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

Objetivos: Describir la calidad del sueño e identificar los factores que la afectan. Diseño Estudio observacional descriptivo y transversal realizado con una muestra de conveniencia de 129 pacientes. La diferencia entre los 3tiempos se calculó mediante la prueba de Wilcoxon y la correlación entre variables mediante la r de Spearman. Con análisis de regresión múltiple se relacionaron las variables independientes con «calidad del sueño». Ámbito Servicio de Medicina Intensiva de un hospital terciario. Participantes Pacientes ingresados en la unidad entre febrero de 2016 y diciembre de 2017. Intervenciones Administración de un cuestionario. Variables Ítems del cuestionario Freedman modificado, variables demográficas y de episodio. Resultados Los factores que más afectaron a la calidad del sueño en los 3tiempos de forma constante fueron el ruido y la luz. Hubo diferencias entre los 3 tiempos para los cuidados (p=0,005) y actividades de enfermería (p=0,019). Mediante el modelo de regresión múltiple se encontró que otros factores que influían en la calidad del sueño eran la edad (p=0,012), la ingesta habitual de alcohol (p=0,023), la administración de benzodiacepinas en UCI (p=0,01) y la comorbilidad (p=0,005). Resultaron diferencias significativas en somnolencia entre el alta y el primer día (p≤0,029), y entre el alta y la mitad de la estancia (p=0,001). Conclusiones La somnolencia disminuyó al final de la estancia. Aunque el ruido y la luz fueron los factores más molestos, solo los cuidados y actividades de enfermería resultaron significativos. La edad, la ingesta habitual de alcohol, la administración de benzodiacepinas en UCI y un mayor índice de comorbilidad interfieren negativamente en la calidad del sueño. (AU)

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. (AU)

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.

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

OBJETIVO: Evaluar las características psicométricas del cuestionario Freedman modificado para la valoración del sueño en el paciente crítico. DISEÑO: Estudio psicométrico. Se exploró la validez de contenido mediante un grupo de expertos y la consistencia interna fue evaluada mediante el coeficiente alfa de Cronbach. Se realizó un análisis factorial para evaluar la validez de constructo; la estabilidad fue medida con análisis test-retest mediante el índice de correlación intraclases. Ámbito: Servicio de Medicina Intensiva de un hospital de referencia. PARTICIPANTES: Pacientes ingresados entre el 23 de febrero de 2016 y el 20 de diciembre de 2017. INTERVENCIONES: Administración de un cuestionario. VARIABLES: Ítems del cuestionario Freedman modificado. RESULTADOS: La pertinencia de los ítems y su definición obtuvieron valores superiores a 3, en una escala tipo Likert con valor máximo de 4 puntos. El alfa de Cronbach indicó un valor global de 0,933. El índice de correlación intraclases obtuvo valores superiores a 0,75 en la mayoría de los ítems del cuestionario. El análisis factorial obtuvo asociación entre las variables analizadas y los 4 factores. CONCLUSIONES: El cuestionario Freedman modificado presentó unas buenas características psicométricas. Puede resultar un instrumento fiable para evaluar la calidad del sueño en el paciente crítico, así como los factores ambientales relacionados

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

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.

Traspaso de información en Medicina Intensiva / Handover in Intensive Care

El traspaso de información (TI) es una tarea frecuente y compleja que lleva implícito el traspaso de la responsabilidad del cuidado del paciente. Las deficiencias en este proceso se asocian a importantes brechas en la seguridad clínica e insatisfacción de pacientes y profesionales. Los esfuerzos por estandarizar el TI se han incrementado en los últimos años, dando pie a la aparición de herramientas mnemotécnicas. Globalmente las prácticas locales del TI son heterogéneas y el nivel de formación, bajo. El objetivo de esta revisión es enfatizar la importancia del TI y proporcionar una estructura metodológica que favorezca el TI efectivo en las UCI, reduciendo el riesgo asociado a este proceso. Específicamente, se hace referencia al TI durante los cambios de guardia y los turnos de enfermería, durante el traslado de los pacientes a otras áreas diagnósticas y terapéuticas y en el momento del alta de UCI. También se contemplan las situaciones de urgencia y se señala la potencial participación de pacientes y familiares. Por último, se proponen fórmulas para la medición de la calidad y se mencionan posibles mejoras en este proceso, especialmente en el ámbito de la formación

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training

Handover in Intensive Care. / Traspaso de información en Medicina Intensiva.

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.

Sesgo de retraso en el ingreso en la Unidad de Cuidados Intensivos como causa de mal pronóstico o lead time bias / Bias in time delay in ICU admission as a mortality risk factor or “lead time bias”

Objetivo. Comprobar cómo el tiempo de retraso en el ingreso, cuantificado conforme al sistema EPEC, influye en el resultado final de los pacientes ingresados en nuestro Servicio de Medicina Intensiva.Diseño. Análisis retrospectivo de datos recogidosde forma sistemática y prospectiva durante un período de 6 meses del año 2003.Ámbito. Servicio de Medicina Intensiva de 19 camas (15 de la Unidad de Cuidados Intensivos convencional y 4 de Cuidados Intermedios) en un hospital docente de referencia.Pacientes. Cuatrocientos ochenta y un pacientesingresados en nuestro Servicio y seguidos hasta su alta hospitalaria. Principales variables de interés. El riesgo de muerte de los pacientes fue estimado por mediode EPEC, SAPS 2 y MPM II 0. Las variables recogidasfueron sexo, edad, procedencia, tipo de paciente,riesgo de muerte por los tres sistemas mencionados, retraso en el ingreso en horas (conforme EPEC) y estado vital (vivo o muerto) tanto a la salida de la Unidad de Cuidados Intensivos como al abandonar el hospital.Resultados. Fallecieron 44 pacientes de los 481ingresados, siendo el retraso global en el ingresode 0,7 ± 1,98 horas (2,96 ± 3,28, límites 0,25-20 horas,para aquellos con retraso > 0). No se enconencontrarondiferencias en el retraso de ingreso entre vivosy fallecidos, y existió una correlación muy malaentre el pronóstico realizado con consideracióndel tiempo de retraso en el ingreso y el que se estableció sin considerarlo (SAPS 2 y MPM II 0).Conclusiones. Nuestro estudio no permite relacionarel sesgo temporal (retraso en el ingreso)con la supervivencia o no de los pacientes. Por eldiseño de EPEC se distingue entre el «retraso fisiopatológico » (detección inapropiada de la situaciónde gravedad) y el «retraso logístico» (condicionadopor factores tales como falta de camas disponibles). Nuestro estudio y EPEC sólo consideran este último. No puede descartarse que el incremento de mortalidad respecto al pronóstico esté relacionado directamente con el primer tipo de retraso y no con el sesgo temporal globalmente considerado

Objective. To assess if delay in admission to theIntensive Care Unit (ICU), measured according tothe prognostic estimation of survival in critical patients (EPEC) system, influences the final outcomeof patients admitted to our ICU.Design. Retrospective and systematic analysis of data collected during six months in 2003. Setting. Nineteen-bed ICU (15 from Standard intensive care and 4 from intermediate care) in a referral teaching hospital.Patients. Four hundred and eighty one patientsconsecutively admitted to our ICU and followedup to hospital discharge Main interest variables. Risk of death was estimated with the EPEC, SAPS II and MPM II 0.Variables collected were gender, age, origin ofadmission, risk of death by means of the 3 methodsmentioned, admission time delay (lead time bias) as measured by EPEC and life status on ICU and hospital discharge (alive or dead).Results. A total of 44 out of 481 patients diedduring the hospital stay, overall admission delaybeing 0.7 ± 1.98 hours (2.96 ± 3.28, range 0.25-20hours, for those with delay > 0). No differenceswere found when comparing delay in admission among those surviving and the deceased, and there was very bad correlation between the prognosis made considering delay time for admission and that established without considering it (SAPS II or MPM II 0).Conclusions. Our study does not make it possibleto relate lead time bias with patient survival.Due to the EPEC design, it is possible to differentiate“physiopathological delay” (inappropriate detection of the critical situation) and “logistic delay”(conditioned by factors such as lack of availablebeds). Our study as well as the EPEC only considers the latter. It cannot be ruled out that the increase in mortality regarding prognosis is directly related with first type of delay and not with the overall lead time bias

[Information strategies in a polyvalent Intensive Care Unit]. / Estrategias de información en una Unidad de Cuidados Intensivos polivalente.

INTRODUCTION: Understanding the information provided to families and surrogates of the critically ill patients admitted to ICUs and its adequate communication without contradictions, is a fundamental aspect related with the possible participation of these persons in the treatment decision making and with the quality perceived regarding the care process. Our aim in this study is to assess these two aspects (information and communication of information). DESIGN: Opinion study elaborated by the medical team and nursing staff of a multidisciplinary ICU. METHOD: Observational qualitative study performed through an open answers questionnaire. Search for agreement on terminology and concepts that should be included in the information and estimation of the different contents of information provided by the main health care professional groups (physicians and nurses). Using the Delphi technique to elaborate an information communication sheet between different staff members in order to homogenize the information process. RESULTS: The analysis of the questionnaire reveals the great heterogeneity of the contents and modes of information provided. This may cause difficulties in understanding and the integration of families and relatives in the care process. The agreement achieved among the different between physicians to facilitate the information and avoid subjective interpretations by the informed people is presented.

Estrategias de información en una Unidad de Cuidados Intensivos polivalente / Information Strategies in a polyvalent intensive care unit

Introducción. La comprensión de la informaciónproporcionada a los familiares y allegados delos enfermos críticos ingresados en la Unidadde Cuidados Intensivos (UCI), y la transmisión,adecuada y sin contradicciones, de esta información,es un aspecto fundamental relacionado con la posible participación en las decisiones terapéuticasy con la calidad percibida respecto al proceso asistencial. Con el fin de establecer la adecuación de estos dos aspectos (comprensión y transmisión de la información) se ha realizado el presente estudio.Diseño. Estudio de opinión elaborado por elequipo médico, con la supervisión de enfermeríade una UCI polivalente.Método. Estudio cualitativo observacional.Encuesta de preguntas de respuesta abierta.Acuerdo de terminología y conceptos que debecontener la información y estimación de los distintoscontenidos de información proporcionada por los principales estamentos asistenciales (médicosy enfermeras). Elaboración, por técnica Delphi, de una hoja de transmisión de la información entre distintos facultativos, con el fin de homogeneizarel proceso informativo.Resultados. El análisis del cuestionario demuestrala gran heterogeneidad de los contenidosy formas de la información proporcionada, lo querepercute en defectos de comprensión y aparentescontradicciones, y a su vez dificulta la comprensiónde esa información y la integración de familiaresy allegados en el proceso asistencial.Se presenta el acuerdo logrado entre los distintosfacultativos encuestados para facilitar la informacióny evitar interpretaciones subjetivas porparte de los informados

Introduction. Understanding the informationprovided to families and surrogates of the criticallyill patients admitted to ICUs and its adequatecommunication without contradictions, is a fundamentaspect related with the possible participationof these persons in the treatment decisionmaking and with the quality perceived regardingthe care process. Our aim in this study is to assessthese two aspects (information and communicationof information).Design. Opinion study elaborated by the medicalteam and nursing staff of a multidisciplinary ICU.Method. Observational qualitative study performedthrough an open answers questionnaire.Search for agreement on terminology and conceptsthat should be included in the informationand estimation of the different contents of informationprovided by the main health care professionalgroups (physicians and nurses). Using theDelphi technique to elaborate an informationcommunication sheet between different staffmembers in order to homogenize the informationprocess.Results. The analysis of the questionnaire revealsthe great heterogeneity of the contents andmodes of information provided. This may cause difficulties in understanding and the integration offamilies and relatives in the care process.The agreement achieved among the differentbetween physicians to facilitate the informationand avoid subjective interpretations by the informedpeople is presented (AU)

[Evaluation of the quality of inter-clinic documents. Does their proper filling out by the family doctor affect the reply obtained from the specialist?]. / Evaluación de la calidad del documento de interconsulta. 'Influye la adecuada cumplimentación del médico de familia en la respuesta que obtiene del especialista?

OBJECTIVE: To analyse the filling out of the inter-clinic form (IF) at a centre with special fields of care (CS) and to assess whether its proper filling out in primary care (PC) affects the reply from specialist care. DESIGN: Cross-sectional, descriptive study. SETTING: Primary health care area in the Community of Valencia. PARTICIPANTS: Randomised sample of IFs of patients referred for the first time from PC to specialists. MAIN MEASUREMENTS: Evaluation criteria were grouped in two: those IFs were considered acceptable (IFCA) in which the family doctor included the reason for consultation or his/her diagnostic impression, as well at least one of the following: anamnesis, personal background, physical examination, further tests or current medication. The remaining IFs were considered inadequately filled out (IFCI). RESULTS: The sample analysed for the IF audit of the CS was 392 people. The result of the audit in the specialist clinics was that 243 IFs were blank (62.0%); the specialist doctor was identified in 19% of cases; the diagnosis was given in 23.5%; treatment, in 21%, and the follow-up plan, in 20%. In the PC evaluation, there were no blank IFs; anamnesis was recorded in 41.8%; reason for consultation in 73%; suspected diagnosis in 58.2%, and treatment in 11.5%. The sample to analyse the differences in the filling of the form in specialist care according to the quality of the PC filling out was 529 IFs. 56.3% of the IFs were considered acceptable. No statistically significant differences were found in the filling of any of the criteria of evaluation by the specialist doctor between the IFs from PC of acceptable and inadequate quality, except on the question of specifying treatment. CONCLUSIONS: We found no relationship between the quality of the IF from PC and the reply from specialist care. Currently, the filling out of IFs continues to be deficient.

Relación entre pulsioximetría y determinación de la saturación arterial de oxígeno. influencia de los fármacos vasoactivos presores sobre la correlación sattco2-sato2 / Relationship between pulse oximetry and determination of arterial oxygen saturation. influence of vasoactive drugs on the sattco2-sato2 correlation

Objetivo. Estudiar la relación existente entre la saturación de oxígeno obtenida por pulsioximetría (SattcO2) y la obtenida por cooximetría (SatHbO2), o por cálculo de la saturación de oxígeno por el análisis convencional de la gasometría sanguínea (SatO2) y evaluar la posible influencia que en esta relación puedan tener las infusiones de fármacos vasoactivos presores. Pacientes y método. El estudio se llevó a cabo en una UCI polivalente de 15 camas de un hospital docente de referencia, desde diciembre de 1998 a abril de 1999. Se obtuvieron 104 pares simultáneos de muestras procedentes de pacientes ingresados por causa médica o quirúrgica (urgente o programada). De estos pacientes, 57 estaban sometidos a la administración de infusiones presoras vasoactivas. Los datos recogidos fueron: SattcO2, SatHbO2 (por cooximetría) y SatO2 (por análisis convencional de muestra de sangre arterial). El estado hemodinámico de los pacientes se estimó mediante el registro de la presión arterial, la frecuencia cardíaca y la temperatura axilar. Se recogieron el tipo y la dosis de los fármacos vasopresores administrados (noradrenalina, dopamina o dobutamina, o combinaciones de ellas). Tras la obtención de los datos se estableció la correlación entre SattcO2 y SatHbO2 y entre SattcO2 y SatO2, mediante una ecuación de regresión y la concordancia por método de Bland-Altman, y se estudiaron las diferencias existentes entre las saturaciones obtenidas por uno u otro método (diferencia media de saturación de O2).Resultados. El análisis demostró que la administración o no de infusiones de aminas vasoactivas presoras no interfiere en la concordancia y correlación de las saturaciones de oxígeno obtenidas por uno u otro de los métodos mencionados. Las diferencias medias de saturaciones de oxígeno obtenidas fueron menores del 3 por ciento, con rangos de concordancia de 5,35 y 10,38 entre SattcO2 y SatHbO2, según los pacientes recibieran o no aminas vasopresoras, y con rangos de concordancia de 6,23 y 10,42 entre SattcO2 y SatO2 en los mismos subgrupos de pacientes. Conclusión. En nuestro estudio, los datos obtenidos por pulsioximetría constituyen un buen reflejo de la saturación de oxígeno real de la sangre arterial (medida o calculada), aunque la sobrestiman ligeramente (menos del 3 por ciento); esta concordancia es independiente de la utilización de aminas vasoactivas presoras (AU)