Auditoría de las alarmas del monitor de cabecera en una unidad de cuidados críticos / Audit of the bedside monitor alarms in a critical care unit

Objetivo: Recoger y evaluar la respuesta a las alarmas del monitor de cabecera (AMC) por parte de las enfermeras en una unidad de cuidados intensivos (UCI). Metodología: Estudio observacional prospectivo (octubre 2011-enero 2012). Auditoría aleatorizada y ciega del manejo de alarmas. Se relacionó la programación/límites de alarmas con la experiencia en UCI. Se evaluó la respuesta a AMC con las variables: tipo de alarma (relevante/no relevante/alerta) y tipo de respuesta. Análisis descriptivo de variables, Anova para análisis multivariante y Chi-cuadrado con SPSS 17.0. Resultados: Se analizaron 434 auditorías. La programación fue: tensión arterial (TA) 88,25%, frecuencia cardiaca (FC) 98,62%, saturación O2 (SatO2) 96,79%, frecuencia respiratoria (FR) 65,75%. Las alarmas originadas fueron: 49,73% TA, 10,75% FC, 39,25% SatO2, 3,27% FR. La enfermera atiende el 93,3% de las mismas y se atendieron un 50% antes de 10 segundos. Fueron alarmas no relevantes un 56,16%, relevantes 25,12% y alerta 18,72%. Por manipulación 41,8%. Conclusión: Las alarmas son programadas y atendidas por la enfermera existiendo uniformidad en la programación y selección de límites. Un 25% de AMC conllevaron actitud terapéutica

Aims: Quantifying and evaluating the response to the bedside monitor alarms (BMA) by nurses in intensive care unit (ICU). Metodology: Prospective observational study (October 2011-January 2012). Randomized blind audit on alarm management. Alarm programming and alarm limits were related to experience in ICU. We evaluated the response to BMA with the variables: alarm type (relevant/not relevant/alert) and response type. Descriptive analysis of variables for multivariate ANOVA and Chi-square test with SPSS 17.0. Results: 434 audits were analyzed. The programming was: Blood pressure (BP) 88.25%, heart rate (HR) 98.62% O2 saturation (SO) 96.79%, respiratory rate (FR) 65.75%. The alarms originated were BP 49.73%, 10.75% HR, 39.25% SO, 3.27% FS. The nurse responded to 93.3% of them and 50% were treated before 10sec. 56.16% of the alarms were not relevant, 25.12% relevant and 18.72% alerting. 41.8% were due to handling. Conclusion: The alarms are programmed/attended by the nurse and there is uniformity in programming/selection limits. 25% of BMA carried therapeutic attitude

Análisis del estreñimiento en pacientes con traumatismo grave / Analysis of constipation in severe trauma patients

Objetivos: Valorar la incidencia y factores de riesgo del estreñimiento en pacientes con traumatismo grave (TG). Material y método: Estudio observacional retrospectivo (enero a diciembre de 2011) de las historias clínicas de pacientes con TG y estancia ≥ 5 días. Análisis descriptivo de variables, análisis inferencial: «t» de Student y Chi cuadrado con SPSS 17.0. Significación p < 0,05. Resultados: Ochenta pacientes cumplieron los criterios de inclusión; solo se pudieron analizar 69. Presentaron estreñimiento el 84,06% de acuerdo con la definición proporcionada por el Grupo de Trabajo de Metabolismo y Nutrición de la SEMYCIUC. El día más frecuente de la primera deposición fue el 7.° y el 9.° tras tolerancia de nutrición enteral. Hubo significación estadística de la presencia de estreñimiento con: estancia, días de sedación/relajación/opiáceos y ventilación mecánica (VM). No se dio significación estadística entre nutrición enteral precoz (NEP) y estreñimiento. Conclusiones: La frecuencia de estreñimiento en los pacientes con TG es muy elevada. La estancia en UCI, los días de sedoanalgesia, relajación y la VM son factores de riesgo que se asocian a la aparición de esta complicación. Deberían prescribirse laxantes de forma profiláctica

Objectives: To evaluate the incidence and risk factors of constipation in patients with severe trauma (ST). Materials and method: A retrospective observational study (January-December 2011) of medical records in ST-patients with a minimum stay of 5 days was performed. Descriptive analysis of variables, inferential analysis: Student’s T test and Chi-square of SPSS 17.0. Significance level P < .05. Results: A total of 80 patients filled the inclusion criteria, but only 69 could be analyzed. Of these, 84.06% showed constipation (according to its definition by the Work Group for Metabolism and Nutrition SEMICYUC). The most frequent day of first stool was day 7 and 9 after tolerance of enteral nutrition. Statistical significance (S.S.) of constipation was found with stay, days of sedation/relaxation/opiates, and mechanical ventilation. There was no S.S. between early enteral nutrition (EEN) and constipation (P > .05). Conclusions: There is a very high incidence of constipation in ST patients. ICU stay, days of analgesic sedation, relaxation, and mechanical ventilation are risk factors that influence the occurrence of this problem. Laxatives should be prescribed prophylactically

[Audit of the bedside monitor alarms in a critical care unit]. / Auditoría de las alarmas del monitor de cabecera en una unidad de cuidados críticos.

AIMS: Quantifying and evaluating the response to the bedside monitor alarms (BMA) by nurses in intensive care unit (ICU). METODOLOGY: Prospective observational study (October 2011-January 2012). Randomized blind audit on alarm management. Alarm programming and alarm limits were related to experience in ICU. We evaluated the response to BMA with the variables: alarm type (relevant/not relevant/alert) and response type. Descriptive analysis of variables for multivariate ANOVA and Chi-square test with SPSS 17.0. RESULTS: 434 audits were analyzed. The programming was: Blood pressure (BP) 88.25%, heart rate (HR) 98.62% O(2) saturation (SO) 96.79%, respiratory rate (FR) 65.75%. The alarms originated were BP 49.73%, 10.75% HR, 39.25% SO, 3.27% FS. The nurse responded to 93.3% of them and 50% were treated before 10 sec. 56.16% of the alarms were not relevant, 25.12% relevant and 18.72% alerting. 41.8% were due to handling. CONCLUSION: The alarms are programmed/attended by the nurse and there is uniformity in programming/selection limits. 25% of BMA carried therapeutic attitude.

[Analysis of constipation in severe trauma patients]. / Análisis del estreñimiento en pacientes con traumatismo grave.

OBJECTIVES: To evaluate the incidence and risk factors of constipation in patients with severe trauma (ST). MATERIALS AND METHOD: A retrospective observational study (January-December 2011) of medical records in ST-patients with a minimum stay of 5 days was performed. Descriptive analysis of variables, inferential analysis: Student's T test and Chi-square of SPSS 17.0. Significance level P<.05. RESULTS: A total of 80 patients fulfilled the inclusion criteria, but only 69 could be analyzed. Of these, 84.06% showed constipation (according to its definition by the Work Group for Metabolism and Nutrition SEMICYUC). The most frequent day of first stool was day 7 and 9 after tolerance of enteral nutrition. Statistical significance (S.S.) of constipation was found with stay, days of sedation/relaxation/opiates, and mechanical ventilation. There was no S.S. between early enteral nutrition (EEN) and constipation (P>.05). CONCLUSIONS: There is a very high incidence of constipation in ST patients. ICU stay, days of analgesic sedation, relaxation, and mechanical ventilation are risk factors that influence the occurrence of this problem. Laxatives should be prescribed prophylactically.

Aplicación de la Escala de conductas indicadoras de dolor (ESCID) en el paciente con trauma grave no comunicativo y ventilación mecánica / Pain behaviour indicator scale (ESCID) application in severe non-communicative trauma patients receiving mechanical ventilation

Objetivo: Valorar el dolor en el paciente no comunicativo con trauma grave y ventilación mecánica antes, durante y después de la aspiración de secreciones, movilizaciones y curas. Material y método Estudio observacional prospectivo de octubre a diciembre de 2011. Variables a estudio: puntuación ESCID y variables hemodinámicas (presión arterial, frecuencia cardiaca y frecuencia respiratoria) 5 min antes, durante y 15 min después de los 3 procedimientos, registro en el evolutivo de enfermería de: valoración del dolor, administración y efectividad de la analgesia. Análisis descriptivo de variables, t de Student/ANOVA para análisis multivariante con SPSS 17.0.ResultadosCiento ochenta y cuatro observaciones: 46,8% aspiración de secreciones, 38,5% movilizaciones y 14,7% curas, en 29 pacientes. La puntuación ESCID fue: curas, 0,4 ± 1 antes, 3,4 ± 2,7 durante y 0,4 ± 1 después; aspiración de secreciones bronquiales, 0,4 ± 1,1 antes, 3,6 ± 2,2 durante y 1,1 ± 0,5 después; movilización, 0,5 ± 1,1 antes, 3 ± 2,8 durante y 0,2 ± 0,8 después, aumentando significativamente durante la realización de los 3 procedimientos antes-durante/durante-después, p = 0,000. Todas las variables hemodinámicas se modificaron significativamente durante la realización de la movilización y aspiración de secreciones; antes-durante/durante-después, p = 0,000, a excepción de las curas, en las que solo se modificó la frecuencia respiratoria. El 27% de los procedimientos recibieron analgesia: antes 9%, durante 15% y después 3,2%, requiriendo mayor analgesia las curas (33,3%). El registro en la gráfica de enfermería de la valoración del dolor/efectividad de la analgesia fue del 20,66%.ConclusiónSe objetiva un aumento en la puntuación ESCID durante la realización de los procedimientos (AU)

Objective: To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. Material and method: A prospective and observational study from October to December 2011was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5 minutes before, during and 15 minutes after the 3 procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student’s Ttest/ANOVA for multivariate analysis with SPSS 17.0.Results: A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and14.7% wound care were performed in 29 patients. ESCID score was 0.4 ± 1 before, 3.4 ± 2.7during and 0.4 ± 1 after for wound care; 0.4 ± 1.1 before, 3.6 ± 2.2 during and 1.1 ± 0.5 for tracheal suctioning; 0.5 ± 1.1 before, 3 ± 2.8 during and 0.2 ± 0.8 after for mobilization. These increased significantly during the performance of the 3 procedures before-during/during-after:P = .000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P = .000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before,15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%.Conclusion: An increase on the ESCID score was observed while performing the procedures (AU)

[Pain behaviour indicator scale (ESCID) application in severe non-communicative trauma patients receiving mechanical ventilation]. / Aplicación de la Escala de conductas indicadoras de dolor (ESCID) en el paciente con trauma grave no comunicativo y ventilación mecánica.

OBJECTIVE: To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. MATERIAL AND METHOD: A prospective and observational study from October to December 2011 was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5 minutes before, during and 15 minutes after the 3 procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student's T test/ANOVA for multivariate analysis with SPSS 17.0. RESULTS: A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and 14.7% wound care were performed in 29 patients. ESCID score was 0.4±1 before, 3.4±2.7 during and 0.4±1 after for wound care; 0.4±1.1 before, 3.6±2.2 during and 1.1±0.5 for tracheal suctioning; 0.5±1.1 before, 3±2.8 during and 0.2±0.8 after for mobilization. These increased significantly during the performance of the 3 procedures before-during/during-after: P=.000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P=.000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before, 15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%. CONCLUSION: An increase on the ESCID score was observed while performing the procedures.

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

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

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

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

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