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Rodríguez-García R, González-Lamuño L, Santullano M, Martín-Carro B, Fernández-Martín JL, Cienfuegos Basanta MDC, Forcelledo L, Palomo Antequera C. Clinical features and disease progression of elderly patients at the ICU setting. Med Intensiva 2024; 48:254-262. [PMID: 38519374 DOI: 10.1016/j.medine.2024.02.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/28/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To describe and characterize a cohort of octogenarian patients admitted to the ICU of the University Central Hospital of Asturias (HUCA). DESIGN Retrospective, observational and descriptive study of 14 months' duration. SETTING Cardiac and Medical intensive care units (ICU) of the HUCA (Oviedo). PARTICIPANTS Patients over 80 years old who were admitted to the ICU for more than 24 h. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Age, sex, comorbidity, functional dependence, treatment, complications, evolution, mortality. RESULTS The most frequent reasons for admission were cardiac surgery and pneumonia. The average admission stay was significantly longer in patients under 85 years of age (p = 0,037). 84,3% of the latter benefited from invasive mechanical ventilation compared to 46,2% of older patients (p = <0,001). Patients over 85 years of age presented greater fragility. Admission for cardiac surgery was associated with a lower risk of mortality (HR = 0,18; 95% CI (0,062-0,527; p = 0,002). CONCLUSIONS The results have shown an association between the reason for admission to the ICU and the risk of mortality in octogenarian patients. Cardiac surgery was associated with a better prognosis compared to medical pathology, where pneumonia was associated with a higher risk of mortality. Furthermore, a significant positive association was observed between age and frailty.
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Affiliation(s)
- Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | | | | | - Beatriz Martín-Carro
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Enfermedad renal), Instituto de Salud Carlos III, Oviedo, Spain
| | - Jose Luis Fernández-Martín
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Enfermedad renal), Instituto de Salud Carlos III, Oviedo, Spain
| | | | - Lorena Forcelledo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen Palomo Antequera
- Universidad de Oviedo, Oviedo, Spain; Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
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Vila-Vidal M, Estruga-Asbert A, Jam-Gatell R. Use of an assessment system for the allocation of human resources in the intrahospital transport of the patient admitted to an intensive care unit. Enferm Intensiva (Engl Ed) 2024:S2529-9840(24)00018-1. [PMID: 38679521 DOI: 10.1016/j.enfie.2024.02.001] [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: 07/01/2023] [Accepted: 02/01/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Currently, in intensive care units (ICUs), the in-hospital transport (HIT) of patients is carried out without a unified criterion of personnel necessary for it. OBJECTIVE To evaluate the concordance of the Patient Assessment System for Transport-ICU (PAST-ICU) with the medical criteria (CM) to determine the Human Resources (HR) and identify Adverse Effects (AE). METHODS Descriptive, cross-sectional and prospective study of the IHT of patients admitted to an area of adult medical-surgical critical patients. The PAST-ICU instrument was created to recommend the HR of HIT. Through the assessment of clinical parameters, the Past-ICU indicates whether the HIT should be performed with (1) a stretcher-bearer (2) Stretcher-bearer/nurse or (3) stretcher-bearer/nurse/doctor. AE were recorded during the hospital transfer. Prior to the IHT, the nurse performed the PAST-ICU and the result was contrasted with the Medical Criteria (MC) responsible for the patient, the latter prevailing. STUDY PERIOD Phase 1: pilot test 2013-2014. Phase 2: 2015-2021. VARIABLES Reason and duration HIT, PAST-ICU sheet, checklist, AE. RESULTS Phase 1: 458 IHT were analyzed. The concordance index between the PAST-ICU and the MC was 84,9% (389 IHT). The Cohen Kappa of 58,5% and p < 0,001. There were a total of 16 AE. Phase 2: 3423 IHT. The Concordance index of 87,2% (2984 TIH). The Cohen Kappa of 63%and the P < 0,001. Registered 49 AE. CONCLUSION The PAST-ICU could be a useful, safe and reliable tool to adapt the necessary HR. There was good concordance between the PAST-ICU vs the MC to determine the HR in the HIT. The percentage of AE was low.
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Affiliation(s)
- M Vila-Vidal
- Área de Críticos, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, Spain
| | - A Estruga-Asbert
- Área de Críticos, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, Spain.
| | - R Jam-Gatell
- Área de Críticos, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, Spain
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Albarracin Duarte JA, Chaparro Hernández J, Rojas Aceros JA, Valoyes Gélvez JE, Ascuntar J, Jaimes F. Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00062-3. [PMID: 38588770 DOI: 10.1016/j.redare.2024.04.001] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/07/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality. DESIGN Prospective cohort study between June 2019 and March 2020. SETTING Hospital Universitario San Vicente Fundación, Colombia. PATIENTS Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Symptoms and signs associated with infection, with their time of evolution, specified in the study. RESULTS From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04-3.7), respiratory rate (OR 1.19 with 95% CI 1.0-1.4) and capillary refill time (OR 3.4 with 95% CI 1.9-6.1). CONCLUSIONS Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.
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Affiliation(s)
| | | | | | | | - J Ascuntar
- Gerente en Sistemas de Información en Salud, GRAEPIC (Grupo Académico de Epidemiología Clínica), Universidad de Antioquia, Medellín, Colombia
| | - F Jaimes
- Médico Internista, Epidemiólogo y Doctor en Epidemiologia en Enfermedad Infecciosas, GRAEPIC (Grupo Académico de Epidemiología Clínica), Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia.
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Soto S, Adasme R, Vivanco P, Figueroa P. Efficacy of the "Start to move" protocol on functionality, ICU-acquired weakness and delirium: A randomized clinical trial. Med Intensiva 2024; 48:211-219. [PMID: 38402053 DOI: 10.1016/j.medine.2024.01.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To evaluate the efficacy of the Start to move protocol compared to conventional treatment in subjects over 15 years of age hospitalized in the ICU on an improvement in functionality, decrease in ICU-acquired weakness (DAUCI), incidence of delirium, days of mechanical ventilation (MV), length of stay in ICU and mortality at 28 days. DESIGN randomized controlled clinical trial. SETTING Intensive Care Unit. PARTICIPANTS Includes adults older than 15 years with invasive mechanical ventilation more than 48h, randomized allocation. INTERVENTIONS Start to move protocol and conventional treatment. MAIN VARIABLES OF INTEREST Functionality, incidence of ICU-acquired weakness, incidence of delirium, days on mechanical ventilation, ICU stay and mortality-28 days, ClinicalTrials.gov number, NCT05053724. RESULTS 69 subjects were admitted to the study, 33 to the Start to move group and 36 to conventional treatment, clinically and sociodemographic comparable. In the "Start to move" group, the incidence of IUCD at ICU discharge was 35.7% vs. 80.7% in the "conventional treatment" group (p=0.001). Functionality (FSS-ICU) at ICU discharge corresponds to 26 vs. 17 points in favor of the "Start to move" group (p=0.001). The difference in Barthel at ICU discharge was 20% in favor of the "Start to move" group (p=0.006). There were no significant differences in the incidence of delirium, days of mechanical ventilation, ICU stay and 28-day mortality. The study did not report adverse events or protocol suspension. CONCLUSIONS The application of the "Start to move" protocol in ICU showed a reduction in the incidence of IUAD, an increase in functionality and a smaller decrease in Barthel score at discharge.
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Affiliation(s)
- Sebastián Soto
- Unidad del Paciente Crítico, Hospital Félix Bulnes, Cerro Navia, Santiago, Chile.
| | - Rodrigo Adasme
- Equipo de Terapia Respiratoria, Hospital Clínico Red Salud Christus-UC, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
| | - Paulina Vivanco
- Unidad del Paciente Crítico, Hospital de Urgencia Asistencia Pública, Estación Central, Santiago, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
| | - Paola Figueroa
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
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Muñoz-Rey MP, Delgado-Hito P, Juvé-Udina ME, Cuzco-Cabellos C, Huertas-Zurriaga A, Romero-García M. The diary in the intensive care unit: Concept analysis. Enferm Intensiva (Engl Ed) 2024:S2529-9840(23)00070-8. [PMID: 38228417 DOI: 10.1016/j.enfie.2023.08.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/13/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action. AIM This research proposes to critically examine the concept of 'Intensive Care Unit Diary' by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content. METHOD A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant. RESULTS The concept analysis shows that the 'ICU Diary' is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay. It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions. CONCLUSIONS The concept of 'UCI Diary' is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.
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Affiliation(s)
- M P Muñoz-Rey
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain; Grupo de Investigación Enfermera NURECARE-IGTP, Instituto de Investigación Germans Trias i Pujol, Badalona, Spain
| | - P Delgado-Hito
- Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Grupo de investigación enfermera del Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain; Red internacional proyecto HU-CI, Madrid, Spain.
| | - M E Juvé-Udina
- Grupo de investigación enfermera del Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain
| | - C Cuzco-Cabellos
- Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Área de Vigilancia intensiva Hospital Clínico, Barcelona, Spain
| | - A Huertas-Zurriaga
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain; Grupo de Investigación Enfermera NURECARE-IGTP, Instituto de Investigación Germans Trias i Pujol, Badalona, Spain
| | - M Romero-García
- Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Grupo de investigación enfermera del Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain; Red internacional proyecto HU-CI, Madrid, Spain
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Salas-Bergües V, Lizarazu-Armendáriz E, Eraso-Pérez de Urabayen M, Mateo-Manrique P, Mendívil-Pérez M, Goñi-Viguria R. Levels of burnout and exposure to ethical conflict and assessment of the practice environment in nursing professionals of intensive care. Enferm Intensiva (Engl Ed) 2023; 34:195-204. [PMID: 37455225 DOI: 10.1016/j.enfie.2023.02.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nursing professionals working in Intensive Care Units (ICU) are at high risk of developing negative emotional responses as well as emotional and spiritual problems related to ethical issues. The design of effective strategies that improve these aspects is determined by knowing the levels of burnout and ethical conflict of these professionals, as well as the influence that the practice environment might have on them. OBJECTIVES To analyze the relationship between levels of burnout, the exposure to ethical conflicts and the perception of the practice environment among themselves and with sociodemographic variables of the different intensive care nursing professionals. METHODS Descriptive, correlational, cross-sectional, observational study in an ICU of a tertiary level university hospital. The level of burnout was evaluated with the Maslach Burnout Inventory Human Services Survey scale; the level of ethical conflict with the Ethical Conflict Questionnaire for Nurses and the perception of the environment with the Practice Environment Scale of the Nursing Work Index. Descriptive and inferential statistics were performed. The association between categorical variables was analyzed using Fisher's exact chi-square test (χ2) RESULTS: 31 nurses and 8 nursing assistants were evaluated, which meant a participation rate of 82,93%. 31,10% of the nursing professionals presented signs of burnout, 14,89% considered that they work in an unfavorable environment and 87,23% presented a medium-high index of exposure to ethical conflict. The educational level (χ2=11.084, p=0.011) and the professional category (χ2=5.007, p=0.025) influenced the level of burnout: nursing assistants presented higher levels of this. When comparing the level of burnout with the environment and the index of ethical conflict, there were no statistically significant differences. CONCLUSIONS The absence of association found in the study between Burnout and ethical conflict with the perception of the practice environment suggests that personal factors may influence its development.
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Affiliation(s)
- V Salas-Bergües
- Enfermería, Área de Investigación, Clínica Universidad de Navarra, Pamplona, Spain
| | - E Lizarazu-Armendáriz
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - P Mateo-Manrique
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain.
| | - M Mendívil-Pérez
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Goñi-Viguria
- Enfermería, Práctica Avanzada del Área de Críticos, Clínica Universidad de Navarra, Spain
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Lozano Gómez H, Rodríguez García A, Rodríguez Esteban MÁ, López Ferraz C, Murcia Hernández MDP, Fernández Zapata A, Villarreal Tello E, Ruiz Ruiz J, Fraile Gutiérrez V, Socias Crespi L, Pallas Beneyto LA, Villanueva Anadón B, Porcar Rodado E, Araiz Burdio JJ. Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit. Med Intensiva 2023; 47:501-515. [PMID: 37076405 DOI: 10.1016/j.medine.2023.03.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To design a mortality indicator in acute coronary syndrome (ACS) in the intensive care unit (ICU). DESIGN A multicenter, observational descriptive study was carried out. PARTICIPANTS Patients with ACS admitted to the ICUs included in the ARIAM-SEMICYUC registry between January 2013 and April 2019. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic parameters, time of access to the healthcare system, and clinical condition. Revascularization therapy, drugs and mortality were analyzed. Cox regression analysis was performed, followed by the design of a neural network. A receiver operating characteristic curve (ROC) was plotted to calculate the power of the new score. Lastly, the clinical utility or relevance of the ARIAM indicator (ARIAM's) was assessed using a Fagan test. RESULTS A total of 17,258 patients were included in the study, with a mortality rate of 3.5% (n = 605) at discharge from the ICU. The variables showing statistical significance (P < .001) were entered into the supervised predictive model, an artificial neural network. The new ARIAM's yielded a mean of 0.0257 (95%CI: 0.0245-0.0267) in patients discharged from the ICU versus 0.27085 (95%CI: 0.2533-0.2886) in those who died (P < .001). The area under the ROC curve of the model was 0.918 (95%CI: 0.907-0.930). Based on the Fagan test, the ARIAM's showed the mortality risk to be 19% (95%CI: 18%-20%) when positive and 0.9% (95%CI: 0.8%-1.01%) when negative. CONCLUSIONS A new mortality indicator for ACS in the ICU can be established that is more accurate and reproducible, and periodically updated.
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Affiliation(s)
- Herminia Lozano Gómez
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - Adrián Rodríguez García
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Cristina López Ferraz
- Complejo Hospitalario Universitario Nuestra Sra. de la Candelaria (Sta. Cruz de Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | - Juan José Araiz Burdio
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, 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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Raurell-Torredà M, Arias-Rivera S, Rodríguez-Delgado ME, Campos-Asensio C, Fernández-Castillo RJ. Effectiveness of closed blood sampling systems in intensive care patients: a scoping review. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00026-5. [PMID: 37423775 DOI: 10.1016/j.enfie.2023.05.001] [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: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Anemia associated with blood extraction for diagnostic purposes is a highly prevalent entity in intensive care units (ICU) for adults. The evidence recommends its prevention through different strategies, among which we can find the use of closed blood sampling systems (CBSS). Different experimental studies support the use of these devices. OBJECTIVE To identify knowledge gaps regarding the effectiveness of CBSS in ICU patients. METHODS Scoping review with search in PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs Institute databases, between September-2021 and September-2022. No time, language, or other limits were applied to ensure the recovery of all relevant studies. Gray literature sources: DART-Europe, OpenGrey and Google Scholar. Two researchers independently reviewed titles and abstracts and assessed full texts against the inclusion criteria. The following data was extracted for each study: design and sample, inclusion and exclusion criteria, variables, type of CBSS, results and conclusions. RESULTS 18 articles were included in the final review, 11 clinical trials (RCTs) published between 1992 and 2014. Three systematic reviews were found, but they only analyzed the effect of CBSS in reducing blood loss, hemoglobin stabilization, and the need for transfusion. Five of the RCTs analyzed the risk of infection, one catheter complications, and two alterations in blood pressure readings. CONCLUSIONS The use of CBSS is recommended to reduce blood loss in ICUs. However, there are discrepancies about their ability to prevent anemia and/or the need for blood transfusion. Its use does not increase catheter-related infection rates or alter the measurement of mean arterial pressure.
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Affiliation(s)
- M Raurell-Torredà
- Departament Infermeria Fonamental i Medicoquirúrgica, Universitat de Barcelona, Barcelona, Spain
| | - S Arias-Rivera
- Enfermera Investigación, Hospital Universitario de Getafe, Madrid, Spain
| | - M E Rodríguez-Delgado
- Unidad de Cuidados Intensivos. Hospital Universitario Clínico San Cecilio, Granada, Spain.
| | | | - R-J Fernández-Castillo
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
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Sundarsingh V, Poddar B, Saran S, Jena SK, Azim A, Gurjar M, Singh RK, Baronia AK. Glucometrics in the first week of critical illness and its association with mortality. Med Intensiva 2023; 47:326-337. [PMID: 36344343 DOI: 10.1016/j.medine.2022.06.025] [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: 01/12/2022] [Accepted: 06/05/2022] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. DESIGN Prospective observational study. SETTING Mixed ICU of teaching hospital. PATIENTS Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. MAIN VARIABLES OF INTEREST Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. RESULTS A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162-178.75), SD 31mg/dL (26-38.75), CV 18.6% (17.1-22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5-1131.5) and TIR 57% (50-67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). CONCLUSIONS Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections.
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Affiliation(s)
- V Sundarsingh
- Department of Critical Care Medicine, Father Muller Medical College Hospital, Mangalore, India
| | - B Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - S Saran
- Department of Critical Care Medicine, King George Medical University, Lucknow, India
| | - S K Jena
- Department of Critical Care Medicine, Kalinga Institute of Medical Sciences, Bhuvaneswar, India
| | - A Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - M Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R K Singh
- Department of Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A K Baronia
- Government Medical College, Pithoragarh, India
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Ramos R, de la Villa S, García-Ramos S, Padilla B, García-Olivares P, Piñero P, Garrido A, Hortal J, Muñoz P, Caamaño E, Benito P, Cedeño J, Garutti I. COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:278-283. [PMID: 37142346 PMCID: PMC10151902 DOI: 10.1016/j.eimce.2021.10.013] [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: 07/05/2021] [Accepted: 10/20/2021] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Our work describes the frequency of superinfections in COVID-19 ICU patients and identifies risk factors for its appearance. Second, we evaluated ICU length of stay, in-hospital mortality and analyzed a subgroup of multidrug-resistant microorganisms (MDROs) infections. METHODS Retrospective study conducted between March and June 2020. Superinfections were defined as appeared ≥48h. Bacterial and fungal infections were included, and sources were ventilator-associated lower respiratory tract infection (VA-LRTI), primary bloodstream infection (BSI), secondary BSI, and urinary tract infection (UTI). We performed a univariate analysis and a multivariate analysis of the risk factors. RESULTS Two-hundred thirteen patients were included. We documented 174 episodes in 95 (44.6%) patients: 78 VA-LRTI, 66 primary BSI, 9 secondary BSI and 21 UTI. MDROs caused 29.3% of the episodes. The median time from admission to the first episode was 18 days and was longer in MDROs than in non-MDROs (28 vs. 16 days, p<0.01). In multivariate analysis use of corticosteroids (OR 4.9, 95% CI 1.4-16.9, p 0.01), tocilizumab (OR 2.4, 95% CI 1.1-5.9, p 0.03) and broad-spectrum antibiotics within first 7 days of admission (OR 2.5, 95% CI 1.2-5.1, p<0.01) were associated with superinfections. Patients with superinfections presented respect to controls prolonged ICU stay (35 vs. 12 days, p<0.01) but not higher in-hospital mortality (45.3% vs. 39.7%, p 0.13). CONCLUSIONS Superinfections in ICU patients are frequent in late course of admission. Corticosteroids, tocilizumab, and previous broad-spectrum antibiotics are identified as risk factors for its development.
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Affiliation(s)
- Rafael Ramos
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sofía de la Villa
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Sergio García-Ramos
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo García-Olivares
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Piñero
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Garrido
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Hortal
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Estrela Caamaño
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Benito
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jamil Cedeño
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Garutti
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Li X, Liu D, Liu C, Mao Z, Liu Y, Yi H, Zhou F. Conservative versus liberal oxygen therapy in relation to all-cause mortality among patients in the intensive care unit: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Med Intensiva 2023; 47:73-83. [PMID: 35644886 DOI: 10.1016/j.medine.2021.08.015] [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: 04/19/2021] [Accepted: 08/22/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the benefits and harmful effects of conservative versus liberal oxygen therapy in patients admitted to the Intensive Care Unit (ICU). DESIGN A systematic review and meta-analysis was carried out. SETTING ICU. PARTICIPANTS Adult patients (aged 18 years or older) were randomized to either a lower oxygenation target strategy (conservative oxygen therapy) or a higher oxygenation target strategy (liberal oxygen therapy) in the ICU. INTERVENTIONS Patients received different oxygenation target strategies. RESULTS Ten studies involving 5429 adult patients admitted to the ICU were included in the meta-analysis. The pooled results showed no decreased all-cause mortality at 28 days (RR 0.90; 95%CI 0.75-1.09; p = 0.28), 90 days (RR 1.02; 95%CI 0.92-1.13; p = 0.71) or longest follow-up (RR 0.97; 95%CI 0.88-1.08; p = 0.63) among patients administered conservative oxygen therapy. Secondary outcomes were comparable between the two groups. The results of sensitivity analyses and subgroup analyses were consistent with the main analyses. CONCLUSION No beneficial or harmful effects of conservative oxygen therapy were found compared to liberal oxygen therapy in relation to all-cause mortality among adult patients in the ICU. Conservative oxygen therapy did not reduce all-cause mortality at 28 days, 90 days or longest follow-up. Other important clinical outcomes were also comparable between the two groups.
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Affiliation(s)
- X Li
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, PR China; Medical School of Chinese PLA, PR China.
| | - D Liu
- Department of Emergency Medicine, The Fourth Medical Centre, Chinese PLA General Hospital, PR China.
| | - C Liu
- Medical School of Chinese PLA, PR China.
| | - Z Mao
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, PR China.
| | - Y Liu
- Department of Emergency Medicine, Peking Union Medical College Hospital, PR China
| | - H Yi
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, PR China; Medical School of Chinese PLA, PR China
| | - F Zhou
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, PR China.
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Pérez-Pedrero Sánchez-Belmonte MJ, Sánchez-Casado M, Moran Gallego FJ, Piza Pinilla R, Gomez Hernando C, Paredes Borrachero I. [Herpes simplex virus type 1 (HSV-1) over-infection in patients with acute respiratory distress syndrome secondary to COVID-19 pneumonia: Impact on mortality]. Med Clin (Barc) 2023; 160:66-70. [PMID: 35760608 PMCID: PMC9167944 DOI: 10.1016/j.medcli.2022.04.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Herpes simplex virus type1 (HSV-1) reactivation have been described in patients with invasive mechanical ventilation and recently in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 with higher rates of reactivation than were detected previously in critical care, and although the diagnosis of HSV-1 pneumonia is not easy, its presence is associate with an increase in morbidity and mortality. The objective of this study is to determinate if the identification of HSV-1 in lower airway of patients with ARDS secondary to COVID-19 have influence in clinical outcome and mortality. METHOD Two hundred twenty-four admitted patients in intensive care unit (ICU) of Complejo Hospitalario Universitario de Toledo diagnosed of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) were reviewed and were selected those with mechanical ventilation who had undergone (BAL). It was registered all results of HSV-1 PCR (negative and positive). RESULTS During the study period (November 28, 2020 to April 13, 2021) was admitted 224 patients in ICU diagnosed of SARS-CoV-2 pneumonia. Eighty-three patients of them had undergone BAL, with HSV-1 PCR positive result in 47 (56%), and negative result in 36 (43.4%). We performed pathological anatomy study in BAL samples on 26 of the total BAL realized. Typical cytopathic characteristics of HSV-1 were found in 13 samples (50%) and 11 of them (84.6%) have had HSV-1 PCR positive result. Thirty days mortality was significantly higher in the group of patients with HSV-1 PCR positive result (33.5% vs. 57.4%, P=.015). This difference was stronger in the group of patients with HSV-1 findings in the pathological anatomy study (30.8% vs. 69.2%, P=.047). CONCLUSION Our results suggest that ARDS secondary to SARS-CoV-2 pneumonia is highly associated to HSV-1 reactivation and that the finding of HSV-1 in lower airway is associated with a worst prognostic and with significantly mortality increase. It is necessary to carry out more extensive studies to determinate if treatment with acyclovir can improve the prognosis of these patients.
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Affiliation(s)
| | - Marcelino Sánchez-Casado
- Departamento de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España,Autor para correspondencia
| | | | - Roman Piza Pinilla
- Departamento de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España
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Torres-Toledano M, Granados-García V, López-Tapia JDJ, Miguel-Tiburcio ET, Flores YN, Aracena-Genao B, Ramírez-Palacios P. COVID-19 medical care direct costs during the first year of pandemic in a hospital converted for increasing bed capacity. GAC MED MEX 2023; 159:171-179. [PMID: 37494712 DOI: 10.24875/gmm.m23000768] [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: 01/10/2023] [Accepted: 04/01/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND COVID-19 health emergency caused an increase in the demand for hospitalization and high costs for the health system. OBJECTIVE To estimate COVID-19 care direct costs from the perspective of the healthcare provider in a secondary care hospital that underwent conversion during the first year of health emergency. MATERIAL AND METHODS Retrospective, observational study. Information on quantities of goods and services was obtained from the SINOLAVE and CVOED platforms and from hospital administrative sources. Four cost groups were defined and estimated with 2021 unit prices in US dollars. RESULTS Mean hospital length of stay (n = 3,241 patients) was 10.8 ± 8.2 days. Average cost of care per patient was USD 6,557 ± 4,997. Respiratory therapy with assisted mechanical ventilation was used by 13% of patients. CONCLUSIONS The costs of COVID-19 medical care represent a large amount of resources. Most part of the costs (95%) were derived from hospital stay, respiratory therapy without assisted mechanical ventilation and costs related to personal protective equipment, hygiene, infrastructure adaptation and payments to medical personnel.
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Affiliation(s)
- Marisol Torres-Toledano
- Internal Medicine Department, Zone 58 General Hospital, Instituto Mexicano del Seguro Social, State of Mexico, Mexico
| | - Víctor Granados-García
- Epidemiologic and Health Services Research Unit, Aging Area, Health Research Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - José de Jesús López-Tapia
- Director's Office, Zone 76 General Hospital with Family Medicine Unit, Instituto Mexicano del Seguro Social, State of Mexico, Mexico
| | - Elizabeth T Miguel-Tiburcio
- Emergency Department, Zone 76 General Hospital with Family Medicine Unit, Instituto Mexicano del Seguro Social, State of Mexico, Mexico
| | - Yvonne N Flores
- Morelos Epidemiologic and Health Services Research Unit, Instituto Mexicano del Seguro Social, Morelos, México
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, United States of America
- Center for Cancer Prevention and Control Research-Kaiser-Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, United States of America
| | - Belkis Aracena-Genao
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, United States of America
| | - Paula Ramírez-Palacios
- Morelos Epidemiologic and Health Services Research Unit, Instituto Mexicano del Seguro Social, Morelos, México
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Mahendra AD, Hanifah S, Sari CP. Cross-sectional study of potential incompatibility of intravenous medications in a Neonatal Intensive Care Unit in Indonesia. Farm Hosp 2023; 47:T16-T19. [PMID: 36707310 DOI: 10.1016/j.farma.2022.12.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/26/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The purpose of this study is to determine the most common incompatible and unknown compatibility drug combinations and determine the compatibility of each pair of drugs used in hospitals based on reference books and journals. METHODS This is a prospective cross-sectional study. All babies who were admitted to the Neonatal Intensive Care Units from May First to July 31st 2021 were sample of the study. Patients who did not receive at least two drugs coadministrated concurrently and who stayed less than 24 hours were excluded. Only drug-drug combinations were considered and the other non-drug administrations (electrolyte solutions, parenteral nutritions, and blood products) were excluded. Compatibility data were obtained from literature and online search engines (micromedex NeoFax Essentials 2020, UCL Hospitals Injectable Medicines Administration Guide: Pharmacy Department, 3rd Edition, Trissel Handbook on injectable drugs 15th edition, and published journals). RESULTS The most commonly prescribed drug combinations were ampicillin-gentamicin (31.72%), amikacin-ampicillin sulbactam (9.05%), amikacin-ampicillin sulbactam-aminophylline (3.08%). The most common drug incompatible combination was ampicillin-gentamicin (31.71%), for the most drug combinations whose compatibility unknown were amikacin-ampicillin sulbactam (9.05%). CONCLUSIONS The high prevalence of incompatible drugs and unknown compatibility was identified, so checking its compatibility can be carried out through a two-dimensional chart to minimize the incidence of incompatibilities.
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Affiliation(s)
- Andika Dwi Mahendra
- Departameto de Farmacia, Hospital General Dr. Soeradji Tirtonegoro, Klaten, Indonesia; Departamento de Farmacia, Facultad de Matemáticas y Ciencias Naturales, Universidad Islámica de Indonesia, Yogyakarta, Indonesia.
| | - Suci Hanifah
- Departamento de Farmacia, Facultad de Matemáticas y Ciencias Naturales, Universidad Islámica de Indonesia, Yogyakarta, Indonesia
| | - Chynthia Pradiftha Sari
- Departamento de Farmacia, Facultad de Matemáticas y Ciencias Naturales, Universidad Islámica de Indonesia, Yogyakarta, Indonesia
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Roshdy A, Elsayed AS, Saleh AS. Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey. Med Intensiva 2022; 46:549-558. [PMID: 36155678 DOI: 10.1016/j.medine.2021.06.007] [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: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. DESIGN Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. SETTING International study conducted in 78 countries. PARTICIPANTS Physicians working in ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training. RESULTS 466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction. CONCLUSION ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.
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Affiliation(s)
- A Roshdy
- Intensive Care Unit, North Middlesex University Hospital, London, UK; Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - A S Elsayed
- Intensive Care Unit, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - A S Saleh
- Alhayat Clinic, Edku, el-Beheira, Egypt
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Rodriguez-Ruiz E, Campelo-Izquierdo M, Veiras PB, Rodríguez MM, Estany-Gestal A, Hortas AB, Rodríguez-Calvo MS, Rodríguez-Núñez A. Moral distress among healthcare professionals working in intensive care units in Spain. Med Intensiva 2022; 46:383-391. [PMID: 35753710 DOI: 10.1016/j.medine.2021.06.005] [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: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DESIGN Cross-sectional, prospective study. SETTING ICUs in Spain. PARTICIPANTS HCPs currently working in Spanish ICUs. INTERVENTIONS A 55-item questionnaire was electronically distributed. MAIN VARIABLES The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). RESULTS In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. CONCLUSIONS In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.
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Affiliation(s)
- E Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - M Campelo-Izquierdo
- Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - P B Veiras
- Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - M M Rodríguez
- Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - A Estany-Gestal
- Epidemiology and Clinical Research Unit, Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - A B Hortas
- Epidemiology and Clinical Research Unit, Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | | | - A Rodríguez-Núñez
- Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain; Paediatric Intensive Care Unit, Department of Pediatrics, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
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González-Alcantud B. Barriers to the application of the nursing methodology in the Intensive Care Unit. Enferm Intensiva (Engl Ed) 2022; 33:151-162. [PMID: 35927175 DOI: 10.1016/j.enfie.2021.12.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/07/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The Nursing Process is the scientific method specific to the nursing discipline. However, although in recent years it has rapidly expanded in certain areas, this has not been the case in special units such as the intensive care unit. OBJECTIVE To determine the reasons nurses show little awareness of incorporating nursing methodology in intensive care units. METHOD Literature review conducted between November and December 2020 in the databases Pubmed, Cinahl, Cuiden, Lilacs, Cochrane, Sicelo, Web of Science, in addition to a search of grey literature and electronic journals. Boolean operators AND and OR were used and the temporal limiter of the last 10 years (2010-2020) was applied. RESULTS A total of 20 articles were selected. Intensive Care Units nurses perceived a lack of knowledge on how to use nursing methodology. This problem begins in university education and continues in the institutions with little continuing education. Nurses' work overload takes time from being able to use this tool, which is among the lowest of their priorities. CONCLUSIONS Research studies are required on solutions that, in the nurses' words, could be useful in tackling this problem, and on the impact that training programmes in methodology have on its application in practice.
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Gómez Tovar LO, Henao-Castaño ÁM, Troche-Gutiérrez IY. Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team. Enferm Intensiva (Engl Ed) 2022; 33:113-125. [PMID: 35945109 DOI: 10.1016/j.enfie.2021.05.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/07/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS Four significant themes emerged from the analysis: (1) delirium prevention, (2) pharmacological treatment, (3) non-pharmacological treatment, and (4) barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.
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Affiliation(s)
- L O Gómez Tovar
- Programa de Enfermería, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - Á M Henao-Castaño
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
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Arrambide-Herrera JG, Robles-Torres JI, Ocaña-Munguía MA, Romero-Mata R, Gutiérrez-González A, Gómez-Guerra LS. Predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis: 5-year experience in a tertiary care hospital. Actas Urol Esp 2022; 46:98-105. [PMID: 35120854 DOI: 10.1016/j.acuroe.2021.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/18/2020] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Emphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience. METHODS A retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011 to 2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using X2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at P < .05. RESULTS A total of 63 patients were included, of which 55 (87.3%) were females, with a mean age of 55.5 ± 12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (P = .005), qSOFA ≥ 2 (P = .003), hypoalbuminemia (P = .02), and early nephrectomy (P = .002) were associated with intensive care admission. Huang scale 4 (P = .006) and early nephrectomy (P = .001) were associated to mortality. CONCLUSIONS Emphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition. Hemodynamic instability, hypoalbuminemia, qSOFA ≥ 2, Huang scale ≥3, and early nephrectomy are associated with poor prognosis.
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Affiliation(s)
- J G Arrambide-Herrera
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - J I Robles-Torres
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - M A Ocaña-Munguía
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - R Romero-Mata
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - A Gutiérrez-González
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - L S Gómez-Guerra
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico.
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Sánchez Martín C, Madrid Martínez E, González Pellicer R, Armero Ibáñez R, Martínez González E, Llau Pitarch JV. Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:48-53. [PMID: 35033481 PMCID: PMC8739016 DOI: 10.1016/j.redare.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of Galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1 mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.
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Affiliation(s)
- C Sánchez Martín
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain.
| | - E Madrid Martínez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - R González Pellicer
- Servicio de Microbiología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - R Armero Ibáñez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - E Martínez González
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - J V Llau Pitarch
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain; Anestesiología, Universitat de València, Valencia, Spain
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Bosch-Alcaraz A, Alcolea-Monge S, Fernández Lorenzo R, Luna-Castaño P, Belda-Hofheinz S, Falcó Pegueroles A, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gámez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, García-Soler P, Tamame-San Antonio M. Grade of sedation in the critically ill pediatric patient and its correlation with sociodemographic and clinical variables. Multicentre COSAIP study. Enferm Intensiva (Engl Ed) 2021; 32:189-97. [PMID: 34772640 DOI: 10.1016/j.enfie.2020.12.001] [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: 07/06/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022]
Abstract
AIMS To determine the grade of sedation in the critically ill paediatric patient using Biespectral Index Sensor (BIS) and to analyse its relationship with sociodemographic and clinical patient variables. METHODS Observational, analytical, cross-sectional and multicentre study performed from May 2018 to January 2020 in 5 Spanish paediatric critical care units. Sex, age, reason for admission, presence of a chronic pathology, type and number of drugs and length of stay were the sociodemographic and clinical variables registered. Furthermore, the grade of sedation was assessed using BIS, once per shift over 24 h. RESULTS A total of 261 paediatric patients, 53.64% of whom were male, with a median age of 1.61 years (0.35-6.55), were included in the study. Of the patients, 70.11% (n = 183) were under analgosedation and monitored using the BIS sensor. A median of BIS values of 51.24 ± 14.96 during the morning and 50.75 ± 15.55 during the night were observed. When comparing BIS values and sociodemographic and clinical paediatric variables no statistical significance was detected. CONCLUSIONS Despite the limitations of the BIS, investigations and the present study show that BIS could be a useful instrument to assess grade of sedation in critically ill paediatric patients. However, further investigations which determine the sociodemographic and clinical variables involved in the grade of paediatric analgosedation, as well as studies that contrast the efficacy of clinical scales like the COMFORT Behaviour Scale-Spanish version, are required.
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Ventura Expósito L, Arreciado Marañón A. Needs and participation strategies proposed by the family in the daily care of the critically ill patient. Enferm Clin (Engl Ed) 2021; 31:294-302. [PMID: 34565501 DOI: 10.1016/j.enfcle.2020.10.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient. OBJECTIVE I) Knowing the feelings and needs of the patients' relative admitted to an ICU of a third level hospital in Catalonia and II) to study the participation strategies proposed by the relatives. METHODS Phenomenological qualitative study. The sample population selected was the patients' relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied. RESULTS 15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care. CONCLUSIONS It is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.
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Affiliation(s)
| | - Antonia Arreciado Marañón
- Departamento de Enfermería, Facultad de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), Spain
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Roshdy A, Elsayed AS, Saleh AS. Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey. Med Intensiva 2021; 46:S0210-5691(21)00174-1. [PMID: 34417082 DOI: 10.1016/j.medin.2021.06.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. DESIGN Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. SETTING International study conducted in 78 countries. PARTICIPANTS Physicians working in ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training. RESULTS 466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction. CONCLUSION ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.
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Affiliation(s)
- A Roshdy
- Intensive Care Unit, North Middlesex University Hospital, London, UK; Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - A S Elsayed
- Intensive Care Unit, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - A S Saleh
- Alhayat Clinic, Edku, el-Beheira, Egypt
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Gómez Tovar LO, Henao-Castaño ÁM, Troche-Gutiérrez IY. Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team. Enferm Intensiva (Engl Ed) 2021; 33:S1130-2399(21)00081-X. [PMID: 34412959 DOI: 10.1016/j.enfi.2021.05.001] [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: 10/28/2020] [Revised: 03/23/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.
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Affiliation(s)
- L O Gómez Tovar
- Programa de Enfermería, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - Á M Henao-Castaño
- Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
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Raurell-Torredà M, Regaira-Martínez E, Planas-Pascual B, Ferrer-Roca R, Martí JD, Blazquez-Martínez E, Ballesteros-Reviriego G, Vinuesa-Suárez I, Zariquiey-Esteva G. Early mobilisation algorithm for the critical patient. Expert recommendations. Enferm Intensiva (Engl Ed) 2021; 32:153-163. [PMID: 34366295 DOI: 10.1016/j.enfie.2020.11.001] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Investigadora principal proyecto MoviPre, Barcelona, Spain
| | - E Regaira-Martínez
- Clínica Universidad de Navarra, Pamplona, Spain; GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC).
| | - B Planas-Pascual
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - R Ferrer-Roca
- Hospital Universitario Vall d'Hebron, Barcelona, Spain; Presidente de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
| | - J D Martí
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Clínic de Barcelona, Barcelona, Spain
| | - E Blazquez-Martínez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario de Bellvitge, L'Hospitalet de Llobgregat, Barcelona, Spain
| | - G Ballesteros-Reviriego
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - I Vinuesa-Suárez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - G Zariquiey-Esteva
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Rodriguez-Ruiz E, Campelo-Izquierdo M, Veiras PB, Rodríguez MM, Estany-Gestal A, Hortas AB, Rodríguez-Calvo MS, Rodríguez-Núñez A. Moral distress among healthcare professionals working in intensive care units in Spain. Med Intensiva 2021; 46:S0210-5691(21)00170-4. [PMID: 34332793 DOI: 10.1016/j.medin.2021.06.004] [Citation(s) in RCA: 1] [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: 03/11/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DESIGN Cross-sectional, prospective study. SETTING ICUs in Spain. PARTICIPANTS HCPs currently working in Spanish ICUs. INTERVENTIONS A 55-item questionnaire was electronically distributed. MAIN VARIABLES The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). RESULTS In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. CONCLUSIONS In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.
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Affiliation(s)
- E Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - M Campelo-Izquierdo
- Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - P B Veiras
- Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - M M Rodríguez
- Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - A Estany-Gestal
- Epidemiology and Clinical Research Unit, Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - A B Hortas
- Epidemiology and Clinical Research Unit, Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | | | - A Rodríguez-Núñez
- Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain; Paediatric Intensive Care Unit, Department of Pediatrics, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
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Olaechea Astigarraga PM, Álvarez Lerma F, Beato Zambrano C, Gimeno Costa R, Gordo Vidal F, Durá Navarro R, Ruano Suarez C, Aldabó Pallás T, Garnacho Montero J. Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study. Med Intensiva 2021; 45:332-346. [PMID: 34127405 DOI: 10.1016/j.medine.2021.05.003] [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: 09/27/2019] [Accepted: 01/26/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU). DESIGN A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified. SETTING Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry. PATIENTS Subjects admitted during over 24 h and diagnosed with cancer in the last 5 years. PRIMARY ENDPOINTS The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables. RESULTS Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1%-48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; p < .001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted to the ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%). CONCLUSIONS Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%).
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Affiliation(s)
- P M Olaechea Astigarraga
- Servicio de Medicina Intensiva, Hospital Universitario Galdakao-Usansolo, Biocruces Bizkaia Health Research Institute, Galdácano, Vizcaya, Spain.
| | - F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - C Beato Zambrano
- Servicio de Oncología Médica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - R Gimeno Costa
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - R Durá Navarro
- Servicio Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C Ruano Suarez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain
| | - T Aldabó Pallás
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Garnacho Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Vargas JM, Moreno Mochi MP, López CG, Alarcón JA, Acosta N, Soria K, Nuñez JM, Villafañe S, Ramacciotti J, Del Campo R, Jure MA. [Impact of an active surveillance program and infection control measures on the incidence of carbapenem-resistant Gram-negative bacilli in an intensive care unit]. Rev Argent Microbiol 2021; 54:134-142. [PMID: 34088536 DOI: 10.1016/j.ram.2021.03.003] [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: 07/08/2020] [Revised: 03/11/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022] Open
Abstract
Hospital-acquired infections caused by carbapenem-resistant Gram-negative bacteria (CRGNB) have been increasingly reported worldwide and are associated with high rates of mortality especially in intensive care units(ICUs). Early identification through rectal surveillance cultures and implementation of infection control measures(ICM) including contact precautions, staff education on cleaning and hand hygiene may reduce the spread of these microorganisms. The aim of this work was to assess the impact of enhanced ICM on CRGNB colonization and to describe the molecular epidemiology of these bacteria in a polyvalent ICU in a tertiary level hospital. A prospective study including audits and active surveillance culture program, with molecular characterization, was conducted before and after the implementation of prevention programs and infection control measures. Microbiological screening was performed in chromogenic media; PCR targeting β-lactamases genes (blaKPC, blaNDM, blaVIM and blaOXA-48, blaSHV and blaCTX-M), molecular typing by PFGE; and MLST in K. pneumoniae were performed. CRGNB colonization was reduced from 16.92% to 9.67% upon implementing the infection control measures. In K. pneumoniae the most frequent carbapenemase type was KPC-2 associated with SHV-2 and CTX-M-15, and was disseminated in various STs (ST17, ST13, ST2256, ST353); there was no persistence of particular clones and virulence factors showed no association with hypervirulence. IMP-1 carbapenemase predominated in A. baumannii and the PFGE analysis individualized 3 clusters, assuming that the dissemination in the ICU was clonal. The early detection of patients colonized with CRBGN by using epidemiological surveillance cultures and the implementation of prophylactic measures are key to reducing the incidence of these microorganisms.
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Affiliation(s)
- Juan Martín Vargas
- Laboratorio de Bacteriología Certificado, Cátedra de Bacteriología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina.
| | - María Paula Moreno Mochi
- Laboratorio de Bacteriología Certificado, Cátedra de Bacteriología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Carolina Graciela López
- Laboratorio de Bacteriología Certificado, Cátedra de Bacteriología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Janet Alejandra Alarcón
- Laboratorio de Bacteriología Certificado, Cátedra de Bacteriología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Nancy Acosta
- Unidad de cuidados intensivos 1 (UCI1), Hospital Ángel Cruz Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | - Karina Soria
- Departamento de Infectología, Hospital Ángel Cruz Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | - Juan Manuel Nuñez
- Departamento de Infectología, Hospital Ángel Cruz Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | - Sandra Villafañe
- Departamento de Infectología, Hospital Ángel Cruz Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | - Jorge Ramacciotti
- Unidad de cuidados intensivos 1 (UCI1), Hospital Ángel Cruz Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | - Rosa Del Campo
- Servicio de Microbiología, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, España
| | - María Angela Jure
- Laboratorio de Bacteriología Certificado, Cátedra de Bacteriología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
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Álvarez-Maldonado P, Hernández-Ríos G, Cerón-Díaz U, Núñez-Pérez-Redondo C, Navarro-Reynoso F, Cicero-Sabido R. Clinical performance and resource utilization in the start of a totally new Intensive Care Unit. Same staff, new area. CIR CIR 2021; 88:337-343. [PMID: 32539000 DOI: 10.24875/ciru.19001397] [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] [Indexed: 11/17/2022]
Abstract
Background There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area. Objective To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital. Method Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI). Results Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01). Conclusions In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.
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Affiliation(s)
- Pablo Álvarez-Maldonado
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México
| | - Grisel Hernández-Ríos
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México
| | - Ulises Cerón-Díaz
- Unidad de Terapia Intensiva, Hospital Español de México. Ciudad de México, México
| | - Carlos Núñez-Pérez-Redondo
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México
| | - Francisco Navarro-Reynoso
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México
| | - Raúl Cicero-Sabido
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México.,Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
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Sánchez Martín C, Madrid Martínez E, González Pellicer R, Armero Ibáñez R, Martínez González E, Llau Pitarch JV. Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00131-6. [PMID: 34565575 PMCID: PMC8057739 DOI: 10.1016/j.redar.2021.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.
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Affiliation(s)
- C Sánchez Martín
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Madrid Martínez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - R González Pellicer
- Servicio de Microbiología, Hospital Universitario Doctor Peset, Valencia, España
| | - R Armero Ibáñez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - E Martínez González
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - J V Llau Pitarch
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España; Anestesiología, Universitat de València, Valencia, España
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Bosch-Alcaraz A, Alcolea-Monge S, Fernández Lorenzo R, Luna-Castaño P, Belda-Hofheinz S, Falcó Pegueroles A, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gámez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, García-Soler P, Tamame-San Antonio M. Grade of sedation in the critically ill paediatric patient and its correlation with sociodemographic and clinical variables. Multicentre COSAIP study. Enferm Intensiva (Engl Ed) 2021; 32:S1130-2399(21)00002-X. [PMID: 33824050 DOI: 10.1016/j.enfi.2020.12.002] [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: 07/06/2020] [Revised: 10/19/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
AIMS To determine the grade of sedation in the critically ill paediatric patient using Biespectral Index Sensor (BIS) and to analyse its relationship with sociodemographic and clinical patient variables. METHODS Observational, analytical, cross-sectional and multicentre study performed from May 2018 to January 2020 in 5 Spanish paediatric critical care units. Sex, age, reason for admission, presence of a chronic pathology, type and number of drugs and length of stay were the sociodemographic and clinical variables registered. Furthermore, the grade of sedation was assessed using BIS, 11per shift over 24hours. RESULTS A total of 261 paediatric patients, 53.64% of whom were male, with a median age of 1.61 years (0.35-6.55), were included in the study. Of the patients, 70.11% (n=183) were under analgosedation and monitored using the BIS sensor. A median of BIS values of 51.24±14.96 during the morning and 50.75±15.55 during the night were observed. When comparing BIS values and sociodemographic and clinical paediatric variables no statistical significance was detected. CONCLUSIONS Despite the limitations of the BIS, investigations and the present study show that BIS could be a useful instrument to assess grade of sedation in critically ill paediatric patients. However, further investigations which determine the sociodemographic and clinical variables involved in the grade of paediatric analgosedation, as well as studies that contrast the efficacy of clinical scales like the COMFORT Behaviour Scale-Spanish version, are required.
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Affiliation(s)
- A Bosch-Alcaraz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España.
| | - S Alcolea-Monge
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - R Fernández Lorenzo
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - P Luna-Castaño
- Unidad de Apoyo a la Investigación Enfermera, Hospital Universitario La Paz, Madrid, España
| | - S Belda-Hofheinz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Falcó Pegueroles
- Departamento de Enfermería Fundamental y Medicoquirúrgica, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - P Piqueras-Rodríguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - I Molina-Gallego
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - C Potes-Rojas
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell (Barcelona), España
| | - S Gesti-Senar
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell (Barcelona), España
| | - R Orozco-Gámez
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M C Tercero-Cano
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Á Saz-Roy
- Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, España
| | - I Jordan
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - P García-Soler
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario Carlos Haya, Málaga, España
| | - M Tamame-San Antonio
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell (Barcelona), España
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Raurell-Torredà M, Regaira-Martínez E, Planas-Pascual B, Ferrer-Roca R, Martí JD, Blazquez-Martínez E, Ballesteros-Reviriego G, Vinuesa-Suárez I, Zariquiey-Esteva G. Early mobilisation algorithm for the critical patient. Expert recommendations. Enferm Intensiva 2021. [PMID: 33745807 DOI: 10.1016/j.enfi.2020.11.001] [Citation(s) in RCA: 1] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Investigadora principal proyecto MoviPre, Barcelona, España
| | - E Regaira-Martínez
- Clínica Universidad de Navarra, Pamplona, España; GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC).
| | - B Planas-Pascual
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
| | - R Ferrer-Roca
- Hospital Universitario Vall d'Hebron, Barcelona, España; Presidente de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
| | - J D Martí
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Clínic de Barcelona, Barcelona, España
| | - E Blazquez-Martínez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario de Bellvitge, L'Hospitalet de Llobgregat, Barcelona, España
| | - G Ballesteros-Reviriego
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
| | - I Vinuesa-Suárez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - G Zariquiey-Esteva
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
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Escudero-Acha P, Leizaola O, Lázaro N, Cordero M, Cossío AM, Ballesteros D, Recena P, Tizón AI, Palomo M, Misis Del Campo M, Freita S, Duerto J, Mas Bilbao N, Vidal B, González-Romero D, Diaz-Dominguez F, Revuelto J, Blasco ML, Domezain M, Pavía-Pesquera MAC, Pérez Ruiz M, Pobo A, Gomez-Acebo I, González-Castro A; Grupo de Trabajo ADENI. Limiting ICU admission from emergency services and wards. Med Clin (Barc) 2021:S0025-7753(20)30856-3. [PMID: 33423823 DOI: 10.1016/j.medcli.2020.08.021] [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: 06/08/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die. METHODS Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests. RESULTS The ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p=.0158), the presence of severe chronic disease (P=.0169) and futility of treatment (P=.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P=.0021). CONCLUSIONS There are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility.
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Ventura Expósito L, Arreciado Marañón A. Needs and participation strategies proposed by the family in the daily care of the critically ill patient. Enferm Clin (Engl Ed) 2020; 31:S1130-8621(20)30530-1. [PMID: 33309510 DOI: 10.1016/j.enfcli.2020.10.029] [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: 05/28/2020] [Revised: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient. OBJECTIVE 1) Knowing the feelings and needs of the patients' relative admitted to an ICU of a third level hospital in Catalonia and 2) To study the participation strategies proposed by the relatives. METHODS Phenomenological qualitative study. The sample population selected was the patients' relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied. RESULTS 15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care. CONCLUSIONS It is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.
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Affiliation(s)
| | - Antonia Arreciado Marañón
- Departamento de Enfermería, Facultad de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), España
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Sarrate E, Jiménez MJ, Morgades M, Marcos P, Ricart P, Vives S, Xicoy B, Torrent A, Misis MT, Bordeje ML, Batlle M, Moreno M, Sancho JM, Ribera JM, Ferra C. Impact of previous admission to an intensive care unit on stem cell transplantation outcome. Med Clin (Barc) 2020; 155:382-7. [PMID: 32561189 DOI: 10.1016/j.medcli.2020.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The impact of an admission to ICU before stem cell transplantation (SCT) on post-SCT outcome is not well established. PATIENTS AND METHODS We reviewed the medical records of patients who had received a first SCT between 2000 and 2016 in our institution. The outcome of 22 patients who required ICU admission during chemotherapy prior to SCT (ICU group) was compared with 44 matched patients (1:2) who did not need it (NO-ICU group). RESULTS There were no differences in transplant complications, in time to neutrophil and platelet recovery or in the length of hospital stay during SCT between the ICU and NO-ICU groups. However, microbiologically documented infections were more common in the ICU group (16/20) than in the NO-ICU group (18/39) (p=.027). The 5-yr overall survival probability (CI 95%) was 49% (28-70%) in the ICU vs. 45% (29-61%) in the NO-ICU group (p=.353), while the 5-yr incidence of non-relapse mortality was 32% (14-52%) and 24% (12-38%) (p=.333), respectively. Six patients (27%) in the ICU group and 8 (18%) in the NO-ICU group required admission to the ICU during or after the SCT procedure (p=.293). Twelve (54%) patients in the ICU and 22 (50%) in the NO-ICU group died, the causes of death were similar in both groups. CONCLUSION Our results show that admission to the ICU prior to SCT does not have a negative impact on patient outcomes following SCT and should not be considered as an exclusion criterion for SCT.
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Regaira-Martínez E, Garcia-Vivar C. The process of giving information to families in intensive care units: A narrative review. Enferm Intensiva (Engl Ed) 2021; 32:18-36. [PMID: 32763104 DOI: 10.1016/j.enfi.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/26/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022]
Abstract
AIM Information is one of the most important needs of families of critical patients. Healthcare professionals also identify the great value of communication with families to reduce their anxiety and stress. Despite this, families may feel inadequately informed, causing added suffering. The purpose of this study is to provide an understanding of both families' and healthcare professionals' perspectives on information giving within intensive care units (ICU). METHOD A narrative review was conducted using MEDLINE, CINAHL, PsycINFO databases and the Cochrane Library to identify studies published in either English or Spanish from 2002 to 2018. RESULTS 47 studies were included, and five categories were identified: 1)"the need to know"; 2)family satisfaction with the information received; 3)impact of information on families' experiences in the ICU; 4)nurses and physicians' perceptions of information transmission, and 5)information process in the ICU. CONCLUSIONS Providing honest and truthful information to the families of critical patients is essential to reduce family anxiety and increase family control, although this often appears to be inadequately accomplished by staff. Interdisciplinary involvement in information giving may be beneficial for both families and ICU professionals. This review brings new understanding about the process of information to families of ICU patients and it can be used to improve the quality and humanization of care in the ICUs.
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Ballesteros Sanz MÁ, Hernández-Tejedor A, Estella Á, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez MJ, Alcaraz Peñarrocha RM, Amézaga Menéndez R, Burgueño Laguía P. [Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. Med Intensiva 2020; 44:371-388. [PMID: 32360034 PMCID: PMC7142677 DOI: 10.1016/j.medin.2020.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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Affiliation(s)
- M Á Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | | | - Á Estella
- Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
| | | | - A Sandiumenge Camps
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - P Vidal Cortés
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - C de Haro
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Medicina Intensiva, CIBERES Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - E Aguilar Alonso
- Servicio de Medicina Intensiva, Hospital Infanta Margarita, Cabra, Córdoba, España
| | - L Bordejé Laguna
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - I García Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M García Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M J Párraga Ramírez
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | | | - R Amézaga Menéndez
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Islas Baleares, España
| | - P Burgueño Laguía
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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Bosch-Alcaraz A, Fernández-Lorenzo R, Saz-Roy MA, Domínguez-Delso MC, Santaolalla-Bertolin M, Ferrer-Orona M, Alcolea-Monge S. Comparative analysis of environmental noise levels in two paediatric intensive care units. Enferm Intensiva (Engl Ed) 2021; 32:11-7. [PMID: 32430187 DOI: 10.1016/j.enfi.2020.02.007] [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: 07/16/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 11/22/2022]
Abstract
AIMS 1) To determine noise levels in two paediatric intensive care units (PICU) of a tertiary hospital and 2) to analyse whether these values comply with the current standards. METHOD Observational, descriptive and cross-sectional study carried out in two PICU with different infrastructure: bays separated by curtains and individual bedrooms. A PCE-999 sound level meter was used to determine noise levels, which were registered in decibels (dB). At the same time, an ad hoc data recording document was designed in which we differentiated between each unit (open concept or closed), time of recording. RESULTS A total of 330 tests, 72 from open PICUs and 258 from closed PICUs were collected. The noise in the open PICU was 56.74 ± 3.61 decibels versus 50.36 ± 4.71 in the closed PICU, obtaining the highest levels during the morning. DISCUSSION As it occurs in other studies, noise levels exceed the allowed limits. At the same time, the main sources of noise in the PICU came from alarms, medical equipment, such as monitors or respirators, and conversations between health professional. CONCLUSIONS This investigation has shown high levels of environmental noise in the two PICUs analysed. The data obtained indicate that the architectural concept of individual bedrooms may have an impact in decreasing this environmental input.
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Olaechea Astigarraga PM, Álvarez Lerma F, Beato Zambrano C, Gimeno Costa R, Gordo Vidal F, Durá Navarro R, Ruano Suarez C, Aldabó Pallás T, Garnacho Montero J; grupo de estudio ENVIN-HELICS., Listado de responsables y unidades participantes en estudio ONCOENVIN ordenados por número de pacientes aportados al estudio epidemiológico. Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study. Med Intensiva 2021; 45:332-46. [PMID: 32307264 DOI: 10.1016/j.medin.2020.01.013] [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] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU). DESIGN A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified. SETTING Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry. PATIENTS Subjects admitted during over 24hours and diagnosed with cancer in the last 5 years. PRIMARY ENDPOINTS The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables. RESULTS Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1-48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; P<.001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted in ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%). CONCLUSIONS Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%).
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Acosta Pedemonte NB, Rocchetti NS, Villalba J, Lerman Tenenbaum D, Settecase CJ, Bagilet DH, Colombo LG, Gregorini ER. Bacillus cereus bacteremia in a patient with an abdominal stab wound. Rev Argent Microbiol 2020; 52:115-7. [PMID: 31791818 DOI: 10.1016/j.ram.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 07/14/2019] [Accepted: 07/19/2019] [Indexed: 11/20/2022] Open
Abstract
Bacillus cereus is a gram positive microorganism commonly involved in gastrointestinal infection but capable of causing severe infections and bacteremia. We describe here a case of bacteremia caused by B. cereus in a previously healthy young woman admitted to the intensive care unit following emergency surgery due to a penetrating abdominal stab wound and subsequent hepatic lesion. She developed fever during admission and cultures were taken. B. cereus was isolated in blood and hepatic fluid collection cultures. Treatment was adjusted according to the isolate, with good clinical results. It is important to highlight the pathogenic potential of this microorganism and not underestimate it as a contaminant when it is isolated from blood samples.
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Álvarez-Maldonado P, Hernández-Ríos G, Reding-Bernal A, Cicero-Sabido R. Eventos adversos en una nueva unidad de cuidados intensivos. Influencia del diseño y la tecnología de las instalaciones en las tasas de incidencia. GAC MED MEX 2019; 155:613-618. [PMID: 31787762 DOI: 10.24875/gmm.19005421] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction New hospitals are replacing old facilities. There is little information on the performance of an intensive care unit (ICU) when it is relocated in a new and equipped area. Objective To analyze the impact of the change of ICU facilities from a shared environment to individual beds on the occurrence of adverse events. Method Cross-sectional, comparative study, with prospectively collected data from patients admitted from March 01, 2014 to February 28, 2017 to the former ICU (f-ICU) and from July 17, 2017 to January 17, 2019 to the new ICU (n-ICU) of a public teaching hospital. The rate of adverse events was measured in events per 1,000 patient-days. Results Among 1,188 patients (f-ICU, n = 681 vs. n-ICU, n = 507), a reduction in the rate of unforeseen cardiac arrest (rate ratio: 0.31; 95% confidence interval [CI] = 0.12-0.80) and an increase in the rate of unplanned extubation (rate ratio: 2.49; 95% CI = 1.24-5.01) were observed, with both being statistically significant. The other nine monitored adverse events showed no changes. Conclusions In comparison with the f-ICU, most of the monitored adverse events did not significantly change within the first 18 months of activities at the n-ICU.
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Affiliation(s)
- Pablo Álvarez-Maldonado
- Servicio de Neumología y Cirugía de Tórax. Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Grisel Hernández-Ríos
- Servicio de Neumología y Cirugía de Tórax. Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Arturo Reding-Bernal
- Dirección de Investigación. Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Raúl Cicero-Sabido
- Servicio de Neumología y Cirugía de Tórax. Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
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Jonguitud López B, Álvarez Lara D, Sosa Medellín MA, Montoya Barajas F, Palacios Saucedo GC. Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity. Med Intensiva 2019; 45:156-163. [PMID: 31810578 DOI: 10.1016/j.medin.2019.09.021] [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: 02/13/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity. DESIGN A retrospective, longitudinal and analytical cohort study was carried out. SETTING Medical-surgical intensive care unit (ICU) of a tertiary hospital. PATIENTS Pregnant or puerperal patients of any age admitted to the ICU. INTERVENTIONS Calculation of prognostic scores upon admission. VARIABLES OF INTEREST APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality. RESULTS A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve >0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality. CONCLUSIONS The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration.
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Affiliation(s)
- B Jonguitud López
- Unidad de Cuidados Intensivos, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.(o) 25, IMSS, Monterrey, Nuevo León, México.
| | - D Álvarez Lara
- Unidad de Cuidados Intensivos, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.(o) 25, IMSS, Monterrey, Nuevo León, México
| | - M A Sosa Medellín
- Unidad de Cuidados Intensivos, Hospital de Traumatología y Ortopedia de la Unidad Médica de Alta Especialidad N.(o) 21, IMSS, Monterrey, Nuevo León, México
| | - F Montoya Barajas
- Unidad de Cuidados Intensivos, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.(o) 25, IMSS, Monterrey, Nuevo León, México
| | - G C Palacios Saucedo
- Departamento de Enseñanza, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.(o) 25, IMSS, Monterrey, Nuevo León, México
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Abella Álvarez A, Janeiro Lumbreras D, Lobo Valbuena B, Naharro Abellán A, Torrejón Pérez I, Enciso Calderón V, Varillas Delgado D, Conejo Márquez I, García Manzanedo S, López de la Oliva Calvo L, García Arias M, Gordo Vidal F. [Analysis of the predictive value of preventive isolation criteria in the intensive care unit]. Med Intensiva 2019; 45:205-210. [PMID: 31780256 DOI: 10.1016/j.medin.2019.09.022] [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: 07/08/2019] [Revised: 08/23/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). DESIGN A prospective observational study was carried out from May 2014 to May 2015. SETTING Polyvalent Intensive Care Unit. PATIENTS A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM"). VARIABLES Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. RESULTS During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77). CONCLUSIONS The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".
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Affiliation(s)
- A Abella Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - D Janeiro Lumbreras
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - B Lobo Valbuena
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - A Naharro Abellán
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - I Torrejón Pérez
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - V Enciso Calderón
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - D Varillas Delgado
- Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - I Conejo Márquez
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - S García Manzanedo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | | | - M García Arias
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España.
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Caballero J, García-Sánchez M, Palencia-Herrejón E, Muñoz-Martínez T, Gómez-García JM, Ceniceros-Rozalén I; miembros del GTSAD SEMICYUC., Anexo. Miembros de GTSAD. Oversedation Zero as a tool for comfort, safety and intensive care unit management. Med Intensiva 2020; 44:239-47. [PMID: 31733988 DOI: 10.1016/j.medin.2019.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/22/2019] [Accepted: 09/07/2019] [Indexed: 01/18/2023]
Abstract
Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.
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Nacher-Fuentes L, Sanchez-Pujol A, Rodriguez-Navarro S, Duran-Ayra L. Dexmedetomidine implementation in pain management in the immediate postoperative period of cardiac surgery. Enferm Intensiva (Engl Ed) 2019; 31:105-112. [PMID: 31694783 DOI: 10.1016/j.enfi.2019.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study arose from the need to improve all tasks related to monitoring pain in post cardiac surgery patients. OBJECTIVES Checking and quantifying the pain suffered by patients undergoing cardiac surgery in the first 24hours of their stay in the intensive care unit (ICU), treated with Dexmedetomidine (Dex) as analgesic adjuvant, as well as their degree of sedation and the need for opiates such as rescue analgesia. MATERIAL AND METHODS Unicentric study, observational, descriptive, from April 2016 to September 2017. Both genders, all adult, undergoing cardiac surgery, operating theatre-extubated and Dex continuous infusion carriers. Pain degree level was evaluated by the Visual analogue Scale of Pain (VAS), from immediately post-surgery until 24hours from ICU entry and sedation degree, by the Richmond Sedation Agitation Scale (RASS), only while the Dex infusion lasted. RESULTS 109 patients were included. The results obtained showed that the average pain suffered by patients during the first 24hours was .47 with standard deviation (SD) of 1.25; the average maximum pain experienced was 3.58 with a range of 0 to 8 and the RASS average was -.68 (SD: 0,80). In addition, 44.04% of the patients needed rescue opiates, although only 7.32% showed severe pain greater than 6. CONCLUSIONS The Dex infusion patients showed mild levels of pain, however, a small percentage, who must be taken into account, suffered severe pain.
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Affiliation(s)
- L Nacher-Fuentes
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España.
| | - A Sanchez-Pujol
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España
| | - S Rodriguez-Navarro
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España
| | - L Duran-Ayra
- Unidad de Cuidados Intensivos (UCI), Centro Médico Teknon Quirón-Salud, Barcelona, España
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Ramírez II, Adasme RS, Arellano DH, Rocha ARM, Andrade FMD, Núñez-Silveira J, Montecinos NA, Dias S, Damiani LF, Gutierrez-Arias R, Lobo-Valbuena B, Gordo-Vidal F. Identifying and managing patient-ventilator asynchrony: An international survey. Med Intensiva 2021; 45:138-46. [PMID: 31668560 DOI: 10.1016/j.medin.2019.09.004] [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: 06/15/2019] [Revised: 08/01/2019] [Accepted: 09/01/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the main factors associated with proper recognition and management of patient-ventilator asynchrony (PVA). DESIGN An analytical cross-sectional study was carried out. SETTING An international study conducted in 20 countries through an online survey. PARTICIPANTS Physicians, respiratory therapists, nurses and physiotherapists currently working in the Intensive Care Unit (ICU). MAIN VARIABLES OF INTEREST Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) and the ability of HCPs to correctly identify and manage 6 PVA. RESULTS A total of 431 healthcare professionals answered a validated survey. The main factors associated to proper recognition of PVA were: specific training program in mechanical ventilation (MV) (OR 2.27; 95%CI 1.14-4.52; p=0.019), courses with more than 100h completed (OR 2.28; 95%CI 1.29-4.03; p=0.005), and the number of ICU beds (OR 1.037; 95%CI 1.01-1.06; p=0.005). The main factor influencing the management of PVA was the correct recognition of 6 PVAs (OR 118.98; 95%CI 35.25-401.58; p<0.001). CONCLUSION Identifying and managing PVA using ventilator waveform analysis is influenced by many factors, including specific training programs in MV, the number of ICU beds, and the number of recognized PVAs.
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Vallès J, Fernández S, Cortés E, Morón A, Fondevilla E, Oliva JC, Diaz E. Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit. Med Intensiva 2019; 44:294-300. [PMID: 31378384 DOI: 10.1016/j.medin.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/27/2019] [Revised: 06/05/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the measurement of antimicrobial consumption by defined daily dose (DDD) versus by days of therapy (DOT). DESIGN Retrospective analysis of clinical and administrative data from patients admitted to a polyvalent ICU. SETTING ICU at a University Hospital in Spain. PATIENTS All patients admitted to the ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST For the DDD method, the World Health Organization (WHO)-assigned DDD was determined for the all the prescribed antimicrobials. For the DOT method, one DOT represented the administration of a single agent on a given day regardless of the number of doses administered. To express aggregate use, total DDDs and total DOTs were normalized to 100 patient-days. RESULTS During the study period, 2393 adult patients were admitted to the ICU. Total median antimicrobial drugs measured by DDDs was 535.3 (IQR 319.8-845.5) vs. 344.0 (IQR 117.2-544.5) when measured by DOTs, p<0.001. When antimicrobial consumption was normalized to 100 patient-days, median antimicrobial consumption was also higher when measured by DDDs [2.98/100 patient-days (IQR 1.76-5.25) vs. 1.89/100 patient-days (IQR 0.64-3.0) when measured by DOTs, p<0.001]. CONCLUSIONS For most antibacterial and antifungal drugs used in critically ill patients, estimates of aggregate antibiotic use by DDDs per 100 patient-days and DOTs per 100 patient-days are discordant because the administered dose is dissimilar from the WHO-assigned DDD. DOT methods should be recommended to avoid the overestimation that occurs with DDDs in adult critically ill patients.
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Affiliation(s)
- J Vallès
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain.
| | - S Fernández
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - E Cortés
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Morón
- Department of Pharmacy, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - J C Oliva
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - E Diaz
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
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Alcázar Sánchez-Elvira L, Bacian Martínez S, Del Toro Gil L, Gómez Tello V. Postoperative management in the Intensive Care Unit of head and neck surgery patients. Med Intensiva 2019; 44:46-53. [PMID: 31174894 DOI: 10.1016/j.medin.2019.05.004] [Citation(s) in RCA: 4] [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: 01/29/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 01/26/2023]
Abstract
Patient care after major head and neck surgery has changed in recent years. Tumors are the most common reasons for this type of surgery, though it is also used to treat benign conditions. Recent advances in equipment and surgical techniques have improved the postoperative course in this field, allowing early recovery, less pain and infection, a shorter hospital stay, and even better aesthetic results. This is due to the use of minimally invasive techniques, which are gaining relevance. Such techniques allow complex procedures in the head and neck region, through natural orifices or small incisions, with minimal damage and sequelae for the patients. Despite these advances, however, the complexity of the treatment intervention requires multidisciplinary patient management, mostly in the Intensive Care Unit, in order to monitor the possible occurrence of complications. Potential risk factors include previous comorbidity, the type of surgery involved (e.g., bilateral cervical lymphadenectomy), multiple transfusions, and the appearance of early complications requiring repeat surgery. Despite the existence of several studies, there are no standardized protocols for the postoperative period in surgeries of this kind. This causes many specialists to resort to accelerated recovery protocols (ERAS: "Enhanced Recovery After Surgery") that have already been established in other surgical specialties.
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Affiliation(s)
| | - S Bacian Martínez
- Departamento de Cirugía Máxilofacial,Hospital HLA Universitario Moncloa, Madrid, España
| | - L Del Toro Gil
- Departamento de Otorrinolaringología,Hospital HLA Universitario Moncloa, Madrid, España
| | - V Gómez Tello
- Departamento de Medicina Intensiva, Hospital HLA Universitario Moncloa, Madrid, España; Servicio de Urgencias, Hospital HLA Universitario Moncloa, Madrid, España; Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
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Abstract
Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1-4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. Recently, there have been significant advances related to organizational aspects, new anesthetic and surgical techniques, prognostic scales, perioperative management and greater participation and involvement of the patient. This new series of Medicina Intensiva will address fundamental aspects of how Departments of Intensive Care Medicine can add value to the surgical process, in a coordinated manner with other services. Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.
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