¿Influyen los antecedentes de consumo de sustancias psicótropas en el nivel de dolor del paciente con traumatismo grave? / Does a history of psychoactive substances abuse play a role in the level of pain of the patient with severe trauma?

Objetivo. Analizar la influencia del consumo de sustancias psicótropas en el nivel de dolor de los pacientes con traumatismo grave. Diseño. Estudio analítico longitudinal. Ámbito. Unidad de Cuidados Intensivos (UCI) de Traumatismos y Emergencias. Pacientes. Traumatismo grave, no comunicativo y ventilación mecánica >48 h. Se crearon 2 grupos de pacientes: consumidores de sustancias psicótropas y no consumidores según historia clínica. Intervenciones. Medición del nivel de dolor en situación basal y durante la movilización, mediante la escala de conductas indicadoras de dolor. Variables. Características demográficas, puntuación de dolor, nivel de sedación y tipo y dosis de analgesia y sedación. Resultados. Muestra de 84 pacientes, correspondiendo 42 a cada grupo. El nivel de dolor en ambos grupos, durante la movilización, muestra diferencias significativas p = 0,011, con una media de 3,11 (2,40) para el grupo de consumidores y 1,83 (2,14) para el grupo de no consumidores. Se objetiva un riesgo relativo (RR) de 2,5, IC (1,014-6,163) de tener dolor moderado/grave en el grupo de consumidores respecto al de no consumidores. La dosis media de analgesia y sedación continua es significativamente mayor en el grupo de consumidores: p = 0,032 y p = 0,004, respectivamente. No hay diferencia en la dosis de bolos de analgesia y sedación con p = 0,624 y p = 0,690, respectivamente. Conclusiones. Los pacientes con antecedentes de consumo de sustancias psicótropas muestran mayor nivel de dolor y tienen más riesgo de que este sea moderado/grave respecto a los no consumidores, a pesar de recibir mayor dosis de analgesia y sedación continua

Objective. To analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma. Design. Longitudinal analytical study. Scope. Intensive Care Unit (ICU) of Trauma and Emergencies. Patients. severe trauma, non-communicative and mechanical ventilation >48hours. Two groups of patients were created: users and non-users of psychotropic substances according to medical records. Interventions. Measurement of pain level at baseline and during mobilization, using the Pain Indicator Behaviour Scale. Variables. demographic characteristics, pain score, sedation level and type and dose of analgesia and sedation. Results. Sample of 84 patients, 42 in each group. The pain level in both groups, during mobilisation, showed significant differences p = 0.011, with a mean of 3.11 (2.40) for the user group and 1.83 (2.14) for the non-user group. A relative risk of 2.5 CI (1,014-6,163) was found to have moderate / severe pain in the user group compared to the non-user group. The mean dose of analgesia and continuous sedation was significantly higher in the user group: P=.032 and P=.004 respectively. There was no difference in bolus dose of analgesia and sedation with P = .624 and P = .690 respectively. Conclusions. Patients with a history of consumption of psychoactive substances show higher levels of pain and experience a higher risk of this being moderate/severe compared to non-users despite receiving higher doses of analgesia and sedation infusion

Does a history of psychoactive substances abuse play a role in the level of pain of the patient with severe trauma? / ¿Influyen los antecedentes de consumo de sustancias psicótropas en el nivel de dolor del paciente con traumatismo grave?

OBJECTIVE: To analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma. DESIGN: Longitudinal analytical study. SCOPE: Intensive Care Unit (ICU) of Trauma and Emergencies. PATIENTS: severe trauma, non-communicative and mechanical ventilation >48hours. Two groups of patients were created: users and non-users of psychotropic substances according to medical records. INTERVENTIONS: Measurement of pain level at baseline and during mobilization, using the Pain Indicator Behaviour Scale. VARIABLES: demographic characteristics, pain score, sedation level and type and dose of analgesia and sedation. RESULTS: Sample of 84 patients, 42 in each group. The pain level in both groups, during mobilisation, showed significant differences p=0.011, with a mean of 3.11(2.40) for the user group and 1.83(2.14) for the non-user group. A relative risk of 2.5 CI (1,014-6,163) was found to have moderate / severe pain in the user group compared to the non-user group. The mean dose of analgesia and continuous sedation was significantly higher in the user group: P=.032 and P=.004 respectively. There was no difference in bolus dose of analgesia and sedation with P=.624 and P=.690 respectively. CONCLUSIONS: Patients with a history of consumption of psychoactive substances show higher levels of pain and experience a higher risk of this being moderate/severe compared to non-users despite receiving higher doses of analgesia and sedation infusion. Key words: pain, multiple trauma, drug users.

Percepción de las enfermeras sobre la comunicación con la familia de pacientes ingresados en un servicio de medicina intensiva / Nursing perception of communication with intensive care unit patients family members

Introducción: En las unidades de cuidados intensivos (UCI) la familia considera la necesidad de comunicación como una de las más importantes. Objetivo Analizar la percepción de las enfermeras sobre el proceso de comunicación con los familiares de los pacientes adultos ingresados en un servicio de medicina intensiva (SMI). Método: Estudio transversal (diciembre 2012) mediante un cuestionario Nurse Activities for Communicating with families (NACF), adaptado transculturalmente por Santana Cabrera et al. Participantes: enfermeras de un SMI de un hospital universitario de nivel terciario. Análisis descriptivo de variables y estadística inferencial con Chi-cuadrado y Kruskal-Wallis, programa estadístico SPSS 17.0; significativo p < 0,05. Resultados: La cumplimentación fue del 80% (132 de 166 enfermeras). La media de experiencia fue de 9,6 ± 7,95 años. El 55,9% explican a los familiares el tratamiento y equipos del paciente algunas veces, y casi siempre el 37%. Las enfermeras hablan con la familia sobre la enfermedad y el tratamiento que se le está aplicando al paciente siempre/casi siempre en el 59%, y el 35,38% algunas veces. El 54,6% hablan con la familia acerca de sus sentimientos algunas veces, y el 28,46% casi siempre. El 47,8% comunican siempre/casi siempre los cambios en el plan de cuidados. El 87,9% aseguran la confortabilidad del paciente siempre/casi siempre. No existe asociación entre años de experiencia en UCI y las respuestas a los ítems. Se encuentran diferencias entre los tipos de UCI y la información sobre enfermedad y tratamiento. Conclusión: Las enfermeras comunican más aspectos técnicos que los relacionados con los sentimientos de la familia. La confortabilidad del paciente es el ítem que más comunica la enfermera, independientemente de la experiencia y del tipo de unidad de cuidados críticos

Introduction: Communication is referred as one of the most important needs by the families of intensive care unit patients. Aim of the study To analyze nursing perception of the communication process with the family members of an intensive care unit patient. Materials and methods: Transversal study (December 2012) with a questionnaire Nurse Activities for Communicating with Families (NACF), cross-culturally adapted by Santana Cabrera et al. Participants: intensive care unit nurses from a third level university hospital. Descriptive analysis of variables and inferential statistics with Chi-square and Kruskal-Wallis, statistic program SPSS 17.0; significant P < .05. Results: Complementation was of 80% (132 out of 166 nurses). The average experience was of 9.6 ± 7.95 years. 55.9% sometimes explain to families the treatment and equipment of the patient and a 37% almost always. Nurses talk to the families about the disease and the treatment given to the patient always/almost always in 59% of the cases and sometimes in a 35.38%. 54,6% talk to the family about their feelings sometimes and a 28.46% almost always. A 47.8% notify always/almost always changes on the care plan. 87.9% ensure patient comfort always/almost always. There is no relation between years of experience in ICU and the outcomes of the questionnaire. There is a relation between the different kinds of ICUs and the information given about disease and treatment. Discussion: Nurses tend to inform more about technical aspects than feelings related to the families. Patient comfort is the most referred item regardless of years of experience and the kind of intensive care unit

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

Valoración del dolor en la aspiración de secreciones traqueales en pacientes con traumatismo craneal mediante la Escala de conductas indicadoras de dolor (ESCID) / Pain assessment of tracheal suctioning on brain injury patients by pain behavioral indicator scale (ESCID)

Objetivo: Evaluar la respuesta al dolor en el paciente con traumatismo craneal (TC) moderado-grave en la aspiración de secreciones traqueales. Material y método: Estudio piloto observacional longitudinal con muestreo consecutivo; septiembre-diciembre de 2012. Se valoró el dolor 5min antes, durante y 15min después de la aspiración de secreciones traqueales los días 1, 3 y 6 de estancia en la unidad de cuidados intensivos (UCI), así como un procedimiento no doloroso: roce con gasa en el antebrazo del paciente, mediante ESCID. También se registraron la sedoanalgesia y variables hemodinámicas. Análisis descriptivo de variables, estadística inferencial: «t» de Student y Anova con SPSS 17.0; los test estadísticos fueron considerados significativos si el nivel crítico observado era inferior al 5% (p < 0,05). Resultados: Se valoró el dolor en 27 pacientes. El 82% tenía TC-grave y el 18% moderado. La media de dolor durante la realización de la aspiración fue el día 1: 3,18 ± 2,6; el día 3: 2,59 ± 2; y el día 6: 3,94 ± 2,3. Hubo un aumento significativo en las medias de dolor durante la realización del procedimiento los 3 días de valoración (p<0,05), sin embargo al comparar las medias de dolor de los 3 días de valoración no se encontraron diferencias significativas (p>0,05). Durante el procedimiento no doloroso se obtuvieron diferencias significativas el día 6 de valoración (p < 0,05). Conclusión: Durante la aspiración de secreciones traqueales en pacientes con TC en los 6 primeros días de estancia en la UCI se objetiva un dolor leve-moderado mediante la escala ESCID

Objective: To assess pain response on patients with moderate to severe head injury before a common nursing procedure: tracheal suctioning. Material and method: An observational longitudinal pilot study with consecutive sampling performed from September to December of 2012. Pain was assessed by a pain behavioral indicator scale 5minutes before, meanwhile and 15minutes after tracheal suctioning the days 1, 3 and 6 of their intensive care unit (ICU) stay, as well as a non-painful procedure: rubbing with gauze the forearm of the patient. Pseudo-analgesia and hemodynamic variables were also recorded. Descriptive analysis of the variables, inferential statistics with t-student and Anova with SPSS 17.0; statistical tests were considered significant if the critical level observed was less than 5% (P < .05). Results: Pain was assessed on 27 patients. 82% suffered from severe head trauma and 18% moderate. The average pain value during nursing procedure day 1 was 3, 18 ± 2.6, day 3: 2, 59 ± 2 and day 6: 3, 94 ± 2.3. There was a significant increase in mean pain while performing suctioning during the three days of assessment (P < .05); however no significant differences between the average pain value on the three days of the assessment (P > .05) were shown. Data for the painless procedure were significantly different on day 6 (P < .05). Conclusion: During tracheal suctioning in patients with head injury in the first 6 days in the ICU, objective mild-moderate pain according to ESCID scale has been detected

[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.

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

[Pain assessment of tracheal suctioning on brain injury patients by pain behavioral indicator scale (ESCID)]. / Valoración del dolor en la aspiración de secreciones traqueales en pacientes con traumatismo craneal mediante la Escala de conductas indicadoras de dolor (ESCID).

OBJECTIVE: To assess pain response on patients with moderate to severe head injury before a common nursing procedure: tracheal suctioning. MATERIAL AND METHOD: An observational longitudinal pilot study with consecutive sampling performed from September to December of 2012. Pain was assessed by a pain behavioral indicator scale 5 minutes before, meanwhile and 15 minutes after tracheal suctioning the days 1, 3 and 6 of their intensive care unit (ICU) stay, as well as a non-painful procedure: rubbing with gauze the forearm of the patient. Pseudo-analgesia and hemodynamic variables were also recorded. Descriptive analysis of the variables, inferential statistics with t-student and Anova with SPSS 17.0; statistical tests were considered significant if the critical level observed was less than 5% (P<.05). RESULTS: Pain was assessed on 27 patients. 82% suffered from severe head trauma and 18% moderate. The average pain value during nursing procedure day 1 was 3, 18±2.6, day 3: 2, 59±2 and day 6: 3, 94±2.3. There was a significant increase in mean pain while performing suctioning during the three days of assessment (P<.05); however no significant differences between the average pain value on the three days of the assessment (P>.05) were shown. Data for the painless procedure were significantly different on day 6 (P<.05) CONCLUSION: During tracheal suctioning in patients with head injury in the first 6 days in the ICU, objective mild-moderate pain according to ESCID scale has been detected.

[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.

Evaluación del cumplimiento de cabeceros elevados entre 30–45 o en pacientes intubados / Evaluation of the compliance of semirecumbent position between 30–45 o in intubated patients

ObjetivoDeterminar cumplimiento del estándar “cabecero de la cama entre 30–45o en pacientes con vía aérea (VA) artificial”. Conocer la opinión de los profesionales respecto a él.Material y métodosEstudio observacional prospectivo, realizado en diciembre de 2009 en el servicio de medicina intensiva de un hospital terciario. Excluidos: con limitación del esfuerzo terapéutico, decúbito prono y anti-Trendelemburg. Se registró: altura del cabecero, experiencia del enfermero, turno, percepción del auditor, diagnóstico, tipo de VA artificial (traqueostomía o tubo endotraqueal [TOT]), ventilación mecánica (VM), sí/no, y nutrición enteral (NE). Se realizó una encuesta a los enfermeros para saber si conocían el estándar, lo cumplían, método utilizado y sugerencias. Se utilizó la t de Student, ANOVA para análisis multivariable y la χ2, Test de Fisher; se consideró significativo p<0,05.ResultadosSe obtuvieron 546 mediciones válidas, de 53 pacientes. El 40,9% tenía el cabecero correcto (30–45o). Los profesionales con menos de 1 año de experiencia son los que elevan menos el cabecero; sólo el 26,4% de estas determinaciones estaba por encima de 30o. El 34,8% de los pacientes neurocríticos (NC) cumplían el estándar en relación con no NC (46,7%) (p<0,05). El 29,2% de los pacientes con traqueostomía estaban con más de 30o frente al 44% de las mediciones realizadas en pacientes con TOT (p<0,05). No hubo diferencias entre turnos, VM o NE. Capacidad diagnóstica de la percepción del auditor: sensibilidad, 91,6%; especificidad, 72,5%; valor predictivo positivo, 70,2%; valor predictivo negativo (VPN), 92,4%. El 97,9% de los profesionales encuestados conoce el estándar. La estimación visual se utiliza en el 97,2% de los casos.ConclusionesEl cumplimiento del estándar es<50% aunque se conoce bien. A pesar de que la percepción subjetiva tiene un elevado VPN, parece insuficiente para cumplir el estándar(AU)

AimsTo determine compliance of the standard “semirecumbent position between 30–45o in patients with artificial airway (AA)”. To know the opinion of the professionals on this issue.Material and methodsAn observational, prospective study was carried out in December 2009 in the ICU department of a tertiary hospital that excluded the limitation of therapeutic effort, prone position and antitrendelemburg. Data collected: headrest angle, professional experience of the nurse, shift, perception of the auditor, diagnostic, type of AA (tracheostomy or endotracheal tube), mechanical ventilation (MV) (yes/no) and enteral nutrition (EN). Nurses were surveyed to verify if they knew the standard, if they complied with it, the method used and their suggestions. We used the Student's t test and ANOVA for multivariable analysis, and Fisher's χ2; p<0.05=significant.ResultsA total of 546 valid measurements were obtained from 53 patients, of which 40.9% had the correct semirecumbent position (30–45o). Professionals with<1 year of experience were those who raised the headrest the least, with only 26.4% of these measurements over 30o. The standard was met in only 34.8% of the neurocritical patients (NC) vs non NC (46.7%) (p<0.05). It was < 30o in 29.2% of patients with tracheostomy vs 44% measurements performed on patients with TOT (p<0.05). There were no differences between shifts, the use of MV or EN. Diagnostic accuracy of the auditor: sensitivity: 91.6%; specificity: 72.5%; positive predictive value: 70.2%; negative predictive value (NPV): 92.4%. 97.9% of responders know the standard. Visual judgment was used in 97.2% of the cases.ConclusionsMeasured compliance was less than 50% although the standard is well known by the nursing team. Even though the subjective perception has a high NPV, it does not achieve the standard(AU)

[Evaluation of the compliance of semirecumbent position between 30-45° in intubated patients]. / Evaluación del cumplimiento de cabeceros elevados entre 30-45° en pacientes intubados.

AIMS: To determine compliance of the standard "semirecumbent position between 30-45° in patients with artificial airway (AA)". To know the opinion of the professionals on this issue. MATERIAL AND METHODS: An observational, prospective study was carried out in December 2009 in the ICU department of a tertiary hospital that excluded the limitation of therapeutic effort, prone position and antitrendelemburg. DATA COLLECTED: headrest angle, professional experience of the nurse, shift, perception of the auditor, diagnostic, type of AA (tracheostomy or endotracheal tube), mechanical ventilation (MV) (yes/no) and enteral nutrition (EN). Nurses were surveyed to verify if they knew the standard, if they complied with it, the method used and their suggestions. We used the Student's t test and ANOVA for multivariable analysis, and Fisher's χ2; p<0.05=significant. RESULTS: A total of 546 valid measurements were obtained from 53 patients, of which 40.9% had the correct semirecumbent position (30-45°). Professionals with <1 year of experience were those who raised the headrest the least, with only 26.4% of these measurements over 30°. The standard was met in only 34.8% of the neurocritical patients (NC) vs non NC (46.7%) (p<0.05). It was <30° in 29.2% of patients with tracheostomy vs 44% measurements performed on patients with TOT (p<0.05). There were no differences between shifts, the use of MV or EN. Diagnostic accuracy of the auditor: sensitivity: 91.6%; specificity: 72.5%; positive predictive value: 70.2%; negative predictive value (NPV): 92.4%. 97.9% of responders know the standard. Visual judgment was used in 97.2% of the cases. CONCLUSIONS: Measured compliance was less than 50% although the standard is well known by the nursing team. Even though the subjective perception has a high NPV, it does not achieve the standard.

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.