Non-pharmacological interventions to reduce physical restraints in critical care units.

Physical restraint use in critical care units is a frequent low-value care practice influenced by numerous factors creating a local culture. The translation of evidence-based recommendations into clinical practice is scarce so, the analysis of interventions to de-adopt this practice is needed. This update aims to describe and identify nonpharmacological interventions that contribute to minimising the use of physical restraints in adult critically ill patients. Interventions are classified into two groups: those that include education alone and those that combine training with one or more components (multicomponent interventions). These components include less restrictive restraint alternatives, use of physical and cognitive stimulation, decision support tools, institutional multidisciplinary committees, and team involvement. The heterogeneity in the design of the programmes and the low quality of the evidence of the interventions do not allow us to establish recommendations on their effectiveness. However, multicomponent interventions including training, physical and cognitive stimulation of the patient and a culture change of professionals and the organisations towards making restraints visible might be the most effective. The implementation of these programmes should underpin on a prior analysis of each local context to design the most effective-tailored combination of interventions to help reduce or eliminate them from clinical practice.

[Management optimization of neovascular age-related macular degeneration in Spain: Evolution towards proactive treatment models]. / Optimización del manejo de la degeneración macular asociada a la edad neovascular en España: evolución hacia modelos proactivos de tratamiento.

INTRODUCTION AND OBJECTIVE: Healthcare resources optimization is crucial to assume the growing demand of neovascular age-related macular degeneration (nAMD). This work provides guidelines and support so that each hospital can lead its change management. METHODS: The OPTIMUS project (n=10 hospitals) was based on face-to-face interviews with the key staff of the ophthalmology services, and alignment with the main responsible for each centre (nominal group) to identify potential needs for improving nAMD. The OPTIMUS nominal group was expanded to 12 centres (eVOLUTION). Through different remote work sessions, different guides and tools were defined and developed to implement proactive treatment strategies, one-step treatment administration and potential for remote visits (eConsult) in nAMD. RESULTS: The information collected from the OPTIMUS interviews and working groups (n=10 centres) defined roadmaps to promote the development of protocols and proactive treatment strategies, including healthcare workload optimization and one-stop treatment administration in nAMD. With eVOLUTION, processes and tools were developed to promote eConsult: (i) healthcare burden calculator; (ii) definition of potential patients for telematic management; (iii) definition of nAMD management archetypes; (iv) definition of processes for implementation of eConsult by archetype; and (v) key performance indicators for changing evaluation. CONCLUSIONS: Managing change is an internal task that requires an adequate diagnosis of processes and feasible implementation roadmaps. OPTIMUS and eVOLUTION provide the basic tools for an autonomous advance of hospitals in the optimization of AMD management, with the available resources.

Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD. / Valoración de la analgesia, sedación, contenciones y delirio en los pacientes ingresados en unidades de cuidados intensivos españolas. Proyecto ASCyD.

AIMS: Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients' levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. METHOD: An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. RESULTS: One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. CONCLUSIONS: The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874).

Analysis of Kidney Donation and Its Relationship With Graft Failure of the Recipient at 1 Year.

INTRODUCTION: Currently, the shortage of organs available for kidney transplantation and a change in donors' and recipients' profiles (elderly, with cardiovascular risk, donors after cardiac death), it is becoming necessary to assess grafts from expanded-criteria donors (ECD) in order to have methods that allow us to predict viability and graft survival. OBJECTIVE: The aim of this study was to analyze the different methods of renal donor assessment (estimated glomerular filtration rate [eGFR], preimplantation biopsy, and Kidney Donor Profile Index [KDPI] score) as predictors of graft survival and renal function of our recipient at 1 year. METHODS: We performed a descriptive and retrospective study of 183 deceased donor kidney transplantations performed at our center between 2011 and 2015. We calculated the KDPI scores, donor eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration Formula equation, and biopsies were evaluated using Banff classification. RESULTS: ECDs comprised 59.60%, 93% of donors had an eGFR ≥ 60 mL/min/1.73 m2, and 41% presented with a KDPI score ≥ 90%. The most frequent range in the biopsy score was 0-3. The 1-year graft survival rate was 86.90%. Factors that negatively influenced graft survival were donor/recipient age, ECD, KDPI, and cold ischemia time (CIT). CONCLUSION: Prolonged CIT and KDPI ≥ 90% were donor variables that were related to graft failure at 1 year in our center.

[Prevention of ventilator-associated pneumonia: a comparison of level of knowledge in three critical care units]. / Prevención de neumonía asociada a ventilación mecánica, comparación de conocimientos entre tres unidades de críticos.

OBJECTIVE: To determine the level of knowledge of the prevention of ventilator-associated pneumonia guidelines of nurses working in three intensive care units (ICU) in 3 university hospitals in a Spanish region, and evaluate the relationship between this level of knowledge and years worked in the ICU. METHOD: A descriptive, prospective, cross-sectional, multicentre study was conducted using a validated and reliable questionnaire, made up by 9 questions with closed answers drawn from the EVIDENCE study. A total of 98 questionnaires were collected from ICU nurses of the three university hospitals (A, B, and C) from January to April 2014. The sample from hospital A responded the most, in contrast with the sample from hospital B, which was the one with the less participation. The Pearson correlation was calculated in order to determine the relationship between nurse years worked in ICU and level of knowledge. RESULTS: Hospital A obtained in the best mean score in the questionnaire, 6.33 (SD 1.4) points, followed by hospital C with 6.21 (SD 1.4), and finally, the hospital B with 6.06 (SD 1.5) points. A p=.08 was obtained on relating years worked with the level of knowledge. CONCLUSION: The results showed a high level of knowledge compared other studies. There was a tendency between the years worked in the unit and the level of knowledge in ventilator-associated pneumonia prevention.

Efficacy of dialysis in peritoneal dialysis: utility of bioimpedance to calculate Kt/V and the search for a target Kt.

BACKGROUND: To calculate Kt/V, volume (V) is usually obtained by Watson formula, but bioimpedance spectroscopy (BIS) is a simple and applicable technique to determinate V, along with other hydration and nutrition parameters, in peritoneal dialysis (PD) patients. Dialysis efficacy can also be measured with Kt, but no experience exists in PD, so there is no reference/target value for Kt that must be achieved in these patients to be considered adequately dialyzed. We evaluated the efficacy of PD with Kt/V using Watson formula and BIS for V calculation, assessed hydration status in a PD unit by data obtained by BIS, and attempted to find a reference Kt from the Kt/V previously obtained by BIS. METHODS: In this observational prospective study of 78 PD patients, we measured V using BIS (V bis) and Watson formula (V w) and calculated weekly Kt/V using both volumes (Kt/V bis/V bis and Kt/V w). With the BIS technique, we obtained and subsequently analyzed other hydration status parameters. We achieved a reference Kt, extrapolating the value desired (weekly Kt/V 1.7) to the target Kt using the simple linear regression statistical technique, basing it on the results of the previously calculated Pearson's linear correlation coefficient. RESULTS: Volume was 1.8 l higher by Watson formula than with BIS (p < 0.001). Weekly Kt/V bis was 2.33 ± 0.68, and mean weekly Kt/V w was 2.20 ± 0.63 (p < 0.0001); 60.25 % of patients presented overhydration according to the BIS study (OH >1.1 l). The target value of Kt for the reference weekly Kt/V bis (1.7) was 64.87 l. CONCLUSIONS: BIS is a simple, applicable technique for calculating V in dialysis that can be especially useful in PD patients compared with the anthropometric formulas, by the abnormally distributed body water in these patients. Other parameters obtained by BIS will serve to assess both the distribution of body volume and nutritional status in the clinical setting. The target Kt value obtained from Kt/V bis allowed us to measure the efficacy of PD in a practical way, omitting V measurement.

Infecciones osteoarticulares en niños. Revisión de la casuística entre 1997 y 2007 en un hospital General / Osteoarticular infections in children. Review of the casuistic between 1997 and 2007 in a general Hospital

Las infecciones osteoarticulares son más frecuentes en niños que en adultos y causan morbilidad y secuelas a largo plazo importantes. Hemos realizado un estudio retrospectivo de los casos de infección ósteo-articular (IOA) (artritis séptica, osteomielitis aguda o ambas) diagnosticados en nuestro hospital entre 1997 y 2007. Se diagnosticaron 16 niños con IOA, 7 (43%) en los últimos 2 años. Feuron artritis séptica (AS) 9 (56%), uno con afectación ósea asociada, y 7 (44%) osteomielitis aguda (OA). Entre los niños con AS la edad osciló entre 13 y 150 meses (mediana, 33). Las articulaciones más afectadas fueron la rodilla y el tobillo. Se documentaron microbiológicamente 3 casos (33%), (S. aureus, S. pneumoniae y P. aeruginosa). Los días totales de antibioterapia oscilaron entre 18 y 40 (media, 30). Entre los niños con OA, la edad varió entre 16 y 168 meses (mediana, 92). La localización más frecuente fue la tibia. Se documentaron microbiológicamente 4 casos (57%). Todos fueron S. aureus. La duración de la antibioterapia varió entre 24 y 53 días (media, 35). Las infecciones osteoartículares siguen siendo frecuentes, con una aumento progresivo en la incidencia. La principal etiología sigue siendo el S. aureus, por lo que la cobertura antibiótica empírica debe dirigirse contra este microorganismo (AU)

Bone and joint infections are more frequent in children tan in adults and cause orbidity and important long-term sequels. A retrospective analysis of all the diagnosed cases of bone and/or joint between 1997 and 2007 was performed. 16 children were diagnosed of bone and/or infection, 7 (43%) in the last 2 years. Septic arthritis (SA) was found in 9 patients (56%), one of them with bone extension, and acute osteomyelitis (AO) in 7 (44%). Children with SA had ages between 13 and 150 months (median 33). The most frequently affected joints were the knee and the ankle. We documented microbiologically 3 cases (33%), (s. aureus, s. pneumonia and P. aeruginosa). The days of antibiotic therapy ranged between 18 and 40 (mean 30), and those of intravenous therapy between 8 and 24 (mean 13). The age of children diagnosed of AO ranged between 16 and 168 months (median 92). The most frequent location was the tibia. In 2 occasions, surgical drainage was performed. The microbiologic diagnosis was made in 4 cases (57%). All of them were S. aureus. The day of antibiotic therapy ranged between 24 and 53 days (mean 35), our of which between 7 and 46 days (mean 14) was made intravenous. Bone and joint infections are still frequent. The incidence seems to increase in the last years. S. aureus in the main responsible agent, so the empirical antibiotic treatment should be directed against this microorganism (AU)

[Short cold ischaemia time optimises transplant results for kidneys from expanded criteria donors]. / El tiempo de isquemia fría corto optimiza los resultados de los trasplantes renales efectuados con donantes con criterios expandidos.

INTRODUCTION: Outcome of renal transplant from expanded criteria donors (ECD) is usually inferior than those from standard criteria donors (SCD) and may be improved decreasing cold ischemia time (CIT) and minimizing preservation injury. We compare the results obtained with CIT <15 hours in kidney transplants from ECD vs SCD. SUBJECTS AND METHODS: Prospective, single center study of kidney transplants performed since June 2003 to December 2007. Minimum follow-up period was 12 months. Data of donors, receptors and transplant outcome from ECD and SCD are compared. RESULTS: CIT (mean +/- SD) was 9.3+/-2.5 hours in transplants from ECD (n=24) and 8.3+/-3.3 hours in those from SCD (N=50), p=0.18. We did not find significant differences among recipients of grafts from ECD and those from SCD regarding: primary non-function (4.2% vs 2%, respectively), delayed graft function (16.7% vs 10%), surgical complications (25% vs 16%) or acute rejection episodes (8.3% vs 2%). Glomerular filtration rate at one year follow-up was 65.8+/-14.9 ml/min in ECD recipients and 49.4+/-12.5 ml/min (p<0.0001). One year graft survival was 95.8% in ECD recipients and 94% in SCD recipients (p=0.75). CONCLUSIONS: Short CIT in kidney transplant from ECD leads to similar outcome than that obtained from SCD, although renal function is inferior in ECD grafts.

El tiempo de isquemia fría corto optimiza los resultados de los trasplantes renales efectuados con donantes con criterios expandidos / No disponible

Introducción: Los resultados de los trasplantes efectuados condonantes con criterios expandidos (DCE) son inferiores a los obtenidos con donantes con criterios estándar (DCS). Para optimizar su evolución, se podría reducir su tiempo de isquemiafría (TIF) reduciendo su daño de preservación. Comparamoslos resultados obtenidos al aplicar TIF <15 horas tanto a DCE como a DCS. Material y métodos: Realizamos un estudio unicéntrico, de cohortes, prospectivo, de casos incidentes de trasplante renal de cadáver entre junio de 2003 y diciembre de2007. El tiempo mínimo de seguimiento fue de 12 meses. Comparamos los datos de los donantes, de los receptores y de la evolución de los trasplantes efectuados con DCE frente a los de los DCS. Resultados: El TIF para los DCE (N = 24) y para los DCS (N = 50) fue, respectivamente, de 9,3 ± 2,5 y 8,3± 3,3 horas (p = 0,18). No encontramos diferencias significativas entre los receptores de DCE y DCS en cuanto a: no función primaria del injerto 4,2 vs. 4%, retardo en la función del injerto 16,7 vs. 10%, complicaciones quirúrgicas 25 vs. 16% y rechazos agudos 8,3 vs. 2%. El filtrado glomerular estimado al año para los DCS fue de 65,8 ± 14,9 ml/min y para los DCE de 49,4 ± 12,5 ml/min (p <0,0001). La supervivencia renal al año fue del 95,8% para los receptores de DCE y del 94% para los DCS (p = 0,75). Conclusiones: La aplicación de TIF cortos a los DCE permite conseguir una evolución similar a la de los DCS, aunque su función renal sea en todo momento inferior (AU)

Introduction: Outcome of renal transplant from expanded criteria donors (ECD) is usually inferior than those from standard criteria donors (SCD) and may be improved decreasing cold ischemia time (CIT) and minimizing preservation injury. We compare the results obtained with CIT <15 hours in kidney transplants from ECD vs. SCD. Subjects and Methods: Prospective, single center study of kidney transplants performed since June 2003 to December 2007. Minimum follow-up period was 12months. Data of donors, receptors and transplant outcome from ECD and SCD are compared. Results: CIT (mean ± SD)was 9.3 ± 2.5 hours in transplants from ECD (n = 24) and8.3 ± 3.3 hours in those from SCD (N = 50), p = 0.18. We did not find significant differences among recipients of grafts from ECD and those from SCD regarding: primary non-function (4.2% vs. 2%, respectively), delayed graft function (16.7% vs. 10%), surgical complications (25% vs.16%) or acute rejection episodes (8.3% vs. 2%).Glomerular filtration rate at one year follow-up was 65.8± 14.9 ml/min in ECD recipients and 49.4 ± 12.5 ml/min (p<0.0001). One year graft survival was 95.8% in ECD recipients and 94% in SCD recipients (p = 0.75).Conclusions: Short CIT in kidney transplant from ECD leads to similar outcome than that obtained from SCD, although renal function is inferior in ECD grafts (AU)

Delay in treating age-related macular degeneration in Spain is associated with progressive vision loss.

PURPOSE: To assess the impact on visual acuity of delays between diagnosis and treatment in patients with subfoveal neovascular age-related macular degeneration (NV-AMD) and to evaluate NV-AMD patients' emotional status before therapy initiation. METHODS: This retrospective, multicenter, epidemiological study included newly diagnosed NV-AMD patients registered in the Spanish national health system and referred to regional health centers for evaluation/treatment by a retinal specialist from 09/2005 to 03/2006. Records were reviewed and data abstracted at referring physicians' offices (diagnosis visit) and regional health centers (treatment visit). Treatment was at physicians' discretion. The Hospital Anxiety and Depression Scale was administered at the treatment visit (before therapy). RESULTS: Median time from the diagnosis to treatment visit was 2.3 months (95% confidence interval: 0.2-10.8 months). Vision loss had progressed at the treatment visit with a doubling in the percentage of patients with a visual acuity of 20/400 or worse (from 12.4 to 24.7%). The decrease in visual acuity from the diagnosis to the treatment visit was highly statistically significant (P<0.0001) as was the correlation between months to treatment and visual acuity change (r=0.5234, P<0.0001). Time from the diagnosis to the treatment visit remained a significant predictor of progressive vision loss when visual acuity at diagnosis and change in lesion size between diagnosis and treatment were controlled (P<0.0001). Patients with more severe vision loss prior to treatment tended to report more depression. CONCLUSIONS: Delayed treatment of patients newly diagnosed with NV-AMD is associated with substantial visual acuity loss.

[An analysis of the papers presented in national congresses of the Spanish Society of Intensive Nursing and Coronary Units in an 8-year period]. / Análisis de las comunicaciones admitidas en los congresos nacionales de la SEEIUC en 8 años (1998-2005).

INTRODUCTION: The research on critical care nursing is generally presented in the annual national congresses of the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC). This study has aimed to analyze the main features of the papers presented in the above-mentioned congresses in order to get a deeper knowledge of the research capacity of our professional group. MATERIALS AND METHODOLOGY: A descriptive, observational and retrospective study. SAMPLE: all the papers. Dimension studied: structure and process. Time: 8 years. DATA SOURCE: a collection of the papers presented in congresses. DEVELOPMENT: collected variables: number of authors, type of paper, city and region, type of study, timing, nursing role, dimension analyzed, topic, hospital, department, type of statistics, relevance, financing, structural quality and others. Statistical processing: descriptive statistics for quantitative variables with means and standard deviation (SD); qualitative variables are written in percentages. We have contrasted hypotheses with chi(2) accepting if p < 0.05 as a statistical significance. RESULTS: Papers 736 (65-119), oral papers 270 (40.4%), mean of authors 4.87 (1-16), SD 1.97; per provinces: Barcelona 146 (19.8%); per autonomous communities: Catalonia 166 (22.6%); hospitals: University Hospital from Bellvitge 27 (4.2%); research studies 426 (65.3%); prospective studies 333 (51%), quantitative 345 (53%); with descriptive statistics 305 (46.9%); with a health perception and health management pattern 76 (10.3%); analyzed quality area: structure 379 (51.5%); with the presence of an autonomous role 380 (51.6%); most mentioned theme: respiratory care 100 (13.6%), with relevance and/or applicability 450 (69%); financed 23 (3.5%). Fulfillment of scientific structure: 97%. CONCLUSIONS: Intensive Nursing Care shows an important amount of oral papers. Research studies stand out among these papers, the former having high structural quality and relevance and/or applicability.

Polectomía abierta frente a percutánea en la tenosinovitis estenosante del pulgar infantil / Open versus percutaneous surgery for trigger thumb in children

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Distributions of C22-C30 even-carbon-number n-alkanes in Ocean Anoxic Event 1 samples from the Basque-Cantabrian Basin.

The Ocean Anoxic Event 1 (OAE-1) in central sites of the Basque-Cantabrian Basin exhibits very reducing depositional conditions of sedimentation. These sedimentation events have left a distinct mixture of hydrocarbons that are represented by C22-C30 n-alkanes with a predominance of the even-carbon-number homologues, high relative proportions of squalane and C16-C24 n-alkylcyclopentanes predominated by n-undecyl-, n-tridecyl- and n-pentadecylcyclopentane. Other minor compounds encompass a series of C18-C21 n-alkylcyclohexanes and C18-C24 dimethyl n-alkylcyclohexanes maximized by the even-carbon-number homologues as well as iso- and anteiso-alkanes. This unusual distribution of n-alkanes in this environment provides a new case for comparison with previously reported hypersaline and phosphorite sedimentary deposits where the occurrence of similar n-alkane distributions was reported. In the present case, these major n-alkanes and squalane are indicative of transformation under strong reducing conditions. In contrast, the occurrence of the alkylcyclopentanes, irrespective of the presence of even-carbon-number n-alkanes or squalane, suggests that reductive cyclization of fatty acids is less dependent on strong reducing conditions.

Características epidemiológicas de los traumatismos del codo en la infancia / Epidemiological characteristics of elbow traumatisms in childhood

Las fracturas del codo en la infancia son lesiones frecuentes, difíciles de diagnosticar por la inmadurez del esqueleto, y que en ocasiones asocian lesiones neurovasculares; su tratamiento y seguimiento es complejo. Realizamos una revisión retrospectiva de todos los pacientes menores de 16 años que fueron ingresados para tratamiento de fracturas en el codo, realizando un estudio epidemiológico de estas fracturas en nuestra población. Estudiamos las complicaciones asociadas, incluidas las neurovasculares, y valoramos las secuelas. Nuestro objetivo es orientar en el diagnóstico, tratamiento y seguimiento ante un niño con un traumatismo en el codo. En 414 casos de fracturas del codo, la lesión más frecuente es la fractura supracondílea, seguida de la fractura arrancamiento de la epitróclea. La fractura supracondílea es también la que más complicaciones asocia, incluidas las neurovasculares. El nervio cubital es el que más veces está afectado, y la fractura supracondílea es la causa más frecuente. Las lesiones vasculares son menos frecuentes. Sólo se presentaron 4 casos de síndrome compartimental, y ningún caso de síndrome de Volkmann. La incidencia de secuelas, 1 por ciento en nuestra serie, es baja. Concluimos que la fractura supracondílea es la más frecuente y también la más grave, por asociar más complicaciones. A pesar de la gravedad de las complicaciones, las secuelas finales son poco frecuentes. Es necesaria una exploración neurológica al ingreso para el diagnóstico precoz de lesiones neurológicas (AU)

[Acute ICU syndrome. Contributing factors and attitude of the nursing staff]. / Síndrome confusional agudo en UCI: factores que influyen y actitud de enfermería.

It is not uncommon for patients in intensive care units (ICUs) to suddenly and unexpectedly present what is known as acute ICU syndrome. This syndrome appears independently of the patient's situation and diagnosis. The aim of the present study was to determine the incidence of this nursing diagnosis in our department, to identify the possible environmental factors that could contribute to its appearance and to evaluate nursing interventions to resolve this syndrome in the ICU.Data were collected from a register of 62 items containing information on the health status of the patient on presenting the syndrome (vital signs, laboratory investigations, etc.), data on the environment, drugs used and other factors that could, a priori, play a role. The statistical analysis was performed using the SPSS program. This prospective study was carried out in a general ICU with ten beds: six beds in an open ward and four individual rooms. Two hundred forty-three patients were admitted during the 6-month study period. The incidence of ICU syndrome was 8.1 % (20 cases). Factors influencing its appearance were the timing of the shifts, the temperature, and whether patients were in individual rooms or open wards. The frequency of the syndrome was much higher in open wards and in the afternoon (from 15:00 to 22:00). In conclusion, the attitude of the nursing staff should be alert to identify the syndrome early and initiate appropriate measures, such as orienting the patient in time and space, achieving an appropriate temperature, using relaxation techniques, facilitating access to the family, etc., since in 35 % of cases these measures are sufficient to stabilize and/or resolve the problem, without the need of drugs.

Síndrome confusional agudo en uci: factores que influyen y actitud de enfermería / Acute ICU syndrome. Contributing factors and attitude of the nursing staff

En la UCI se observa con cierta frecuencia que los enfermos, independientemente de su situación y enfermedad, presentan de forma brusca e inesperada lo que denominamos síndrome confusional agudo (SCA) como diagnóstico de enfermería. Los objetivos del estudio son: determinar la incidencia de este diagnóstico enfermero en nuestro servicio, conocer las posibles causas del entorno que pueden incidir de forma más importante sobre su aparición, y evaluar la intervención de enfermería para resolver el cuadro confusional agudo del paciente en UCI. Para la recogida de datos, se utilizó un registro con 62 ítems en el que quedan reflejadas las variables sobre el estado del paciente cuando se presentaba el cuadro (constantes vitales, parámetros analíticos, etc.), datos del entorno, fármacos utilizados, y otros factores que a priori podían incidir. Se realizó procesamiento estadístico con el programa estadístico SPSS. El estudio se desarrolló de forma prospectiva, en una UCI polivalente de 10 camas, con 6 camas abiertas y 4 en boxes cerrados. Durante el período de estudio (6 meses), ingresaron 243 enfermos. La incidencia del SCA fue del 8,1 por ciento (20 casos). Como factores que inciden en su aparición se detectaron: el turno horario, el ambiente, y la situación de boxes individuales o camas abiertas, siendo destacable la aparición del cuadro con mucha mayor frecuencia en estas últimas, y en horario de tardes (15 a 22 h). Como conclusión, es importante destacar "la actitud de enfermería" que debe estar alerta para identificar el cuadro precozmente e iniciar las medidas oportunas, como orientar en tiempo y espacio, procurar un ambiente adecuado, emplear técnicas de relajación, facilitar el acceso a la familia, etc., ya que en el 35 por ciento de los casos ha resultado "eficaz" para estabilizar y/o resolver este problema, sin necesidad de fármacos (AU)

[Measurement of care time in patients with acute myocardial infarction admitted to a general ICU: evaluation and improvement]. / Medición de tiempos en la atención al paciente con infarto agudo de miocardio en una UCI polivalente: estudio de evaluación y mejora.

Acute myocardial infarction (AMI) requires early and safe nursing care, particularly with respect to initiating and following up thrombolytic treatment, the most effective therapy according to the literature. Time is decisive. Recommended door-to-needle time should not exceed 35 minutes (from patient's arrival to injection of the thrombolytic agent in the ICU). This quality of care study centered on the measurement of four partial times and their sum. These times corresponded to different phases a patient with AMI undergoes from arrival at the hospital emergency room center to thrombolysis in the ICU. The intrahospital delay in patient care was examined. Times were recorded on a specific register of all patients with priority I AMI (clear criteria for fibrinolysis) who were seen at our center. Total time to fibrinolysis in the ICU was 60 minutes (excessive intrahospital delay). A corrective intervention plan was designed and implemented, which reduced the delay to an acceptable 30 minutes. This improved the quality of care of AMI patients at our center.

[A new candidate for intensive care: patients undergoing rapid opiate withdrawal, and their care]. / Un nuevo candidato para cuidados intensivos: "el paciente que se va a someter a desintoxicación ultracorta por opiáceos, y sus cuidados".

Withdrawal from drugs currently is and interesting topic because of the repercussions it has on different aspects of life, particularly: health, work, family and social relationships, etc. In this article we report a new system for minimizing the adverse effects of withdrawal from opiates (which usually are prolonged), and for carrying out withdrawal as quickly and effectively as possible. A protocol is described in detail, as well as special nursing care. This protocol is called ultrashort withdrawal (24 hours) and it has been developed and used in the intensive care department of the General University Hospital of Murcia (Spain), in collaboration with the center's hospital detoxification unit.

[Prevention of infections caused by venous catheters in intensive care units]. / Prevención de las infecciones relacionadas con catéteres venosos en cuidados intensivos.

The importance of the prevention of infections related to venous catheters comes from the frequent morbility which derives from these devices in ICU and the foresecable increase of infections which are secondary to them with the consequent increase in the load of Nursing work and costs in Spain, bacteriemias related to central catheters are 8%, under 5% for Swan-Ganz and almost inexistent for peripherals. Germs responsible for infectious incidences caused by catheters are basically Staphylococcus coagulase-negative and Staphylococcus aureus. The most affected veins are the jugular, followed by femoral, antecubital, subclavian and peripheral. The colonization of the patient's skin and the connections of catheters are the most frequent origin of infections and, since certain germs create defensive structures which make them more resistant to treatment, it is very important to carry out protocols of prevention and care which should encompass hand washing efficiency, daily care of the wound, use of suitable disinfectants and, very especially, the protection of catheter connections.