[Ten-year evolution of mechanical ventilation in acute respiratory failure in the hematogical patient admitted to the intensive care unit]. / Evolución de 10 años de aplicación de la ventilación mecánica en la insuficiencia respiratoria aguda del paciente hematológico ingresado en la unidad de cuidados intensivos.

OBJECTIVE: A comparison was made between invasive mechanical ventilation (IMV) and noninvasive positive pressure ventilation (NPPV) in haematological patients with acute respiratory failure. DESIGN: A retrospective observational study was made from 2001 to December 2011. SETTING: A clinical-surgical intensive care unit (ICU) in a tertiary hospital. PATIENTS: Patients with hematological malignancies suffering acute respiratory failure (ARF) and requiring mechanical ventilation in the form of either IMV or NPPV. VARIABLES OF INTEREST: Analysis of infection and organ failure rates, duration of mechanical ventilation and ICU and hospital stays, as well as ICU, hospital and mortality after 90 days. The same variables were analyzed in the comparison between NPPV success and failure. RESULTS: Forty-one patients were included, of which 35 required IMV and 6 NPPV. ICU mortality was higher in the IMV group (100% vs 37% in NPPV, P=.006). The intubation rate in NPPV was 40%. Compared with successful NPPV, failure in the NPPV group involved more complications, a longer duration of mechanical ventilation and ICU stay, and greater ICU and hospital mortality. Multivariate analysis of mortality in the NPPV group identified NPPV failure (OR 13 [95%CI 1.33-77.96], P=.008) and progression to acute respiratory distress syndrome (OR 10 [95%CI 1.95-89.22], P=.03) as prognostic factors. CONCLUSION: The use of NPPV reduced mortality compared with IMV. NPPV failure was associated with more complications.

Factors affecting sleep quality in Intensive Care Units.

OBJECTIVE: To report sleep quality and identify related factors. DESIGN: A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING: The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS: Patients admitted between February 2016 and December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS: External factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). CONCLUSIONS: Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

Factors affecting sleep quality in Intensive Care Units. / Factores que afectan a la calidad del sueño en las unidades de cuidados intensivos.

OBJECTIVE: To report sleep quality and identify related factors. DESIGN: A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING: The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS: Patients admitted between February 2016 and December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS: External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). CONCLUSIONS: Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patients. / Evaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico.

AIM: A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients. DESIGN: A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test-retest analysis. SETTING: The Department of Intensive Care Medicine of a reference hospital. PARTICIPANTS: Patients admitted between 23 February 2016 and 20 December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire. RESULTS: Item relevance and definition yielded scores >3 (Likert scale maximum=4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was >0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors. CONCLUSIONS: The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors.

Análisis retrospectivo de la ventilación mecánica no invasiva frente a la ventilación mecánica invasiva en pacientes con exacerbación de la enfermedad pulmonar obstructiva crónica, en una Unidad de Cuidados Intensivos / Retrospective analysis of the Noninvasive mechanical ventilation in front of mechanical ventilation invasive in patients with exacerbation of the disease chronic obstructive pulmonary in a Care Unit Intensive

Objetivo: Análisis comparativo de la ventilación no invasiva frente a la ventilación mecánica invasiva en la exacerbación de la enfermedad pulmonar obstructiva crónica. Diseño: Cohorte retrospectiva (enero 2006- diciembre 2012). Ámbito: Unidad de Cuidados Intensivos médico-quirúrgica. Pacientes: Se analizaron 142 pacientes con insuficiencia respiratoria aguda hipercápnica. Intervenciones: Ninguna. Variables de interés: Infecciones (bacteriemia, neumonía intrahospitalaria, infección urinaria), necesidad de traqueotomía, insuficiencia renal aguda, síndrome de dificultad respiratoria aguda, estancias en la Unidad de Cuidados Intensivos y hospitalaria, duración de la ventilación mecánica y mortalidad en la Unidad de Cuidados Intensivos, hospitalaria y a los 6 meses.Resultados: Ciento veintiún pacientes (86%) recibieron ventilación no invasiva y 20 (14%), ventilación invasiva. Un paciente no recibió soporte ventilatorio. Al ingresar, el grupo de ventilación invasiva presentaba mayor deterioro gasométrico, hemodinámico y neurológico que el grupo de ventilación no invasiva. No hubo diferencias en la tasa de infecciones, la necesidad de traqueotomía, las complicaciones, la duración de la ventilación mecánica, las estancias, ni la mortalidad. Los pacientes en quienes fracasó la ventilación no invasiva presentaron mayor mortalidad comparados con el otro grupo. Conclusiones: La ventilación no invasiva fue el soporte ventilatorio más frecuente en los pacientes con exacerbación de la enfermedad pulmonar obstructiva crónica en nuestra Unidad. Los pacientes con ventilación invasiva tuvieron una evolución clínica muy semejante a la de aquellos sometidos a ventilación invasiva, sin que ello haya supuesto una mayor mortalidad. (AU)

Objective: Comparative analysis of non-invasive ventilation versus invasive ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Design: Retrospective cohort (January 2006-December 2012). Setting: Medical-surgical Intensive Care Unit. Patients: One hundred and forty-two patients with exacerbation of chronic obstructive pulmonary disease were analyzed. Variables of interest: Infections (bacteremia, nosocomial pneumonia, urinary infection), need for tracheostomy, acute renal failure, acute respiratory disease syndrome, lenght of stay at the Intensive Care Unit and hospital, duration of mechanical ventilation and mortality at the Intensive Care Unit, hospital and after 6 months. Results: One hundred and twenty-one patients (86%) underwent non-invasive ventilation and 20 (14%) received invasive ventilation. One patient did not receive ventilatory support. At admission, blood gases, and hemodynamic and neurological parameters were worse in the invasive ventilation group compared with the non-invasive ventilation group. Infection rate, need for tracheostomy, complications, duration of mechanical ventilation, length of stay, and mortality did not show differences. Mortality was higher in patients who failed non-invasive ventilation. Conclusions: Non-invasive ventilation was the most common ventilatory support in patients with exacerbation of chronic obstructive pulmonary disease in our Intensive Care Unit. Patients with invasive ventilation had the same clinical course compared to the non-invasive group, without entailing increased mortality.(AU)