[Physicians' attitudes and perceptions regarding the critical care and critical care specialty]. / Actitudes y percepciones del personal médico del hospital acerca de los Cuidados Intensivos y de la especialidad de Medicina Intensiva.

OBJECTIVE: To evaluate the attitudes and perceptions of the doctors of a hospital regarding critical care and the speciality of Intensive Medicine. DESIGN: Prospective, descriptive study during 3 months. SETTING: Insular University Hospital in Gran CanaRia, Canary Islands, Spain. PATIENTS: Medical specialists and residents. INTERVENTION: Anonymous survey. MAIN VARIABLES: Demographic data of the interviewed doctors were collected and they were asked about their labour or personal previous relation with the Intensive Care Unit (ICU), the attitudes of the critical care doctors' of their hospital and their perceptions regarding the critical care speciality. RESULTS: We interviewed 116 doctors, 75 staff and 41 residents. Less of the third part believed that the ICU was a ward for potentially critical patients. A high percentage of the doctors whom had been refused some admission were not to agree with the arguments that they received. More than 40% of the interviewed ones affirmed had not requested bed in the ICU for any patient who had benefited from it, especially because they were thinking that the admission would be refused. Some doctors think that the professio - nals employed at the ICU are doctors of different specialities. The speciality of Intensive Medicine is perceived by a high level of stress among the professionals. CONCLUSIONS: We detect the ignorance of other professionals about the function of a Service of Intensive Medicine and the model of ICU of our country. Also we find high rates of dissatisfaction among the professionals who was refused some admission in the unit, because of we believe that clinical guides about the criteria of admission must be elaborated and to announce them among the doctors of the hospital. The professionals perceive that we suffer a high level of stress.

[Characteristics and prognosis of patients with very long stay in an Intensive Care Unit]. / Características y pronóstico de los pacientes mayorescon estancia muy prolongadaen una Unidad de Cuidados Intensivos.

OBJECTIVE: To describe the characteristics and prognostic factors of elderly patients hospitalized for > or = 30 days in an Intensive Care Unit (ICU). DESIGN: Retrospective analysis of prospectively collected simple data over 6 consecutive years. SETTING: Polyvalent ICU of the Insular University Hospital in the Canary Islands (Spain). PATIENTS: Adult patients > or = 70 years who were hospitalized in the ICU for a period of 30 or more days. PRIMARY VARIABLES OF INTEREST: Demographic data, clinical diagnosis on ICU admission, Apache II, days of renal replacement therapy (RRT), days of mechanical ventilation and the outcome of the survivors one year later were collected. Mortality at one year of the surviving patients was studied. RESULTS: During the study period, 3,786 patients were admitted to the ICU. Of these, 853 (22.5%) patients were > or = 70 years old and only 42 (4.92%) of these patients remained in the ICU for > or = 30 days. We compared the latter with the > or = 70 year old patients whose stay in the ICU stay was < 30 days. No statistically significant differences in ICU mortality, Apache II, age, gender and the need for RRT were found. As independent variables associated with the long stay, the multivariate analysis showed only the days of mechanical ventilation (p < 0.05). The surviving patients (> or = 70 years old and whose stay in the ICU was > or = 30 days) were older and 21 (65.62%) were still alive one year later. CONCLUSIONS: ICU mortality rates in elderly patients with a stay < or > or = 30 days in the ICU were comparable. Survival at one year of the > or = 70 year-old patients whose long-term intensive care unit stay was > or = 30 days was high. These results are sufficient in our unit to justify prolonged ICU care for elderly patients.

[Needs of the family of intensive care patients: perception of the family and the professional]. / Necesidades de los familiares de pacientes de Cuidados Intensivos: percepción de los familiares y del profesional.

OBJECTIVE: Compare the degree of family satisfaction of patients admitted to our intensive care unit (ICU) with the perception of the professional on the care setting and information received. DESIGN: Prospective, descriptive study during 3 months. SETTING: ICU of the University Hospital Insular of the Canary Islands. SUBJECTS: Family of adult patients admitted to the ICU who were discharged to the ward and the professionals who treated them. INTERVENTION: Personal survey to direct family members of the patients when they are in the ward. The same survey, but modified for the professional, was used on the perception that they believed the family had. VARIABLES OF PRINCIPAL INTEREST: Demographic data of the patient, family, and professional interviewed were collected and they were asked questions on the environmental conditions, relationship and quality of the information by the staff and the organization of the visits. RESULTS: A total of 52 family members and 69 staff members were interviewed. The professional overestimated the needs of the family members in regards to noise, lighting, comfort, privacy, adequacy of the waiting room and information on the care received. The professional, on contrary to the family, thought that they were adequately informed about the apparatuses used and that they knew the name of the nurse. Both groups coincided that they knew the name of the doctors, that they were informed of the situation on admission, that the visiting hours were adequate, that more than 2 family members could go into the box and that they were more comfortable if they could be sitting down. CONCLUSIONS: Satisfaction of the family was greater than that of the professional interviewed. We stress the need to improve the waiting room, personalized care and the need to individually evaluate flexibility in the visiting hours.

[Satisfaction survey administered to the relatives of critical patients]. / Encuesta de satisfacción a los familiares de pacientes críticos.

OBJECTIVE: To know the family needs of patients admitted to our Intensive Care Unit (ICU). DESIGN: Prospective, descriptive study performed over a 6-month period. SETTING: ICU of the Insular University Hospital in Gran Canary Islands. PARTICIPANTS: Adult patients admitted to the ICU for more than 48 hours who were discharged to the hospitalization ward. INTERVENTION: A modified Society of Critical Care Medicine Family Needs Assessment instrument was administered to the first-degree relatives of patients after discharge by face-to-face interviews by not-informing personnel. MAIN VARIABLES: Data were gathered on demographic information on the patients and their interviewed relatives, reason for admission, and evaluation on information, care, empathy with the personnel and comfort. RESULTS: Family members of 99 patients were interviewed. A total of 80% of those interviewed considered the information had been in terms that they could understand, that they understood what was happening to the patient and why things were being done. However, 74% answered that the personnel had never explained the equipment being used. About 90% thought that they had received sincere information and that adequate care was being given. Considering empathy with the personnel, almost all considered they were nice but that 73% of them had never been asked if they needed anything. A total of 85% of them were sure that someone would phone them if there was any significant change in their relative's condition, and they felt comfortable during the time of visit; 74% did not feel alone or isolation. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their relatives in the intensive care unit, but the need to improve some aspects of the communication with families was identified.

[Quality of artificial nutritional support in an intensive care unit]. / Calidad del soporte nutricional artificial en una unidad de cuidados intensivos.

OBJECTIVES: To assess what are the reasons for discrepancies between the amount of nutrients delivered, prescribed and theoretical requirements, in an intensive care unit. DESIGN: Prospective cohort study over a 5 months period. SETTING: Intensive Care Unit of the Insular University Hospital in Gran Canaria. PATIENTS: Adult patients who were prescribed enteral and or parenteral nutrition for > or = 2 days and we followed them for the first 14 days of nutrition delivery. INTERVENTION: The prescribed and the delivered calories were calculated every day, whereas the theoretical requeriments were calculated after the ICU stay, by using the Harris-Benedict formula adjusted with a stress factor. Also the reason for cessation of enteral tube feeding > 1 hour in the days of artificial nutrition were analyzed. RESULTS: Fifty-nine consecutive patients, receiving nutritional support either enterally or intravenously, and 465 nutrition days analyzed. Nutrition was initiated within 48 hours after ICU admission. Enteral nutrition was the preferential route used. Seventy-nine percent of the mean caloric amount required was prescribed, and 66% was effectively delivered; also 88% of the amount prescribed was delivered. The low ratio of delivered-prescribed calories concerned principally enteral nutrition and was caused by gastrointestinal intolerance. We observe a wide variation in practice patterns among physicians to start, increase, reduce or stop enteral nutrition when symptoms of intolerance appear. CONCLUSIONS: In our ICU exists an important difference between the caloric theoretical requests and the quantity really delivered; this deficit is more clear in the enteral nutrition. The knowledge of this situation allows to take measures directed to optimizing the nutritional support of our patients. Possibly the motivation in the medical and nursery personnel in carrying out nutritional protocols it might be the most effective measurement, which it would be necessary to confirm in later studies.

[Acute coronary syndrome without ST elevation during pregnancy. A case report]. / Síndrome coronario agudo sin elevación del ST durante el embarazo. A propósito de un caso.

Ischemic heart disease in the young woman is rare, and even more so in the pregnant woman, but it is reasonable to expect an increase with the increasing average age of children bearing. The etiology of acute coronary syndrome during pregnancy can be divided into two main groups: atherosclerotic mechanisms, more common in older mothers, and non-atherosclerotic mechanisms like dissection, coronary spasm and thrombosis. Management of these patients remains difficult; the treatment should follow the usual principles of care for acute coronary syndrome but taking in account that many standard treatments, such the angiotensin converting enzyme inhibitors, are contraindicated. There is also little experience with many of the newer treatments such as clopidogrel and IIb/IIIa glycoprotein inhibitors or percutaneous coronary intervention. We describe a case of a 38-week pregnant woman who suffered an acute myocardial infarction without ST segment elevation and review the literature.