[Diagnostic blood losses in severe trauma patients]. / Pérdidas sanguíneas diagnósticas en pacientes con trauma grave.

OBJECTIVE: To analyze diagnostic (blood drawings) and iatrogenic (Continuous Renal Replacement Therapy, CRRT) blood losses (BL) in severe trauma patients. METHOD: A one-year descriptive, prospective and observational study. We included patients over 15 years of age, admitted with severe trauma and who had a score of > or =16 on the Injury Severity Index (ISS). Those patients in whom limitation of therapeutic effort had been indicated were excluded. A total of 225 patients with 1619 days of evolution were analyzed for volume of BL/day/patient, type of diagnostic test, clinical outcome and utilization of CRRT. The variables were described as mean +/- standard deviation with the Student's T test. RESULTS: Average blood loss of patient per day was 55.5+/-32.2 cc. Statistically significant differences were found between the blood volume drawn when the first day was compared to the second day, 73.5+/-32.2 vs. 56.3+/-21.9 (p<0.001); clinical outcome (alive vs death) 54.8+/-33 vs. 60.7+/-24.9 (p<0.05); severity (ISS<31 or > or =31) 54.65+/-20 vs. 61.5+/-28.5 (p<0.001), No RRT vs RRT: 50.9+/-18.9 vs. 97.2+/-72.6 (p<0.001). CONCLUSIONS: The greatest diagnostic BL occurs during the resuscitation phase, in the patients who die, in those with greater severity and those undergoing CRRT.

[An analysis of the reliability of 2 types of enteral nutrition pumps]. / Análisis de la fiabilidad en dos tipos de bombas de nutrición enteral.

The main advantages of infusion pumps are their enhanced accuracy and safety in providing enteral nutrition. We proposed to observe pumps reliability in connection with a variety of factors such as the type of pump used, the administration rate and the energy density of the diets used. An experimental design was prepared with two types of enteral nutrition pumps-VP, volumetric pump, and PP, peristaltic pump. The clinical simulation was done by connecting the enteral nutrition equipment to a graduated dosing system, making hourly measurements of the volume infused. The Reliability Index (RI) used was the ratio between the volume infused by the pump and the regulated dose (Vi/Do). Five volumetric pumps (FLEXIFLO COMPANION) and five peristaltic pumps (FLEXIFLO II) were selected at random from a single commercial outlet. Each was used for twenty-three hours, without interruption, to infuse five types of diet with different energy densities (D1:2 Kcal/ml, D2: 1.5 Kcal/ml, D3: 1.25 Kcal/ml, D4: diet with fibre, and D5: reconstituted powder diet) at three different flow rates (40, 80 and 120 ml/h), to provide fifteen experimental conditions with each pump. Reliability was maintained for both types of pump within the margin of error claimed by the manufacturer (+/- 10%) except in the first hour of infusion (RI = 71.4%). Comparison of the overall RI between the two pump types revealed significant differences, with an RI below the reference range for the VP only during hour 23 (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Quality control of nursing records]. / Control de calidad en los registros de enfermería.

Nursing records are one of the main sources of information about the status of patients admitted to intensive care units. In spite of its importance, this information is not always written down. The objective of this study was to analyze the level of compliance and content of sections related with nursing records, overall and by shifts. A retrospective analysis was made of 14 variables in 358 nursing charts chosen randomly, involving a total of 1.075 shifts. The study variables analyzed were: 1) monitoring, 2) medication, 3) losses, 4) nursing incidents, 5) cures, 6) changes, 7) pressure sores, 8) physical therapy, 9) respirator recordings, and 10) nurses' comments (classified by content into 11) systems, 12) priorities, 13) personal observations, and 14) duplication of information. Nursing records related with medical therapy had a significantly better compliance than records of nursing activities per se. When the variables were analyzed by shifts, the only statistically significant variable was nurses' comments. Systems being the modality most frequently used. We conclude that nursing records, which inform us of the patient's status, showed a good level of compliance. Records of therapeutic medical activities were of better quality than those directly related with nursing activities per se.

[Analysis and handling of the jugular catheter in the determination of cerebral anoxia]. / Análisis y manejo del catéter yugular en la determinación de la extracción de oxígeno.

The increase in the incidence of Craneoencephalic Trauma takes us to the search of new techniques such as the calculus of the Fraction of Oxygen Brain Extraction, determined by the channelling of the jugular bulb and later extraction of cerebral venous gasometries simultaneously to peripheric arterial gasometries. The aim of our work is to let Nursing know its handling as well as the diagnostic and therapeutical advantages and their associated complications. We conclude that this technique shows important advantages in the handling of endocraneal hypertension without being a work overload for Nursing. We suggest a performing guide to avoid the most common complications during its maintainance.

Pérdidas sanguíneas diagnósticas en pacientes con trauma grave / Diagnostic blood losses in severe trauma patients

ObjetivoExaminar el perfil de pérdidas sanguíneas diagnósticas (extracciones analíticas) e iatrogénicas (técnicas de depuración extracorpórea [TDE]) en pacientes con trauma grave.MétodoEstudio descriptivo observacional prospectivo durante un año. Incluimos aquellos pacientes mayores de 15 años ingresados por trauma grave con Injury Severity Score (ISS) superior o igual a 16 puntos. Excluimos a aquellos pacientes a los que se hubiera indicado limitación del esfuerzo terapéutico. De 225 pacientes, con 1.619 días de evolución, analizamos volumen perdido/día/paciente, tipo de extracción, evolución clínica y presencia o no de TDE. Las variables se expresan como media±SD comparadas con la prueba de la t de Student.ResultadosEl promedio de pérdidas hemáticas/paciente/día ha sido de 55,5±32,2cm3. Encontramos diferencias estadísticamente significativas en el volumen sanguíneo extraído, comparando el primer día respecto al segundo (73,5±32,2 vs. 56,3±21,9cm3; p<0,001); evolución clínica (alta o éxitus) (54,8±33 vs. 60,7±24,9; p<0,05); gravedad (Injury Severity Score<31 o ≥31) (54,65±20 vs. 61,5±28,5; p<0,001) y sin TDE/TDE (50,9±18,9 vs. 97,2±72,6; p<0,001).ConclusionesLa mayor pérdida de sangre diagnóstica se produce en la fase de resucitación, en los pacientes que fallecen, en aquellos con mayor gravedad y los sometidos a TDE (AU)

ObjectiveTo analyze diagnostic (blood drawings) and iatrogenic (Continuous Renal Replacement Therapy, CRRT) blood losses (BL) in severe trauma patients.MethodA one-year descriptive, prospective and observational study. We included patients over 15 years of age, admitted with severe trauma and who had a score of ≥16 on the Injury Severity Index (ISS). Those patients in whom limitation of therapeutic effort had been indicated were excluded. A total of 225 patients with 1619 days of evolution were analyzed for volume of BL/day/patient, type of diagnostic test, clinical outcome and utilization of CRRT. The variables were described as mean ± standard deviation with the Student's T test.ResultsAverage blood loss of patient per day was 55.5±32.2cc. Statistically significant differences were found between the blood volume drawn when the first day was compared to the second day, 73.5±32.2 vs. 56.3±21.9 (p<0.001); clinical outcome (alive vs death) 54.8±33 vs. 60.7±24.9 (p<0.05); severity (ISS<31 or ≥31) 54.65±20 vs. 61.5±28.5 (p<0.001), No RRT vs RRT: 50.9±18.9 vs. 97.2±72.6 (p<0.001).ConclusionsThe greatest diagnostic BL occurs during the resuscitation phase, in the patients who die, in those with greater severity and those undergoing CRRT (AU)