[Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19]. / Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2.

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p = 0.002), location (p < 0.001) and median duration of hours per PD episode (p = 0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

[Complications of peripheral parenteral nutrition. Clinical observations of 2 cases]. / Complicaciones de la nutrición parenteral periférica. Observación clínica de 2 casos.

INTRODUCTION: Peripheral parenteral nutrition (PPN) is artificial nutrition used when digestive absorption is insufficient. It supplies the nutritional needs of the patient and permits administration through a peripheral catheter. WE PRESENT 2 CLINICAL CASES: The first one entails an epidermolisis through extravasation masked by temporo-spatial disorientation of the patient with appearance of flictenes (blisters). Prolonged treatment and consultation with plastic surgery were required. The second case entails a chemical phlebitis with early detection by nursing professionals. It was resolved with short term treatment and did not require consultation with the plastic surgeon. PLANNING CARE: We elaborated a care plan aimed at identifying real or potential problems related with possible complications of intravenous PPN administration, such as phlebitis and extravasation. The aim of this research was prevention, early detection and treatment. DISCUSSION: Phlebitis is related with catheter characteristics, in-dwelling time and high osmolarity of PPN. Early action decreases injury of the affected tissue. In case 1, the patient requires 19 days of curing. This was only 72 h in case 2. CONCLUSION: The nursing staff plays an essential role in catheter election, localization, administration and preventing complications. Staff training and a procedure protocol greatly reduce the incidence of phlebitis, avoid discomfort for the patient and reduce health care cost.

Bariatric surgery in patients with preoperative therapeutic anticoagulation: a 2015-2021 MBSAQIP database study.

BACKGROUND: The link between obesity and adverse cardiovascular events is well-established. With the rising prevalence of metabolic and bariatric surgery (MBS), a greater number of patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) may present with preoperative therapeutic anticoagulation (AC). OBJECTIVES: This study evaluated perioperative outcomes of SG and RYGB in patients on preoperative AC. SETTING: Patients reported to the 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS: Adults undergoing primary SG or RYGB with and without preoperative anticoagulation (SG-AC or RYGB-AC and non-SG-AC or non-RYGB-AC, respectively) were analyzed from the 2015-2021 MBSAQIP database. Differences in baseline characteristics by AC status for each MBS were adjusted using entropy-balanced weights. Multivariable logistic and linear regressions were developed to analyze the independent association between AC and outcomes of interest. RESULTS: Of 1,178,090 patients included, 72.0% (n = 850,682) had SG and 28.0% (n = 327,408) had RYGB, of which 1.8% (n = 15,021) and 1.9% (n = 6201) had AC, respectively. Compared to non-SG-AC and non-RYGB-AC, both SG-AC and RYGB-AC encountered higher absolute 30-day rates of anastomotic leak, deep vein thrombosis and gastrointestinal bleeding. Following multivariable adjustment, SG-AC was associated with significantly greater odds of adverse cardiovascular events, anastomotic leak, gastrointestinal bleeding, and greater operative length and length of stay. RYGB-AC was associated with higher odds of readmission, unplanned ICU admission, and ED visit. CONCLUSIONS: While preoperative AC may confer distinct outcomes between SG and RYGB, this 7-year study of MBSAQIP demonstrated an overall association with greater postoperative morbidity. Management of MBS patients with preoperative AC requires consideration of thrombohemorrhagic risks.

Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19.

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

The use of botulinum toxin in benign prostatic hyperplasia.

The injection of Botulinum toxin type A (BoNT/A) into the prostate is a minimally invasive alternative treatment for lower urinary tract symptoms. To summarize the action mechanisms of BoNT/A on experimental animals and to analyze its effectiveness according to published clinical studies, we located 24 papers on the treatment of HBP with BoNT/A. The doses applied ranged from 100 (OnabotA) to 600 U (OnabotA and AbobotA). The IPSS score presented a mean post-treatment reduction, for all series, of 10.8 + 2.66 points. Other significant results included the overall mean reduction in QoL score of 2.1 ± 0.62 points, and the pre and post-treatment differences in prostate volume (22.43 ± 20.2 cm(3)), post-voiding residue (76.77 + 51.72 cm(3)) and PSA (1.15 + 0.93 ng/ml). However, only two clinical trials were on sufficient quality to be selected for meta-analysis, and it was observed that the difference of the means, pre- and post-treatment of maximum flow, prostate volume, IPSS and PSA were not statistically significant (P = 0.18). Neither was there any statistically significant difference between pre- and post-treatment post-voiding residue (P = 0.65). In conclusion, BoNT/A alleviates lower urinary tract symptoms due to HBP, but different studies present considerable variations regarding the dose administered, inclusion criteria and follow-up time, as well as poorly defined retreatment, losses to follow up and, above all, a high degree of variability in the communication of results (with large standard deviations). In consequence, further clinical trials are needed.

[Limiting and facilitating factors of changes in the care of families of the critically ill patient]. / Elementos facilitadores y limitadores del cambio en la atención a los familiares del paciente crítico.

INTRODUCTION: Participatory action research (PAR) was conducted in an intensive care unit (UCI), with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit's background context limited or facilitated change. This paper presents findings based on this objective. MATERIALS AND METHODS: Qualitative methodology. DESIGN: Participatory-action research (PAR). DATA GATHERING TECHNIQUES: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed. RESULTS: Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses' lack of involvement in information flow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1) A sense of individual and shared commitment; 2) Leadership in day-to-day matters; 3) A process based on reflection. CONCLUSIONS: A process of participatory action research can lead to change in clinical practice, although this is complex and requires substantial input in terms of personal energy. Contextual factors limiting this change are related to the actual structure of the unit, while factors facilitating it are circumstantial ones and are dependent upon individual people. In this sense, professionals working at the bedside are capable of introducing changes to the context in which they work.

[Physical compatibility of sodium bicarbonate with other drugs often administered in the intensive care unit]. / Compatibilidad física del bicarbonato sódico con fármacos de uso frecuente en la unidad de cuidados intensivos.

INTRODUCTION: Acid-base disorders are associated with many diseases of the critically ill patient. Early treatment with sodium bicarbonate of these metabolic disorders is required for their normalization. This is an alkaline electrolyte solution administered by continuous or intermittent infusion. Its incompatibility due to its alkaline pH has been described, as it produces insoluble carbonate precipitation and causes carbon dioxide gas when mixed with acidic solutions. MATERIAL AND METHOD: An in vitro experimental study was performed. Bicarbonate was mixed with 13 drugs simulating Y-site administration. We combined 5 ml bicarbonate with 5 ml of every drug, at highest daily concentration used. The samples were visually examined to detect color changes, cloudiness, precipitation or gas formation, pH measurement and spectrophotometric analysis at 450 nm and 620 nm. The samples were evaluated at 0, 15, 30, 60 and 120 minutes. The compatibility criteria were absence of visual changes, pH changes<0.5 and variability of absorbance <0.01. RESULTS: We studied each drug individually and mixed with bicarbonate with 27 samples, and 135 measurements were performed. The incompatibilities did not always produce visual changes. Knowing the pH of drugs does not guarantee the compatibility of the mixture. Nitroglycerin with pH 4 is compatible with bicarbonate. Thiopental with pH 11 makes precipitation. Higher absorbances showed color changes, cloudiness and precipitation. CONCLUSIONS: Bicarbonate is physically compatible with esmolol, furosemide, heparin, insulin, morphine, nimodipine, nitroglycerin and urapidil and incompatible with amiodarone, cisatracurium, haloperidol, midazolam and thiopental.

Intracellular distribution of p300 and its differential recruitment to aggresomes in breast cancer.

It has been recently suggested that p300 cytoplasmic redistribution and degradation are important for controlling the availability and activity of the protein as a transcriptional coactivator. As a step towards determining the functional relevance of p300 intracellular redistribution in mammary cancer, we aimed at studying p300 localization in two different animal models of mammary carcinoma as well as in human primary breast carcinoma samples. Analysis of p300 protein levels showed stronger expression in tumor epithelia than in normal mammary gland. Cytoplasmic localization of p300 was observed in malignant cells. Furthermore, cytoplasmic p300 was found in tumor epithelia whereas nuclear localization was observed in normal mammary glands in both animal models and in non-malignant adjacent areas of human breast cancer specimens. Interestingly, proteasomal inhibition induced p300 redistribution to perinuclear inclusion bodies in tumor but not in normal mammary gland-derived cells. These inclusions were confirmed to be aggresomes by doing immunofluorescence for ubiquitin, vimentin and 20S proteasomal subunit. Taken together, these findings show that both the localization of p300 and the recruitment to aggresomes differ between mammary tumors and normal mammary glands, and suggest that the formation of these inclusions could be a potential target for therapeutic intervention.

[Physical compatibility of furosemide in intravenous mixtures for continuous perfusion]. / Compatibilidad visual y física de la furosemida en mezclas intravenosas para perfusión continua.

INTRODUCTION: Patients in the intensive care units simultaneously receive concomitantly many drugs, with limited venous accesses. Thus, several different perfusions must be administered jointly through the same catheter. Furosemide is a solution with no buffer capacity that is easily precipitated. In spite of the recommendation on its data sheet stating that it should not be used with other drugs, studies found in the bibliography suggest that it has physicochemical compatibility with other drugs. However, the concentrations studied do not always coincide with those used in the clinical practice. OBJECTIVES: To study and verify the physical compatibility of furosemide in intravenous mixture. MATERIAL AND METHOD: An experimental study in vitro, in which furosemide was mixed with 12 drugs at a 1:1 proportion was performed. A total of 40 samples were obtained and the following variables were evaluated at different intervals, 0, 15, 30, 60 and 120 min: ph of mixture, color changes, presence of turbidity and precipitation. To do so, visual observation procedures, ph measurements and spectrophotometer absorption at 450 and 620 nm were used. RESULTS: Forty samples, 13 simples, 12 doubles and 15 triples, were obtained. Those mixtures that did not show physical changes, pH variation and absorption variation were considered compatible. CONCLUSION: Furosemide is physically compatible with bicarbonate solution, heparin, insulin, morphine and nitroglycerin and incompatible with amiodarone, cisatracurium, haloperidol, midazolam and urapidil.

Analysis of discarded blood volume for analytical extraction in ICU. / Análisis del volumen sanguíneo desechado para la extracción de analíticas en UCI.

For laboratory sample extraction through catheters, blood volume must be discarded prior to specimen collection to ensure the accuracy of the results. OBJECTIVES: To analyse the discarded blood volume obtained through vascular catheters, according to type of catheter, professional experience in extraction and hospital in Adult Intensive Care Units (ICU) of the Balearic Islands. METHOD: Cross-sectional multicentre descriptive study. Conducted from April to December 2018. Field of study: Adult Intensive Care Units of the Balearic Islands. POPULATION: 296 nurses. SAMPLE: nursing professionals who answered the survey. Data collection instrument: ad hoc, anonymous and voluntary questionnaire. Variables studied: waste volume, type of catheter, sex, professional experience and hospital. Descriptive statistical analysis, standard deviation, coefficient of variation, and non-parametric tests: Kruskal-Wallis and Median test with an CI: 95%, using the SPSS vs20.0 programme. RESULTS: 142 surveys were obtained, 12 hospitals participated: 6 public and 6 private, 72.5% women and 27.5% men. The total mean volume discarded was 5.98ml (± 3.01): peripheral venous catheter (CVP) 5.74ml (± 2.85), arterial cannula 4.37ml (± 2.93), peripheral access central catheter (PICC) 7.34ml (± 3.03) and central venous catheter (CVC) 6.49ml (± 2.99). The medians of waste volume vary greatly between the different ICUs (p <.001). Private hospitals discard larger volumes than public hospitals through CVP: 5.12ml (±2.15) vs. 6.99ml (±2.80) (p=.023), CVC: 5.92ml (±2.58) vs. 7.93ml (±1.71) (p=.026) and PICC: 6.77ml (±2.73) vs. 9.07ml (±2.05) (p=.004). CONCLUSIONS: There is a great variability in the volume of blood discarded, it depends on the hospital. No association was found between the discarded blood and the other variables studied. More conservative extraction techniques should be used.

Blood volume extracted from the critical patient in the first 24 hours after admission. / Volumen de sangre extraído al paciente crítico las primeras 24h de ingreso.

OBJECTIVE: To calculate the number of analytical tests and blood volume drawn during the first 24hours of admission to the Intensive Care Unit (ICU). To analyse values of basal haemoglobin and at 24hours, relate them to blood loss, weight variation, and scoring system. METHOD: An observational descriptive pilot study. Variables studied: age, sex, diagnosis on admission, analytical tests extracted, waste quantity before the extraction of samples, total volume blood extracted in 24hours, weight variation, APACHE, SAPS, basal haemoglobin and at 24hours. Statistical analysis with SPSS vs 20.0. Variables correlation sex, weight variation, the number of analytical tests and haemoglobin change. RESULTS: The study included 100 patients. The average number of extractions per patient/day was 7.2 (±2.6). The average waste quantity was 32.61ml (±15.8). The blood volume used for determinations was 48.18ml / 24h (±16.74). The haemoglobin value decreased in the first 24hours of admission, being higher in men (P<.05). The scoring systems were statistically significant for levels of haemoglobin (Hb1 -0.3; P=.001; Hb2 -0.4; P=.001). CONCLUSIONS: Of the total volume of blood extracted in ICU, 40% belongs to a volume of waste and 60% of blood is used for analytical tests. There is a decrease in haemoglobin exists 24hours after admission of the critical patient. Statistically, it has not been possible to demonstrate its relation with the number of analytical tests.

[Patient safety in antibiotics administration: Risk assessment]. / Seguridad del paciente en la administración de antibióticos: evaluación del riesgo.

OBJECTIVE: To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix. MATERIAL AND METHOD: A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied. RESULTS: Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose. CONCLUSION: More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics.

Role of difucosylated Lewis Y antigen in outcome of locally advanced cervical squamous cell carcinoma treated with cisplatin regimen.

BACKGROUND: Several mechanisms are involved in the development of resistance to therapy in locally advanced cervical squamous cell carcinoma (LACSCC). Studies have shown that CD44 and Lewis Y antigen (LeY) form a complex that is associated with chemoresistance, tumor invasion and metastasis. We assessed the role of CD44 and LeY in the outcome of LACSCC patients treated with different chemotherapy regimens. METHODS: 126 LACSCC patients at FIGO stages IIB-IVA were selected from the GOCS database: 74 patients included in 3 different prospective phase II trials in the neoadjuvant setting (vinorelbine, docetaxel, ifosfamide-vinorelbine-cisplatin) and 52 patients treated with standard radiochemotherapy based on cisplatin (RCBC). Clinical data at baseline, disease-free survival (DFS) and overall survival (OS) were recorded. Univariate and multivariate Cox models were employed. RESULTS: Median age was 45.6 years (range: 24.9-80.5). Sixty-three and 47 tumors were CD44+ and LeY+, respectively. Tumors with expansive growth showed higher grade (p = 0.0024), mitotic index (p = 0.0505), tumor necrosis (p = 0.0191), LeY+ (p = 0.0034) and CD44+/LeY+ coexpression (p = 0.0334). CD44+ cells were present in 91.3% of patients with local recurrence (p = 0.0317). Advanced stage was associated with LeY+ tumors. Patients treated with RCBC had worse DFS and OS when their tumors expressed LeY (p = 0.0083 and p = 0.0137, respectively). Pre-treatment hemoglobin level, FIGO stage and tumor response remained the most significant prognostic factors in Cox regression. CONCLUSIONS: In our cohort of LACSCC patients, the coexpression of CD44 and LeY was not associated with worse outcome. However, in the subgroup of patients receiving RCBC, LeY expression was correlated with shorter DFS and OS.

Expression of ERCC1 and TUBB3 in locally advanced cervical squamous cell cancer and its correlation with different therapeutic regimens.

BACKGROUND: Several studies in solid tumors have shown that expression of excision repair cross-complementation group 1 (ERCC1) and class III ß-tubulin (TUBB3) can predict response to chemoradiotherapy and might be prognostic factors. We assessed the role of ERCC1 and TUBB3 expressions as predictive and prognostic factors in locally advanced cervical squamous cell carcinoma (LACSCC) patients treated with different neoadjuvant regimens. METHODS: ERCC1 and TUBB3 were detected in 88 patients with LACSCC by immunohistochemical analysis. Sixty-two patients were included in 3 different prospective trials and grouped as follows: vinorelbine or docetaxel (group A, n = 44) and ifosfamide-vinorelbine-cisplatin (group B, n = 18). Both groups were compared with standard cisplatin chemoradiotherapy (group C, n = 26). Clinical data at baseline, disease-free survival (DFS) and overall survival (OS) were also collected. Univariate and multivariate Cox models were used to analyze the risk factors. RESULTS: Thirty-five patients (39.8%) and 18 (20.5%) had high ERCC1 and TUBB3 expression, respectively. Both proteins were overexpressed in tumors with unfavorable characteristics. High ERCC1 was associated with advanced FIGO stage (p = 0.034) and progressive disease (49% vs. 28%). Poor DFS (p = 0.021) and OS (p = 0.005) were observed in group C patients with high ERCC1 expression. Multivariate analysis showed that ERCC1 expression, FIGO stage and pretreatment hemoglobin level were significant prognostic factors (p = 0.002, p = 0.008 and p = 0.005, respectively). CONCLUSIONS: ERCC1 expression could be a predictive and prognostic factor in LACSCC patients who receive cisplatin monotherapy. Conversely, TUBB3 had no impact on survival in patients treated with antimicrotubule agents.

Vinorelbine and paclitaxel for locoregional advanced or metastatic non-small-cell lung cancer.

A phase II trial was performed to evaluate the efficacy and toxicity of the novel combination of vinorelbine and paclitaxel as first-line chemotherapy in patients with stages IIIB and IV non-small-cell lung cancer. From January 1997 to September 1999, 34 patients (9 stage IIIB and 25 stage IV) received a regimen consisting of the following: vinorelbine 30 mg/m2 20 minutes intravenous (i.v.) infusion, days 1 and 8; and paclitaxel 135 mg/m2 3-hour i.v. (starting 1 hour after vinorelbine) on day 1. Cycles were repeated every 28 days until progression of disease or unacceptable toxicity development. The median age was 57 years (range 41-70 years); median performance status was 1. Histology was as follows: squamous cell in 24 (71%), large cell in 1 (3%), and adenocarcinoma in 9 (26%). All patients are evaluable for toxicity, whereas 30 are evaluable for response (4 patients refused treatment). Objective response was recorded in 4 of 30 patients (13%, 95% CI 1-25%). No complete response was observed. Partial response was recorded in 4 patients (13%), no change in 10 patients (34%), and progressive disease in 16 patients (53%). The median time to treatment failure was 4 months and median survival was 9 months. The limiting toxicity was myelosuppression: leukopenia in 23 patients (68%), whereas neutropenia was observed in 25 patients (78%). Peripheral neurotoxicity developed in 14 patients (41%) (without G3 or G4 episodes), and constipation (G1-G2: 10 patients), myalgia (G1-G2: 11 patients), diarrhea (G1-G2: 7 patients), and stomatitis were observed in 7 patients. Vinorelbine-paclitaxel combination showed only modest activity against locoregionally advanced or metastatic NSCLC.

Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2 / Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19

La aparición de úlceras por presión (UPP) es una de las complicaciones frecuentes del decúbito prono (DP), debido a la presión prolongada y las fuerzas de cizallamiento. Objetivos: Comparar la incidencia de UPP secundarias a la posición del decúbito prono y describir su localización entre 4 unidades de cuidados intensivos (UCI) de hospitales públicos. Metodología: Estudio observacional descriptivo retrospectivo multicéntrico. La población estuvo formada por pacientes ingresados en la UCI entre febrero de 2020 y mayo 2021, diagnosticados de COVID-19 que precisaron decúbito prono. Las variables estudiadas fueron sociodemográficas, días de ingreso en la UCI, horas totales en DP, prevención de UPP, localización, estadio, frecuencia de cambios posturales, nutrición y aporte de proteínas. La recogida de datos se realizó a través de la historia clínica de las diferentes bases de datos informatizadas de cada hospital. Se realizó análisis descriptivo y asociación entre las variables, utilizando el programa SPSS vs.20.0.Resultados: Ingresaron 574 pacientes por COVID-19, el 43,03% fueron pronados. El 69,6% fueron hombres, la mediana de edad fue 66 (RIC: 55-74) y el IMC de 30,7 (RIC: 27-34,2). La mediana de estancia en la UCI fue de 28 días (RIC: 17-44,2) y la mediana de horas en DP por paciente 48h (RIC: 24-96). La incidencia de aparición de UPP fue del 56,3% y el 76,2% de los pacientes la presentaron; la localización más frecuente fue la frente (74,9%). Existen diferencias significativas entre hospitales en cuanto a la incidencia de UPP (p<0,001), su localización (p=0,000) y la duración media de horas por cada episodio de DP (p=0,001). Conclusiones: La incidencia de UPP secundarias al DP fue muy elevada. Existe gran variabilidad en cuanto a incidencia de UPP entre hospitales, la localización y la duración media de horas por cada episodio de DP.(AU)

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p=0.002), location (p<0.001) and median duration of hours per PD episode (p=0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.(AU)

Seguridad del paciente en la administración de antibióticos: evaluación del riesgo / Patient safety in antibiotics administration: risk assessment

Objetivo. Analizar el nivel de riesgo en la preparación y administración de los antibióticos de uso frecuente en la Unidad de Cuidados Intensivos utilizando una matriz de riesgo. Material y método. Se realizó un análisis de situación y una revisión bibliográfica en bases de datos, protocolos y guías de buenas prácticas sobre terapia intravenosa, medicamentos y vías de administración. Se llevó a cabo una selección de los antibióticos más utilizados en nuestra unidad registrados en el programa ENVIN-HELICS desde el 1 de abril al 30 de junio del 2015. Los pacientes que recibieron tratamiento antimicrobiano en este periodo fueron 257. Se evaluaron 26 antibióticos. Variables a estudio: evaluación del riesgo de cada antibiótico mediante la escala Risk Assessment Tools, de la National Patient Safety Agency, incluyendo pH, osmolaridad, tipo de catéter recomendado para su administración y compatibilidad e incompatibilidad con el resto de los antibióticos estudiados. Resultados. El 65,3% de los antibióticos tuvieron más de 3 factores de riesgo representados con una franja amarilla, y el 34,7% entre 0 y 2 factores de riesgo (franja verde.) No hubo ningún antibiótico con 6 o más factores de riesgo (franja roja). La mayoría de los fármacos necesitaron reconstitución, dilución adicional y la utilización de parte del vial para administrar la dosis prescrita. Conclusión. Más de la mitad de los antibióticos estudiados son de riesgo moderado, por lo que se deberían adoptar medidas para disminuirlo. La matriz de riesgo es una herramienta útil para la evaluación y detección de los puntos débiles asociados a la preparación y administración de antibióticos intravenosos (AU)

Objective. To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix. Material and method. A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied. Results. Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose. Conclusion. More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics (AU)

Análisis del volumen sanguíneo desechado para la extracción de analíticas en UCI / Analysis of discarded blood volume for analytical extraction in ICU

INTRODUCCIÓN: Para la extracción de muestras de laboratorio a través de catéteres, se debe desechar un volumen de sangre para garantizar la exactitud de los resultados. OBJETIVOS: Analizar el volumen sanguíneo desechado obtenido a través de catéter vascular y relacionarlo con el tipo de catéter, la experiencia del profesional que realiza la extracción y el centro hospitalario, en las Unidades de Cuidados Intensivos (UCI) de adultos de les Illes Balears. MÉTODO: Estudio descriptivo multicéntrico transversal. Ámbito de estudio: Unidades de Cuidados Intensivos de adultos de les Illes Balears. Población: 296 enfermeras. Instrumento de recogida de datos: cuestionario ad hoc, anónimo y voluntario. Variables estudiadas: volumen de desecho, tipo de catéter, sexo, experiencia profesional y hospital. Análisis estadístico descriptivo, desviación estándar, coeficiente de variación y pruebas no paramétricas: Kruskal-Wallis y prueba de la mediana con un IC del 95%, mediante el programa SPSS vs20.0. RESULTADOS: Se obtuvieron 142 encuestas, participaron 12 hospitales: 6 públicos y 6 privados; el 72,5% mujeres y el 27,5% hombres. El volumen medio total desechado fue de 5,98± 3,01 ml: catéter venoso periférico (CVP) 5,74ml ± 2,85 ml, cánula arterial 4,37 ± 2,93ml, catéter central acceso periférico (PICC) 7,34±3,03 ml y catéter venoso central (CVC) 6,49± 2,99ml. Las medianas de volumen de desecho fueron muy variables entre las diferentes ucis (p <0,001). Los hospitales privados desechan mayores volúmenes que los públicos a través de CVP: 5,12± 2,15ml vs. 6,99± 2,80ml (p = 0,023), CVC: 5,92± 2,58 ml vs. 7,93± 1,71ml (p = 0,026) y PICC: 6,77± 2,73ml vs. 9,07± 2,05ml (p = 0,004). CONCLUSIONES: Existe una gran variabilidad en el volumen de sangre desechado en función del hospital donde se realiza la extracción. No se ha encontrado asociación entre la sangre desechada y el resto de variables estudiadas. Se deberían utilizar técnicas de extracción más conservadoras

For laboratory sample extraction through catheters, blood volume must be discarded prior to specimen collection to ensure the accuracy of the results. OBJECTIVES: To analyse the discarded blood volume obtained through vascular catheters, according to type of catheter, professional experience in extraction and hospital in Adult Intensive Care Units (ICU) of the Balearic Islands. METHOD: Cross-sectional multicentre descriptive study. Conducted from April to December 2018. Field of study: Adult Intensive Care Units of the Balearic Islands. Population: 296 nurses. Sample: nursing professionals who answered the survey. Data collection instrument: ad hoc, anonymous and voluntary questionnaire. Variables studied: waste volume, type of catheter, sex, professional experience and hospital. Descriptive statistical analysis, standard deviation, coefficient of variation, and non-parametric tests: Kruskal-Wallis and Median test with an CI: 95%, using the SPSS vs20.0 programme. RESULTS: 142 surveys were obtained, 12 hospitals participated: 6 public and 6 private, 72.5% women and 27.5% men. The total mean volume discarded was 5.98ml (± 3.01): peripheral venous catheter (CVP) 5.74ml (± 2.85), arterial cannula 4.37ml (± 2.93), peripheral access central catheter (PICC) 7.34ml (± 3.03) and central venous catheter (CVC) 6.49ml (± 2.99). The medians of waste volume vary greatly between the different ICUs (p <.001). Private hospitals discard larger volumes than public hospitals through CVP: 5.12ml (±2.15) vs. 6.99ml (±2.80) (p=.023), CVC: 5.92ml (±2.58) vs. 7.93ml (±1.71) (p=.026) and PICC: 6.77ml (±2.73) vs. 9.07ml (±2.05) (p=.004). CONCLUSIONS: There is a great variability in the volume of blood discarded, it depends on the hospital. No association was found between the discarded blood and the other variables studied. More conservative extraction techniques should be used

Complicaciones de la nutrición parenteral periférica. Observación clínica de 2 casos / Complications of peripheral parenteral nutrition. Clinical observations of 2 cases

INTRODUCCIÓN: La nutrición parenteral periférica (NPP) es una nutrición artificial utilizada cuando la absorción por vía digestiva es insuficiente. Suple las demandas nutricionales del paciente. Permite su administración por vía periférica. A continuación se presentan 2 casos clínicos. El primero es una epidermólisis por extravasación enmascarada por desorientación temporoespacial del paciente, con aparición de flictenas. Requirió tratamiento prolongado y consulta a cirugía plástica. El segundo caso es una flebitis química con detección precoz por parte de los profesionales de enfermería. Se resolvió con tratamiento a corto plazo y no precisó interconsulta. Plan de cuidados Se elaboró un plan de cuidados dirigido a identificar los problemas potenciales o reales relacionados con las posibles complicaciones de la administración intravenosa de la NPP, como son la extravasación y la flebitis, actuando en la prevención, detección precoz y tratamiento. Discusión: La flebitis está relacionada con las características del catéter, con el tiempo de permanencia y con la alta osmolaridad de la NPP. Una actuación precoz disminuye la lesión del tejido afectado. En el caso 1 el paciente requiere curas durante 19 días, mientras que en el caso 2 solo las precisa 72 h. Conclusión La enfermera desempeña un papel primordial en la elección del catéter, localización, administración y prevención de complicaciones. El adiestramiento del personal y la protocolización del procedimiento minimizan la incidencia de flebitis, evita molestias a los pacientes y reduce el gasto sanitario

INTRODUCTION: Peripheral parenteral nutrition (PPN) is artificial nutrition used when digestive absorption is insufficient. It supplies the nutritional needs of the patient and permits administration through a peripheral catheter. We present 2 clinical cases.: The first one entails an epidermolisis through extravasation masked by temporo-spatial disorientation of the patient with appearance of fiictenes (blisters).Prolonged treatment and consultation with plastic surgery were required. The second case entails a chemical phlebitis with early detection by nursing professionals. It was resolved with short term treatment and did not require consultation with the plasticsurgeon. Planning care: We elaborated a care plan aimed at identifying real or potential problems related with possible complications of intravenous PPN administration, such as phlebitis and extravasation. The aim of this research was prevention, early detection and treatment. Discussion: Phlebitis is related with catheter characteristics, in-dwelling time and high osmolarity of PPN. Early action decreases injury of the affected tissue. In case 1, the patient requires 19 days of curing. This was only 72 h in case 2. CONCLUSION: The nursing staff plays an essential role in catheter election, localization, administration and preventing complications. Staff training and a procedure protocol greatly reducethe incidence of phlebitis, avoid discomfort for the patient and reduce health care cost