Evaluation and handling of constipation in critical patients. / Evaluación y abordaje del estreñimiento en el paciente crítico.

OBJECTIVE: To evaluate the effectiveness of nursing care against constipation and to identify, analyze and evaluate causes and consequences. METHODOLOGY: Observational, descriptive and prospective study in polyvalent ICU tertiary hospital (2013-2015). INCLUSION CRITERIA: >18 years, stay >7 days, connected to respiratory support, with nasogastric tube and enteral or mixed nutrition. Patients with gastrointestinal pathology, encephalopathic and jejunostomy/ileostomy were excluded. The studied variables (age, sex, weight, height, pathology, medical treatment, nutrition and volume type, depositional characteristics, quantity and frequency, corrective measures and complications) were collected by ad hoc grill. It is authorized by the CEIC. RESULTS: 139 patients with a mean age of 62 years and average stay of 11 days were analyzed; 63% suffered from constipation. Opiates and antacid were the drugs administered most frequently (99%), even though patients who took muscle relaxants, iron supplements and/or calcium and anti-hypertensive were the ones who suffered most from constipation (77%; 75%; 70%) The fiber free diet was the most widely used (60% constipated), followed by dietary fiber (51% constipated), and the combination of both (85% constipated). 56% used laxatives as a corrective measure, Magnesium Hydroxide being the most widely used; 54% began the first day. Gastric retention was the most relevant complication (49%). CONCLUSION: Constipation is a real multifactorial problem. We recommend: • Intensified surveillance in patients with drugs that promote constipation. • Use high-fiber diets from the outset. • Apply laxatives and prokinetics early and in combination. We need to create a protocol for prophylaxis and management of constipation.

[Perspective of intensive care nursing staff on the limitation of life support treatment]. / Perspectiva de los profesionales de enfermería de unidades de cuidados intensivos sobre la limitación del tratamiento de soporte vital.

OBJECTIVE: To determine the perspective of intensive care nursing staff on the limitation of life support treatment (LLST) in the Intensive Care Units. METHOD: An exploratory qualitative study was carried out by applying the theory of Strauss and Corbin as the analysis tool. Constructivist paradigm. POPULATION: Nursing staff from three Intensive Care Units of Hospital Universitari de Bellvitge. Convenience sampling to reach theoretical saturation of data. Data collection through semi-structured interview recorded prior to informed consent. Rigor and quality criteria (reliability, credibility, transferability), and authenticity criteria: reflexivity. Demographic data was analysed using Excel. RESULTS: A total of 28 interviews were conducted. The mean age of the nurses was 35.6 years, with a mean seniority of 11.46 years of working in ICU. A minority of nurses (21.46%) had received basic training in bioethics. The large majority (85.7%) believe that LLST is not a common practice due to therapeutic cruelty and poor management with it. There is a correlation with the technical concepts; but among the main ethical problems is the decision to apply LLST. Nurses recognise that the decision on applying LLST depends on medical consensus with relatives, and they believe that their opinion is not considered. Their objective is trying to avoid suffering, and assist in providing a dignified death and support to relatives. CONCLUSIONS: There is still a paternalistic pattern between the doctor and patient relationship, where the doctor makes the decision and then agrees with the relatives to apply LLST. Organ failure and poor prognosis are the most important criteria for applying LLST. It is necessary to develop a guide for applying LLST, emphasising the involvement of nurses, patients, and their relatives.

[Innovations in continuing/permanent education methods for the intensive care nurses]. / Innovaciones en los métodos de formación continuada/permanente de las enfermeras de cuidados intensivos.

Intensive care nursing is carried out in a dynamic environment characterized by the continuous incorporation of new technologies, approaches to care and a request for safety, participation and transparency by the public. Continuing/permanent intensive care nursing training in the acquisition of new competencies is key in this setting. In order to achieve this goal, simulation and problem based learning should be incorporated as essential methodologies to teach these skills. At the same time research should be done on which attitudes, competences, and knowledge are necessary to increase their intellectual knowledge. The core characteristics of ICU and its nursing should allow a deep change in their approach to continuing/permanent nursing education.

[INDUCED HYPOTHERMIA AFTER CARDIAC ARREST]. / Hipotermia inducida posparada cardiorrespiratoria.

INTRODUCTION: Sudden cardiac death in adults remains a challenge in cardiovascular medicine. Cardiac arrest often drives neurological damage resulting from cerebral hypoxia, causing a series of cellulose tissue alterations that lead to brain injury. Therapeutic hypothermia decreases oxygen demand acting as protection to the brain. OBJECTIVES: To describe the casuistry of hypothermia after retourn of spontaneous circulation (ROSC) at Bellvitge University Hospital (BUH) from 2009 to 2012. Develop a tracking sheet of the induced hypothermia process. Reflect professional experience of induced hypothermia after cardiac arrest through a case. METHODOLOGY: Retrospective descriptive study of the 54 cases, 45 men and 9 women, aged between ages 57 (15 to 80) years old treated with hypothermia after ROSC at BUH. Analysis of sociodemographic variables, specific variables and description of the inclusion criteria for hypothermia. Design of nursing record to express standardized care to undertake during the HI and its pilot trial. Monitoring a 60 years old patient who suffers cardiopulmonary arrest and is subjected to hypothermia. RESULTS: Leading cause of cardiopulmonary arrest is acute coronary syndrome (ACS) (63%). Most representative initial rhythm is pulseless ventricular tachycardia/ventricular fibrillation (PVT/VF) (68.5%). There is longer survival in patients whose CPR is less than 30 minutes. The.target temperature of the patients was 33 °C for 24 hours, except for 5 patients who were stopped because of hemodynamic instability. At discharge, 54% were exitus, 4% had severe encephalopathy, 11% mild encephalopathy and 31% without neurological sequel. The applicability of the nursing record that was created for the HI process was checked, which allowed a fast overview of the procedure. It describes the clinical status of the case on admission, during the HI, at 48 hours, at discharge from the coronary care unit (CCU) and at discharge. DISCUSSION: The data collected between 2009 and 2012 of patients with cardiopulmonary arrest candidates to hypothermia showed a favorable neurological recovery within the surviving patients. Additionally, patients with cardiopulmonary arrest not prolonged have a better prognosis agreeing with ROSC previous studies. CONCLUSIONS: Hypothermia is a viable therapy for patients who have undergone cardiopulmonary arrest. It is important to make a specific assessment of each case as well as agree the track record of care applied to these patients to subsequently allow their assessment.

[Effect of music on anxiety and pain in patients with mechanical ventilation]. / Efecto de la música sobre la ansiedad y el dolor en pacientes con ventilación mecánica.

UNLABELLED: The power of music to relieve anxiety or pain has been widely used throughout history. OBJECTIVE: To evaluate effects of music on anxiety and pain in patients on invasive mechanical ventilation. DESIGN: A randomized controlled trial with repeated measures. MATERIAL AND METHOD: This was a randomized, experimental prospective study in a tertiary hospital conducted from January 2009 to June 2010. The sample was made up of 44 participants. Intervention consisted in a 30-minute musical session in which the subject used a headset and was in an individual room. For the control group, the usual setting of an intensive care unit was maintained unchanged. Each patient underwent a minimum of 3 and maximum of 5 sessions. The patient per se selected the music from among a selection prepared by the investigator team. Anxiety and pain and hemodynamic variables of heart rate, respiratory rate systolic and diastolic blood pressure were measured at baseline, after the music session and then one-hour later. RESULTS: Music therapy significantly decreased anxiety score (P=.000) when measured with the State-Trait Anxiety Inventory (STAI) scale. There were no differences in pain in the experimental group (P=.157) when measured with the visual analogue scale. No summative effects were demonstrated during multiple sessions. CONCLUSION: Music reduces anxiety in patients with invasive mechanical ventilation. Invasive mechanical ventilation can be established as a non-pharmacologic tool added to the available therapeutic options.

[Evolution in muscle strength in critical patients with invasive mechanical ventilation]. / Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva.

OBJECTIVE: To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD: A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. INCLUSION CRITERIA: Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS: Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC<48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P<.007) and a longer ICU stay. (P<.003). CONCLUSION: The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay.

Transitions and empowerment theory: A framework for nursing interventions during intensive care unit patient transition.

OBJECTIVES: 1) To explore the main characteristics of intensive care unit transition according to patients' lived experience and 2) To identify nursing therapeutics to facilitate patients' transition from the intensive care unit to the inpatient unit. METHODOLOGY: Secondary Analysis (SA) of the findings of a descriptive qualitative study on the experience of patients admitted to an ICU during the transition to the inpatient unit, based on the Nursing Transitions Theory. Data for the primary study were generated from 48 semi-structured interviews of patients who had survived critical illness in 3 tertiary university hospitals. RESULTS: Three main themes were identified during the transition of patients from the intensive care unit to the inpatient unit: 1) nature of ICU transition, 2) response patterns and 3) nursing therapeutics. Nurse therapeutics incorporates information, education and promotion of patient autonomy; in addition to psychological and emotional support. CONCLUSIONS: Transitions Theory as a theoretical framework helps to understand patients' experience during ICU transition. Empowerment nursing therapeutics integrates the dimensions aimed at meeting patients' needs and expectations during ICU discharge.

[Does noninvasive ventilation avoid intubation of the critical patient?]. / ¿Evita la ventilación no invasiva la intubación del paciente crítico?

In recent years we have witnessed an increased use of noninvasive ventilation (NIV) in our intensive care units (ICUs). Its use is intended mainly in cases of acute respiratory failure (ARF), in order to improve arterial oxygenation, increase alveolar ventilation, decrease work of breathing and avoid intubation. For this reason, we designed a study that has aimed to quantify the number of patients who have benefited from NIV during their admission, to know the type of NIV used in these patients and to determine whether the use of NIV has avoided tracheal intubation. We performed a retrospective, observational and descriptive study in two polyvalent ICUs of a tertiary hospital, with 80 patients with NIV during admission. 65% men and 35% women. Mean age: ±61 years (47-75). Average stay: ±10 days (2-18). NIV mode used was double positive pressure with Nellcor Puritan Bennett® 840. A total of 46% of patients treated with NIV required intubation, thus extending their stay in the ICU by ±6 days. Most patients treated with NIV had a history of chronic obstructive pulmonary disease (COPD) and / or were carriers of VNI with continuous positive pressure (CPAP) at home. Following this analysis, we concluded that treatment with NIV did not prevent tracheal intubation in a considerable number of patients (37) diagnosed with ARF and the NIV was effective in patients with a history of COPD and / or CPAP at home.

Emotional intelligence of intensive care nurses in a tertiary hospital.

Emotional intelligence is defined as "the ability to perceive, assimilate, understand and regulate one's own emotions and those of others, promoting emotional and intellectual growth." The published evidence on the emotional intelligence of nursing staff in charge of a critical area patient in a tertiary hospital is scarce. OBJECTIVE: To analyse the emotional intelligence of nursing staff in the critical patient area. METHODOLOGY: A descriptive, cross-sectional, single-centre study carried out in nursing staff of the Intensive Care Units (ICUs) of a tertiary hospital in Catalonia (September 2016). Variables studied: age, gender, work experience in ICU (years worked), and median score (range) of the dimensions of the Meta Mood Trait Scale (TMMS-24) with three dimensions: 1) Emotional attention (I am able to feel and express my feelings adequately); 2) Clarity of feelings (I understand my emotional states well); 3) Emotional repair (I am able to regulate emotional states correctly). A descriptive analysis was undertaken. RESULTS: All active nursing staff (n = 103) were asked to participate in the study: 92 (89%) accepted and completed the questionnaire (75 (82%) women, 17 (18%) men); 51 (55%) were aged between 21 to 30 years-old, and had more than 6 years of working experience in ICU. The median scores (range) of the different dimensions of the TMMS-24 questionnaire by gender (women/men) were respectively: 1) Emotional attention: 24 (12-37) [Adequate: 25 to 35]; 23 (18-31) [Adequate: 22 to 32]; 2) Clarity of feelings: 29 (15-40) [Adequate: 24-34]; 27 (18-34) [Adequate: 26-35]; 3) Emotional repair: 28 (13-40) [Adequate: 24-34]; 29 (18-39) [Adequate: 24-35]. CONCLUSIONS: The emotional intelligence of the nursing staff was adequate in the dimensions of clarity of feelings and emotional repair. However, it was not adequate in the dimension of emotional attention, therefore it is an area to improve.

[Assessment of changes in body composition in critically ill patients]. / Valoración en la variación de la composición corporal del enfermo crítico.

Critically ill patients are especially prone to malnutrition because their hypermetabolic state produces an increase in nutritional requirements that often are not covered with the formulae supplied. Evaluation of the body composition (BC) makes it possible to quantify the main structural components of the body: muscle, bone and fat. An anthropometry study was made for the assessment of these elements to obtain information on the protein-calorie nutritional status of critically ill patients. We have aimed to describe the variations in the BC of the critical ill patient during the first seven days after ICU admission. The observational study included 50 critically ill patients, of whom 78% were male and 22% women with a mean age of 56 years. Height, weight, body mass index (BMI), bone diameters, muscle perimeters and skinfolds of patients were recorded. The body composition (BC) calculations were performed using the Faulkner, Rocha, Wurch and Matiegka formulae. We obtained the baseline energy expenditure of each patient with the Harris-Benedict formula. After analyzing the data, a decrease was found in the percentage of muscle mass (mean+/-SD: 3+/-0.76), an increase in the percentage of body fat (2+/-0.76) and an increase in BMI at the expense of an augment of weight. We have concluded that during the first week of ICU admission patients lose critical muscle mass and have an increase in fat mass. Awareness of these changes in the BC of patients may be useful to determine the appropriate nutrition for critically ill patients.

Reflections arising from the COVID-19 pandemic. / Reflexiones derivadas de la pandemia COVID-19.

While we were drafting the recommendations for the joint contingency plan between the Spanish Society of Intensive Care and Coronary Unit Nursing (SEEIUC) and the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), predictions were overtaken by events with regard to the magnitude of the COVID-19 pandemic. Members informed us of the lack of personal protection equipment (PPE), the rapid provision of improvised ICUs in various hospital areas and the recruitment of nurses to cover shifts. The failure to recognise the specialty of critical care nursing, included in the macro-specialty of medical-surgical nursing and not yet developed, has highlighted the urgent need to learn from our mistakes: specialisation, increase the number of nurses in teams and protect the public health system.

[Contingency plan for the intensive care services for the COVID-19 pandemic]. / Plan de contingencia para los servicios de medicina intensiva frente a la pandemia COVID-19.

In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.

[Sterile film as a barrier method in central venous catheter placement]. / Film estéril como método de barrera en la colocación del catéter venoso central.

Sepsis related to central venous catheter (CVC) is an important reason of nosocomial infection in which most of the causal microorganisms are originated in the patient's skin. This study aims to evaluate the efficiency of a sterile film as a method of antimicrobial barrier in the placement of CVC. We have studied the infection incidence and the number of days of the catheter placement in two groups, one experimental group in which the CVC was inserted through a sterile adherent film and another group in which the CVC was inserted according to the current hospital protocol. This is a randomized experimental quantitative study in the setting of an Intensive Care Unit (ICU) of the Bellvitge University Hospital. Our study sample was made up of 100 critical patients. The effectiveness of this film was measured by controlling the infection incidence in the different groups, using a point of insertion smear, culture of the catheter tip and blood cultures after withdrawal. The results were interpreted according to the criteria of the ICACC (Interscience Conference on Antimicrobial Agents and Chemotherapy). A decrease of the percentage of positive smears (12.3%), positive tops of catheter (6.1%) and bacteriemia related to the catheter (8.9%) with the use of the barrier method has been demonstrated. We conclude that using the polyethylene hypoallergenic sterile adherent film is an effective antimicrobial barrier method in insertion of the CVC.