions on their job satisfaction and performance; It is also the cause of constant staff turnover.
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Affiliation(s)
- K J Ruíz-González
- Supervisión de Enfermería, Hospital General Dr. Salvador Zubirán Anchondo, Chihuahua, México
| | - L A Pacheco-Pérez
- Departamento de Ciencias de la Salud, Universidad de Sonora, Ciudad Obregón, México.
| | - M I García-Bencomo
- Facultad de Contaduría y Administración, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - M C Gutiérrez Diez
- Facultad de Contaduría y Administración, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - M C Guevara-Valtier
- Facultad de Enfermería, Universidad Autónoma de Nuevo León, Monterrey, México
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Trevisan DD, Nazário-Aoki R, Wopereis-Groot MM, Aurélio-Boes M, de Souza Oliveira-Kumakura AR. Validation and applicability of instrument for documenting the nursing process in intensive care. Enferm Clin (Engl Ed) 2019; 30:4-15. [PMID: 31653601 DOI: 10.1016/j.enfcli.2019.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE to validate the content of an instrument for documenting the steps of the Nursing Process, using the standardized languages NANDA-I, NOC, and NIC (NNN), aiming at hospitalized patients in an Intensive Care Unit (ICU). METHOD A methodological research performed in three steps: design of the existing instrument from the systems NANDA-I, NOC and NIC; content validation by 13 judges, from a four-point Likert-type scale - items were evaluated as to their clarity and pertinence; applicability: judgement of the content regarding clarity, reading ease, and presentation for 40 critical-care nurses. The Content Validity Index (CVI) and the Kappa coefficient (k) was calculated to measure the proportion of relevance and clarity, was well as to verify the level of agreement between the experts in each item. RESULTS The instrument was considered clear and pertinent, with CVI above 0.8 in most items and overall Concordance Index (CI) of 0.90, showing a satisfactory level of agreement between judges. Regarding applicability, the instrument was deliberated clear, of easy reading, and with proper presentation by most critical-care nurses, being validated through 11 diagnoses with their respective results and nursing interventions. CONCLUSION The instrument showed to be valid and applicable for the group studied. It is expected that this study is able to contribute to the improvement of the Nursing Process in intensive care.
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Affiliation(s)
| | - Roberta Nazário-Aoki
- Unidad de Cuidados Intensivos, Clinics Hospital, Universidad de Campinas, Campinas, SP, Brasil
| | | | - Marcos Aurélio-Boes
- Unidad de Cuidados Intensivos, Clinics Hospital, Universidad de Campinas, Campinas, SP, Brasil
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Santana-Padilla YG, Santana-Cabrera L, Bernat-Adell MD, Linares-Pérez T, Alemán-González J, Acosta-Rodríguez RF. Training needs detected by nurses in an intensive care unit: a phenomenological study. Enferm Intensiva (Engl Ed) 2019; 30:181-191. [PMID: 31492569 DOI: 10.1016/j.enfi.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The competences of intensive care (ICU) nurses in their healthcare environment, have increased with the acquisition of new responsibilities associated with new care and devices for critical patients. Many studies suggest the need for specific training of nurses that work in these units. Based on this evidence, the European Federation of Critical Care Nurses Associations, recommends unifying the training of intensive care nurses. Therefore we set ourselves the following objective: to assess the training needs detected by ICU nurses through their experience and practical knowledge. METHOD Descriptive qualitative study, with a phenomenological approach, through semi-structured interview where the four areas (clinical practice, professional, management and educational) covered by the European Federation of Critical Care Nurses Associations were studied. Fifteen nurses from an adult polyvalent ICU were interviewed. RESULTS The interviewees acknowledged that the previous training was deficient for the care and support measures that they had to face. They considered that subsequent training and experience were decisive in order to carry out their work effectively. They also stated that support measures and care are topics to be developed continuously through targeted training. CONCLUSION The nurses in this research study acknowledged that training is needed to achieve the competences required in ICU, and these are affected by the type of unit and patients.
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Affiliation(s)
| | - L Santana-Cabrera
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | | | - T Linares-Pérez
- Centro de Salud Cueva Torres, Gerencia de Atención Primaria de Gran Canaria, Las Palmas de Gran Canaria, España
| | - J Alemán-González
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - R F Acosta-Rodríguez
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
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Garrido Casas J, Menéndez Llaneza C, Pico Gómez-Pavón P, de la Cal López MÁ, Bozalongo S, Torrado Val E. Hospital care for adolescents with cancer in Spain: Needs, resources and organisational model. Enferm Clin (Engl Ed) 2019; 31:S1130-8621(19)30288-8. [PMID: 31445823 DOI: 10.1016/j.enfcli.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/17/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022]
Abstract
In Spain, adolescents with cancer are treated in paediatric onco-haematology units or in adult oncologyunits. For this reason, the Spanish Federation of Parents of Children with Cancer carried out 2 surveys, one in 2013 and other in 2014, to determine the differences in provision of psycho-social services to the patients and their relatives between the 2 types of units. Twenty-eight paediatric and 18 adult units provided information. The results showed that the paediatric units were better adapted to the needs of the adolescent and family patients and to Spanish health authority recommendations: more appropriate environment, resources for education and leisure, facilities for parents and relatives. Specialised psycho-social care from psychologists and social workers is insufficient in both cases and the compliance with national and international recommendations is weak. However, specific units for adolescents are starting to be created in Spain, following the experiences in other countries that define the new role of the nurse as an essential linchpin in the care team.
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Affiliation(s)
| | | | | | | | - Silvia Bozalongo
- Asociación Riojana de Familiares y Amigos de Niños con Cáncer, Logroño, La Rioja, España
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Acevedo-Nuevo M, González-Gil MT, Solís-Muñoz M, Arias-Rivera S, Toraño-Olivera MJ, Carrasco Rodríguez-Rey LF, Velasco-Sanz TR, Martín Rivera BE, Carmona-Monge FJ, Rodríguez-Huerta MD, Lospitao-Gómez S, Martínez Álvarez A, García-González S, Láiz-Díez N. Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. Enferm Intensiva (Engl Ed) 2020; 31:19-34. [PMID: 31253585 DOI: 10.1016/j.enfi.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/06/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS thematic content analysis. Data saturation was achieved. RESULTS Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.
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Bernat Adell MD, Bisbal Andrés E, Galarza Barrachina L, Cebrián Graullera G, Pages Aznar G, Melgarejo Urendez A, Morán Marmaneu MA, Monfort Lázaro A, Ferrandiz Selles MD. Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patients. Med Intensiva 2020; 44:344-50. [PMID: 31178271 DOI: 10.1016/j.medin.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 12/27/2022]
Abstract
AIM A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients. DESIGN A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test-retest analysis. SETTING The Department of Intensive Care Medicine of a reference hospital. PARTICIPANTS Patients admitted between 23 February 2016 and 20 December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire. RESULTS Item relevance and definition yielded scores >3 (Likert scale maximum=4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was >0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors. CONCLUSIONS The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors.
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Taboada M, Soto-Jove R, Mirón P, Martínez S, Rey R, Ferreiroa E, Almeida X, Álvarez J, Baluja A. Evaluation of the laryngoscopy view using the modified Cormack-Lehane scale during tracheal intubation in an intensive care unit. A prospective observational study. ACTA ACUST UNITED AC 2019; 66:250-258. [PMID: 30862397 DOI: 10.1016/j.redar.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTVIES Tracheal intubation in the Intensive Care Unit is associated with a high incidence of difficult intubation and complications. This may be due to a poor view of the glottis during direct laryngoscopy. The aim of this study is to determine if there is a relationship between laryngoscopy view using the modified Cormack-Lehane scale with the incidence of difficult intubation and complications. METHODS All patients who were subjected to tracheal intubated with direct laryngoscopy in the Intensive Care Unit over a 45 month period were included in the study. In all patients, an evaluation was made of the laryngoscopy view using the modified Cormack-Lehane scale, as well as the technical difficulty (number of intubations at first attempt, operator-reported difficulty, need for a Frova introducer), and the incidence of complications (hypotension, hypoxia, oesophageal intubation). RESULTS A total of 360 patients were included. When the grade of the modified Cormack-Lehane scale was increased from 1 to 4, the incidence of first success rate intubation decreased (1: 97%, 2a: 94%, 2b: 80%, 3: 60%, 4: 0%, p<.001), the incidence of moderate and severe difficulty intubation increased (1: 2%, 2a: 4%, 2b: 36%, 3: 77%, 4: 100%, p<.001.), as well as the need for a Frova guide (1: 7%, 2a: 8%, 2b: 45%, 3: 60%, 4: 100%, p<.001). When the grade of the modified Cormack-Lehane scale increased from 1 to 4, the incidence of hypoxia<90% increased (1: 20%, 2a: 20%, 2b: 28%, 3: 47%, 4: 100%, p=.0073), as well as hypoxia<80% (1: 11%, 2a: 10%, 2b: 12%, 3: 27%, 4: 100%, p=.00398). No relationship was observed between the incidence of hypotension and the grade of the modified Cormack-Lehane scale (p=ns). CONCLUSIONS During tracheal intubation in the Intensive Care Unit a close relationship was found between a poor laryngoscopy view using the modified Cormack-Lehane scale and a higher difficulty technique of intubation. A relationship was found between the incidence of hypoxia with a higher grade in the modified Cormack-Lehane scale. No relationship was found between hypotension and the modified Cormack-Lehane scale.
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Affiliation(s)
- M Taboada
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España.
| | - R Soto-Jove
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - P Mirón
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - S Martínez
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - R Rey
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - E Ferreiroa
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - X Almeida
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - J Álvarez
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
| | - A Baluja
- Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España
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Batassini É, Beghetto MG. Constipation in a cohort prospective in adult critically ill patients: How much occurs and why? Enferm Intensiva (Engl Ed) 2018; 30:127-134. [PMID: 30553741 DOI: 10.1016/j.enfi.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the incidence and factors associated with constipation in adult critical care patients. DESIGN Prospective cohort study. SETTING Intensive care unit (ICU) of a high-complexity hospital from November 2015 to October 2016. PATIENTS Adults who were hospitalized for at least 72h in the ICU were followed from their admission to the ICU until their departure. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In the 157 patients followed up, the incidence of constipation was 75.8%. The univariate analysis showed that constipated patients were younger, used more sedation and showed more respiratory and postoperative causes for hospitalization, while non-constipated patients were hospitalized more for gastrointestinal reasons. The use of vasoactive substances, mechanical ventilation and haemodialysis was similar between the constipated and non-constipated patients. Multivariate analysis, days of use of docusate+bisacodyl (HR: .79; 95% CI: .65-.96) of omeprazole or ranitidine (HR: .80; 95%CI: .73-.88) and lactulose (HR: .87; 95%CI: .76-.99) were independent protection factors for constipation. CONCLUSION Constipation has a high incidence among adult critical care patients. Days of drug use acting on the digestive tract (lactulose, docusate+bisacodyl and omeprazole and/or ranitidine) are able to prevent this outcome.
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Affiliation(s)
- É Batassini
- Postgraduate Program in Nursing, Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil.
| | - M G Beghetto
- Postgraduate Program in Nursing, Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Gutiérrez-Cía I, Aibar-Remón C, Obón-Azuara B, Urbano-Gonzalo O, Moliner-Lahoz J, Gea-Velázquez de Castro MT, Aranaz-Andrés JM. [Critically ill patient isolation: risk or protection?]. J Healthc Qual Res 2018; 33:250-5. [PMID: 30401420 DOI: 10.1016/j.jhqr.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/20/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.
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López A, García B, Gómez A, González L, González N, Martín L, Jaime G. Concordance of the ions and GAP anion obtained by gasometry vs standard laboratory in critical care. Med Intensiva 2018; 43:521-527. [PMID: 30193741 DOI: 10.1016/j.medin.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the differences observed in ion and GAP anion determinations obtained by point-of-care (POC) blood gas versus laboratory biochemical testing, and to analyze the possible errors according to the limits of normality. MATERIAL AND METHODS A descriptive, cross-sectional retrospective study was made to assess concordance between two diagnostic tests in patients admitted to the Critical Care Unit of Ourense University Hospital Complex (Spain), between July and November 2015, involving at least one coinciding biochemical test and POC determination. Patients under 18years of age were excluded. RESULTS A total of 1,073 samples were analyzed. Lin's concordance correlation coefficients for sodium, potassium and chlorine were 0.87, 0.84 and 0.72, respectively. Kappa concordance of the normality limits for sodium, potassium and chlorine was 0.63, 0.74 and 0.32. The results indicated poor correlation of the anion GAP and null concordance between POC and biochemical testing, including the value corrected for albumin. CONCLUSIONS Poor concordance was observed between the ion values as determined by biochemistry and blood gases; the two methods are therefore not interchangeable. Kappa agreement with normality limits was good for sodium and potassium, and weak for chlorine. Possible validity was noted in orienting the classification within the ion limits, with the exception of chlorine. No agreement was recorded in relation to the anion GAP, even that corrected for albumin.
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Affiliation(s)
- A López
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España.
| | - B García
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Costa del Sol, Marbella, Málaga, España
| | - A Gómez
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - L González
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - N González
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - L Martín
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - G Jaime
- Servicio de Análisis Clínicos, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
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Rodríguez-Núñez C, Iglesias-Rodríguez A, Irigoien-Aguirre J, García-Corres M, Martín-Martínez M, Garrido-García R. Nursing records, prevention measures and incidence of pressure ulcers in an Intensive Care Unit. Enferm Intensiva (Engl Ed) 2018; 30:135-143. [PMID: 30190248 DOI: 10.1016/j.enfi.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/19/2018] [Accepted: 06/15/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this paper is to determine the incidence and most incident pressure ulcers (PU) category. Establish the main clinical characteristics of these PU. Determine whether there is adequate documentation of PU and of the measures used to prevent them. METHOD Observational descriptive and retrospective study during 2014 at Intensive Care Unit (ICU)-University Hospital of Araba. Study sample, all patients suffering from PU at the time of the study by accidental sampling. Computerised records regarding risk assessment, clinical assessment and pressure sore treatment, provided by the 'Metavision' computer programme and descriptive statistics using SPSS version 22.0. Approval from the Ethics Committee for Clinical Research of the University Hospital of Araba was obtained. RESULTS The incidence of patients suffering from PU during 2014 was 6.78%. The most common locations for PU were the sacral region and the heels: the most incident pressure ulcers category was grade II, followed by grade I. Out of the 98 PU treated in our patients, 43 occurred outside the ICU and 55 in the unit itself. The lack of records, in all the variables described about PU, was 19.10%. CONCLUSIONS The incidence of pressure ulcers was lower than in the current literature. The most frequent category, location and clinical characteristics are comparable to previous studies. There is a high rate of failing to record the characteristics of the PU declared. Good PU prevention measures and recording were carried out.
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Affiliation(s)
- C Rodríguez-Núñez
- Unidad de Cuidados Intensivos, Hospital Universitario de Araba-Sede Txagorritxu, Organización Sanitaria Integrada Araba, Vitoria-Gasteiz, España.
| | - A Iglesias-Rodríguez
- Unidad de Cuidados Intensivos, Hospital Universitario de Araba-Sede Txagorritxu, Organización Sanitaria Integrada Araba, Vitoria-Gasteiz, España
| | - J Irigoien-Aguirre
- Unidad de Cuidados Intensivos, Hospital Universitario de Araba-Sede Txagorritxu, Organización Sanitaria Integrada Araba, Vitoria-Gasteiz, España
| | - M García-Corres
- Unidad de Cuidados Intensivos, Hospital Universitario de Araba-Sede Txagorritxu, Organización Sanitaria Integrada Araba, Vitoria-Gasteiz, España
| | - M Martín-Martínez
- Unidad de Cuidados Intensivos, Hospital Universitario de Araba-Sede Txagorritxu, Organización Sanitaria Integrada Araba, Vitoria-Gasteiz, España
| | - R Garrido-García
- Unidad de Cuidados Intensivos, Hospital Universitario de Araba-Sede Txagorritxu, Organización Sanitaria Integrada Araba, Vitoria-Gasteiz, España
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Torre M, Santos Popper MC, Bergesio A. Burnout prevalence in intensive care nurses in Argentina. Enferm Intensiva (Engl Ed) 2018; 30:108-115. [PMID: 30060919 DOI: 10.1016/j.enfi.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/08/2018] [Accepted: 04/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Burnout syndrome among intensive care professionals has been widely documented internationally. Few studies address the incidence and prevalence in Latin America. And there are no validated studies about the situation in Argentina. Our goal was to determine burnout prevalence among intensive care nurses in Argentina and related risk factors. MATERIALS AND METHODS Online self-administered survey evaluating demographic variables and the Maslach Burnout Inventory in 486 critical care nurses between June and September 2016. RESULTS A percentage of 84.4 of participants show moderate or high levels of burnout syndrome (95% CI 80.8 to 87.4). No significant association was found between burnout and gender, age, years of practice, academic degree, role or multiplicity of jobs. There was no statistical difference in burnout prevalence among different types of populations of care (neonatal, paediatric or adult care). Nurse to patient ratios of 1:3 or higher was found to be a statistically significant risk factor for emotional exhaustion and depersonalization sub-scales (P=.002 and .0039, respectively). CONCLUSION More than 80% of nurses caring for critically ill patients in Argentina show moderate or high levels of burnout syndrome and this is related to a high nurse:patient ratio (1:3 or higher).
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Affiliation(s)
- M Torre
- Unidad de Cuidados Críticos, Hospital Dr. Emilio Ferreyra, Necochea, Buenos Aires, Argentina.
| | | | - A Bergesio
- Instituto de Matemática Aplicada, Universidad Nacional del Litoral, Santa Fe, Argentina
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Raurell-Torredà M, Argilaga-Molero E, Colomer-Plana M, Ródenas-Francisco A, Garcia-Olm M. Nurses' and physicians' knowledge and skills in non-invasive ventilation: Equipment and contextual influences. Enferm Intensiva (Engl Ed) 2018; 30:21-32. [PMID: 29954679 DOI: 10.1016/j.enfi.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences. METHOD Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]). RESULTS Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27±.5 vs 2.62±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P<.001). There were no differences between hospitals or units (P=.07 and P=.09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P=.6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment. CONCLUSIONS There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended.
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Affiliation(s)
- M Raurell-Torredà
- Escuela de Enfermería, Facultad Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.
| | - E Argilaga-Molero
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - M Colomer-Plana
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, España
| | | | - M Garcia-Olm
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, España
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Rodriguez-Calero MA, Barceló Llodrá E, Cruces Cuberos M, Blanco-Mavillard I, Pérez Axartell MA. Effectiveness of an evidence-based protocol for the control of stress-induced hyperglycaemia in critical care. Enferm Intensiva (Engl Ed) 2018; 30:4-12. [PMID: 29935968 DOI: 10.1016/j.enfi.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 11/17/2022]
Abstract
AIM To assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. METHOD Prospective "pre-post" quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140-180mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40mg/dl) and hyperglycaemia over 200mg/dl. RESULTS We analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24±13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p<.001). Only one case of severe hypoglycaemia was identified, which happened in the pre-intervention period. The rate of severe hyperglycaemia was lower in the post-intervention group (19.19 vs. 16.28 p=.001). CONCLUSIONS Our experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients.
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Affiliation(s)
- M A Rodriguez-Calero
- Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Mallorca, España.
| | - E Barceló Llodrá
- Área del Paciente Crítico, Hospital de Manacor, Manacor, Mallorca, España
| | - M Cruces Cuberos
- Unidad de Cuidados Intensivos, Hospital de Manacor, Manacor, Mallorca, España
| | - I Blanco-Mavillard
- Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Mallorca, España
| | - M A Pérez Axartell
- Unidad de Cuidados Intensivos, Hospital de Manacor, Manacor, Mallorca, España
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