Cross-cultural adaptation of the FRAIL scale for critically ill patients in Spain.

AIM: To translate and culturally adapt the FRAIL scale into Spanish and perform a preliminary test of diagnostic accuracy in patients admitted to intensive care units. DESIGN: Cross-sectional diagnostic study. METHODS: Five intensive care units (ICU) in Spain were participated. Stage 1: Three native Spanish-speaking bilingual translators familiar with the field of critical care translated the scale from English into Spanish. Stage 2: Three native English-speaking bilingual translators familiar with critical care medicine. Stage 3: Authors of the original scale compared the English original and back-translated versions of the scale. Stage 4: Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the comprehension and relevance of each of the items of the Spanish version in 30 patients of 3 different age ranges (<50, 50-65 and >65 years). RESULTS: The FRAIL scale was translated and adapted cross-culturally for patients admitted to intensive care units in Spain. The process consisted of four stages: translation, back translation, comparison and pilot test. There was good correspondence between the original scale and the Spanish version in 100% of the items. The participating patients assessed the relevance (content validity) and comprehensibility (face validity) of each of the items of the first Spanish version. The relevance of some of the items scored low when the scale was used in patients younger than 65 years. CONCLUSIONS: We have cross-culturally adapted the FRAIL scale, originally in English, to Spanish for its use in the critical care medical setting in Spanish-speaking countries. IMPLICATIONS FOR PROFESSIONALS: Physicians and nurses can apply the new scale to all patients admitted to the intensive care units. Nursing care can be adapted according to frailty, trying to reduce the side effects of admission to these units for the most fragile patients. REPORTING METHOD: The manuscript's authors have adhered to the EQUATOR guidelines, using the COSMIN reporting guideline for studies on the measurement properties of patient-reported outcome measures. PATIENT OR PUBLIC CONTRIBUTION: In a pilot clinical study, we applied the first version of the FRAIL-Spain scale to intensive care unit (ICU) patients. Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the relevance (content validity) and comprehensibility (face validity) of the five items of the first Spanish version. Relevance was assessed using a 4-point Likert scale ranging from 1 (no relevance) to 4 (high relevance), and comprehensibility was assessed as poor, acceptable or good. Each health professional applied the scale to three patients (total number of patients = 30) of three different age ranges (<50, 50-65 and >65 years) and recorded the time of application of the scale to each patient. Although the frailty scales were initially created by geriatricians to be applied to the elders, there is little experience with their application in critically ill patients of any age. Therefore, more information is needed to determine the relevance of using this scale in critical care patients. In this pilot study, we considered that nurses and critical care physicians should evaluate frailty using this adapted scale in adult patients admitted to the Intensive Care Units.

[Analysis of the factors involved in the evolution of patients over 80 years of age admitted to the intensive care unit: Should we change our procedure?] / Análisis de los factores implicados en la evolución de los pacientes mayores de 80 años, ingresados en la unidad de cuidados intensivos: ¿debemos cambiar nuestro proceder?

BACKGROUND AND OBJECTIVES: The care of older patients in intensive care units (ICU) is becoming more frequent. To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality. PATIENTS AND METHODS: Retrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression. RESULTS: Six hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge. An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality. CONCLUSIONS: In older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis.

Análisis de los factores implicados en la evolución de los pacientes mayores de 80 años, ingresados en la unidad de cuidados intensivos: ¿debemos cambiar nuestro proceder? / Analysis of the factors involved in the evolution of patients over 80 years of age admitted to the intensive care unit: Should we change our procedure?

Antecedentes y objetivos: Cada vez es más frecuente la asistencia de los pacientes de más edad en las unidades de cuidados intensivos (UCI).Describir las características de los pacientes mayores ingresados en la UCI y analizar los factores asociados a la mortalidad.Pacientes y métodos: Estudio transversal retrospectivo, con pacientes ≥80 años, admitidos en la UCI del Hospital Universitario Rey Juan Carlos, desde marzo 2012 a diciembre 2018. Se recogieron variables demográficas, comorbilidades y mortalidad en la UCI, en hospital y al año, analizadas mediante análisis univariante y regresión logística binaria.Resultados: Seiscientos veinte pacientes, edad media 83,6 años (DE: 3,25), el 31% precisó ventilación mecánica invasiva (VMI), el 25% vasopresores y el 29% terapia renal sustitutiva (TRS) por fracaso renal agudo (FRA). El 60% fueron ingresos de origen médico. La mortalidad intrahospitalaria fue de 156 pacientes (25%), 91 fallecieron en la UCI y 65 en planta, siendo las estancias en la UCI más breves de los supervivientes (2,72; DE: 0,22) respecto a los fallecidos (3,74; DE: 0,38), con diferencias estadísticamente significativa. El 63% permanecieron vivos un año después del alta de la UCI.Se obtuvo un modelo explicativo de mortalidad en la UCI mediante regresión logística que incluía los siguientes factores: VMI (OR: 5,78; IC 95%: 2,73-12,22), vasopresores (OR: 2,54; IC 95%: 1,24-5,19), FRA/TRS (OR: 2,69; IC 95%: 1.35-5.35), ingreso médico (OR: 2,88; IC 95%: 1,40-5,92), ingreso urgente (OR: 2,33; IC 95%: 1,30-4,18) y limitación de soporte vital (LTSV) (OR: 47,35; IC 95%: 22,96-97,68). Los días en la UCI (OR: 0,93; IC 95%: 0,87-0,99) se relacionarían inversamente con la mortalidad.Conclusiones: En los pacientes mayores no hay un aumento de la mortalidad con una supervivencia al año >63%. La necesidad de VMI, el uso de fármacos vasopresores y FRA/TRS, fueron factores asociados a la mortalidad en el análisis multivariante. (AU)

Background and objectives: The care of older patients in intensive care units (ICU) is becoming more frequent.To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality.Patients and methods: Retrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression.Results: Six hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge.An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality.Conclusions: In older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis. (AU)

[ISAR Score (Identification of Seniors At Risk) predicts mortality in patients older than 75 years admitted in Intensive Care]. / ISAR Score (Identification of Seniors At Risk) predice la mortalidad en mayores de 75 años ingresados en Cuidados Intensivos.

BACKGROUND AND OBJECTIVES: Currently, the patient's baseline situation is a more important prognostic factor than age. The purpose of this study is to estimate the prognostic value of the ISAR score (Identification of Senior at Risk) in patients ≥75 years admitted to intensive care (ICU). PATIENTS AND METHODS: Prospective multicenter study including patients ≥75 years admitted to the ICU > 24hours. On admission, 28 days and 6 months after discharge from the ICU, mortality and baseline were evaluated using the ISAR score, the Lawton and Brody scale (LB) and the Barthel index (BI), the Frail fragility scale. scale (FS), the Charlson comorbidity index (ICC), Dementia rating score (DRC). RESULTS: 38 of 94 patients (40%) were high risk (ISAR ≥ 3) and were characterized by BI 90 (65-100), LB 4 (3-5), and CDR 1 (0-2), ICC 7.5 (6-10). 58% had FS ≥ 3. In the long term, they were in a situation of dependency [BI 50 (2.5-77.5), LB 3 (0-4), CDR 1 (0-1.5)]. The ICU mortality at 28 days and 6 months was 18.4%, 25.7% and 35.3%, respectively, being statistically significant. The area under the ISAR score ROC curve was 0.749 to 0.797, in all the mortality periods studied, although the difference with other predictive variables was not significant, but the p value was the lowest. CONCLUSIONS: The ISAR score predicts mortality in critically elderly patients with a discriminative capacity comparable to other predictive variables.

Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review.

A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. The histopathologic study of the lung showed findings typical of an acute fibrinous and organizing pneumonia. Apropos of this case we performed a PubMed search. We found 13 articles, including a total of 29 patients. Acute fibrinous and organizing pneumonia is an unusual cause of acute lung injury. The diagnostic criterion is histopathologic. There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes.

A metabolomic approach for diagnosis of experimental sepsis.

BACKGROUND: The search for reliable diagnostic biomarkers of sepsis remains necessary. Assessment of global metabolic profiling using quantitative nuclear magnetic resonance (NMR)-based metabolomics offers an attractive modern methodology for fast and comprehensive determination of multiple circulating metabolites and for defining the metabolic phenotype of sepsis. OBJECTIVE: To develop a novel NMR-based metabolomic approach for diagnostic evaluation of sepsis. METHODS: Male Sprague-Dawley rats (weight 325-375 g) underwent cecal ligation and puncture (n = 14, septic group) or sham procedure (n = 14, control group) and 24 h later were euthanized. Lung tissue, bronchoalveolar lavage (BAL) fluid, and serum samples were obtained for (1)H NMR and high-resolution magic-angle spinning analysis. Unsupervised principal components analysis was performed on the processed spectra, and a predictive model for diagnosis of sepsis was constructed using partial least-squares discriminant analysis. RESULTS: NMR-based metabolic profiling discriminated characteristics between control and septic rats. Characteristic metabolites changed markedly in septic rats as compared with control rats: alanine, creatine, phosphoethanolamine, and myoinositol concentrations increased in lung tissue; creatine increased and myoinositol decreased in BAL fluid; and alanine, creatine, phosphoethanolamine, and acetoacetate increased whereas formate decreased in serum. A predictive model for diagnosis of sepsis using these metabolites classified cases with sensitivity and specificity of 100%. CONCLUSIONS: NMR metabolomic analysis is a potentially useful technique for diagnosis of sepsis. The concentrations of metabolites involved in energy metabolism and in the inflammatory response change in this model of sepsis.

Análisis de la incapacidad temporal en trabajadores de la rama sanitaria de un área de salud / Analysis of short-term time off of health workers in a health area

Objetivo. Describir las características de la incapacidad temporal (IT): duración, causas y distribución por edad y sexo. Diseño. Estudio observacional, descriptivo. Emplazamiento. Área 1 de Madrid. Participantes. Trabajadores del sector sanitario en situación de IT adscritos al Área 1 de Madrid durante los primeros 6 meses de 2003. Mediciones principales. Las variables estudiadas fueron: fecha de alta, fecha de baja, duración de la IT, causa de la baja (CIE-9), edad y sexo. Resultados. Se incluyó a 418 trabajadores del sector sanitario (3,7%). La edad media fue de 32,7 ± 20 años, con un 78,79% de mujeres. La enfermedad respiratoria es la causa más frecuente de IT (38%) en ambos sexos y en todos los grupos de edad, excepto en los más jóvenes ( 56 años) con menos IT pero de mayor duración (57,18; IC del 95%, 10,74-103,63), aunque no es estadísticamente significativo. Conclusiones. La causa que origina la IT es el factor que más determina la duración de la baja laboral. Su prevención supondría la mejor herramienta de gestión

Objective. To describe the characteristics of short-term time off work (STT): duration, causes and distribution by age, and sex. Design. Descriptive, observational study. Setting. Area 1, Madrid, Spain. Participants. Health workers with STT in Area 1, Madrid, during the first 6 months of 2003. Main measurements. The variables studied were: date of start and finish of STT, its duration, its cause (ICD-9), age, and sex. Results. Four-hundred eighteen health workers (3.7%), with a mean age of 32.7±20 years old and 78.79% women. Respiratory pathology was the most frequent cause of STT (38%) in both sexes and in all age-groups, except in the youngest (56), which had less, but longer-lasting STT (57.18; 95% CI, 10.74-103.63), though this was not statistically significant. Conclusions. The pathology causing STT is the factor that most determines STT's duration. Its prevention would be the best way of managing STT

[Analysis of short-term time off of health workers in a health area]. / Análisis de la incapacidad temporal en trabajadores de la rama sanitaria de un área de salud.

OBJECTIVE: To describe the characteristics of short-term time off work (STT): duration, causes and distribution by age, and sex. DESIGN: Descriptive, observational study. SETTING: Area 1, Madrid, Spain. PARTICIPANTS: Health workers with STT in Area 1, Madrid, during the first 6 months of 2003. MAIN MEASUREMENTS: The variables studied were: date of start and finish of STT, its duration, its cause (ICD-9), age, and sex. RESULTS: Four-hundred eighteen health workers (3.7%), with a mean age of 32.7+/-20 years old and 78.79% women. Respiratory pathology was the most frequent cause of STT (38%) in both sexes and in all age-groups, except in the youngest (<25), in whom bone and muscle pathology was more common. In decreasing order of frequency appeared bone and muscle pathology (26%), infections (13%), and mental illness (10%). The average duration of STT was 38.8+/-88.7 days. There was a statistically significant relationship between the duration of STT and its cause. Respiratory pathology was the shortest (8.85; 95% CI, 6.54-11.17) and mental illness, the longest (153.8; 95% CI, 87-220.75). The age group with most STT (37-45 years old) had a mean length of STT lower (26.93; 95% CI, 16.34-37.51) than the oldest age group (>56), which had less, but longer-lasting STT (57.18; 95% CI, 10.74-103.63), though this was not statistically significant. CONCLUSIONS: The pathology causing STT is the factor that most determines STT's duration. Its prevention would be the best way of managing STT.