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

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

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

ResumenEl enfermo crítico es susceptible a la desnutrición, debido a que su situación hipermetabólica produce un aumento de los requerimientos nutricionales, que muchas veces no se cubren con las fórmulas suministradas. La evaluación de la composición corporal (CC) permite cuantificar los componentes estructurales principales del cuerpo: músculo, hueso y grasa. Para esta valoración utilizamos la antropometría, que nos informa del estado nutricional caloricoproteico. Nuestro objetivo es la descripción de las variaciones en la CC del enfermo crítico los primeros siete días de ingreso. Se realizó un estudio observacional, descriptivo y prospectivo en una unidad polivalente con 50 pacientes críticos; de ellos, el 78% eran hombres y el 22% mujeres con una media de edad de 56 años.ResumenSe registró talla, peso, índice de masa corporal, diámetros óseos, perímetros musculares y pliegues cutáneos del paciente. Los cálculos de CC fueron realizados mediante las fórmulas de Faulkner, Rocha, Wurch y Matiegka. Se obtuvo el gasto energético basal de cada paciente mediante fórmula de Harris-Benedict. Tras el análisis de los datos se observó una disminución del porcentaje de masa muscular: el 3% (DE: 0,76), un aumento del porcentaje de masa grasa del 2% (DE: 0,76) y un aumento del índice de masa corporal a expensas del aumento del peso, por lo que podemos concluir que durante la primera semana de ingreso el paciente crítico pierde masa muscular, existe un aumento paradójico de la masa grasa y que el conocimiento de las variaciones de la CC del paciente crítico puede ser útil para determinar la pauta de nutrición adecuada (AU)

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

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

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

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

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

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

La sepsis asociada al catéter venoso central (CVC) es una causa importante de infección nosocomial. La mayoría de los microorganismos causantes se originan en la piel del paciente. Este estudio pretende evaluar la eficacia de un film estéril como método de barrera antimicrobiana en la punción del CVC. Estudiamos la incidencia de infección y el número de días de estancia del catéter en dos grupos, un grupo experimental al que se le insertará el CVC a través de un film adherente estéril y otro grupo control en el que el CVC se insertará según el protocolo vigente del hospital. Se trata de un estudio experimental cuantitativo aleatorizado en el ámbito de una Unidad de Cuidados Intensivos del Hospital Universitario de Bellvitge. La muestra objeto de nuestro estudio es de 100 pacientes críticos. La efectividad del film se medirá controlando la incidencia de infección en los diferentes grupos, mediante frotis punto de inserción, cultivo de punta del catéter y hemocultivos a la retirada. Los resultados son interpretados de acuerdo con los criterios de la Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), y se evidencian disminución del porcentaje de frotis del punto de inserción positivos (12,3%), puntas de catéter con cultivo positivo (6,1%) y bacteriemia relacionada con catéter (8,9%) con la utilización del método de barrera. Concluimos que la utilización del film adherente estéril de polietileno hipoalergénico es un método de barrera antimicrobiana eficaz en la colocación del CVC

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