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.

[Burnout syndrome in different intensive care units]. / Síndrome de burnout en distintas Unidades de Cuidados Intensivos.

OBJECTIVES: To determine the prevalence of the professional burnout syndrome in health care personnel of different Intensive Care Units (ICUs). To know the association between burnout, its dimensions and sociodemographic-laboral variables. To compare the dimensions of burnout, characteristics of the personnel and of the patients of the different ICUs. MATERIAL AND METHODS: Analytic, comparative, cross-sectional study performed in the ICU of a tertiary hospital in November 2006 performed in a sample of 289 professionals. The Maslach Burnout Inventory questionnaire and sociodemographic-laboral variables were provided. The following were evaluated in the ICUs: Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay, isolations and travel of third parties. The chi2 test, Fischer test, Kruskall-Wallis test and multivariate logistic regression analysis were used. RESULTS: A total of 73% of the workers answered. Ages ranged from 37 +/- 9 and 81% were women. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% of residents, 13% physicians and 10% auxiliary workers. Burnout was associated to low professional satisfactions, relationship with regular colleagues, low work recognition and time worked and experience in the ICU to high emotional tiredness, with a p < 0.05. In a polyvalent ICU, higher values of the following were obtained: TISS 42 +/- 11, NEMS 35 +/- 10, mortality 18%, stay 5 +/- 9, isolation 21%, burnout syndrome 17%, elevated emotional tiredness 49%, elevated depersonalization 63% and low professional performance 44%. CONCLUSIONS: The prevalence of the burnout syndrome in our sample was 14%, those being affected most being the nursing professionals. We detected elevated levels of depersonalization and middle levels of emotional tiredness and professional performance. The variables related with professional burnout syndrome were low professional satisfaction, relationship with regular colleagues, low work recognition, and elevated emotional tiredness in the more expert personnel. The ICU with the greatest prevalence of burnout during the month studied attended patients with greater TISS, NEMS, mortality, stay and isolations.

Síndrome de burnout en distintas Unidades de Cuidados Intensivos / Burnout syndrome in different Intensive Care Units

Objetivos. Determinar la prevalencia del síndrome de desgaste profesional (burnout) enel personal sanitario de distintas Unidades de Cuidados Intensivos (UCI).Conocer la asociaciónentre el burnout, sus dimensiones y variables sociodemográficas-laborales. Comparardimensiones del burnout, características del personal y de los pacientes de distintas UCI.Material y métodos. Estudio analítico comparativo transversal, realizado en UCI de un hospitalterciario, en noviembre de 2006. La muestra fue 289 profesionales. Se entregó el cuestionarioMaslach Burnout Inventory y variables sociodemográficas-laborales. Se valoró en UCI:Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower UseScore (NEMS), mortalidad, estancia, aislamientos y desplazamientos terciarios. Se empleó laprueba de la χ2, Fischer, Kruskall-Wallis y análisis multivariable de regresión logística.Resultados. Contestaron el 73% de los trabajadores, edad 37 ± 9 y un 81% eran mujeres.Prevalencia de burnout 14%, afectados el 16% de enfermeros, 14% de residentes, 13% demédicos y 10% de auxiliares. El burnout se asoció a satisfacción profesional baja, relacióncon compañeros regular, reconocimiento laboral bajo, y tiempo trabajado y experienciaen UCI a un cansancio emocional elevado, con una p < 0,05. En la UCI Polivalente se obtuvieronvalores más elevados de: TISS 42 ± 11, NEMS 35 ± 10, mortalidad 18%, estancia5 ± 9, aislamientos 21%, síndrome burnout 17%, cansancio emocional elevado 49%, despersonalizaciónelevada 63% y realización profesional baja 44%.Conclusiones. La prevalencia del síndrome de burnout en nuestra muestra fue del 14%,siendo los profesionales de enfermería los más afectados. Detectamos niveles elevadosde despersonalización y niveles medios de cansancio emocional y de realización profesional.Las variables relacionadas con el (..) (AU)

Objectives. To determine the prevalence of the professional burnout syndrome inhealth care personnel of different Intensive Care Units (ICUs). To know the associationbetween burnout, its dimensions and sociodemographic-laboral variables. To comparethe dimensions of burnout, characteristics of the personnel and of the patients of thedifferent ICUs.Material and methods. Analytic, comparative, cross-sectional study performed in the ICUof a tertiary hospital in November 2006 performed in a sample of 289 professionals. TheMaslach Burnout Inventory questionnaire and sociodemographic-laboral variables wereprovided. The following were evaluated in the ICUs: Therapeutic Intervention ScoringSystem (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay,isolations and travel of third parties. The χ2 test, Fischer test, Kruskall-Wallis test andmultivariate logistic regression analysis were used.Results. A total of 73% of the workers answered. Ages ranged from 37 ± 9 and 81% werewomen. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% ofresidents, 13% physicians and 10% auxiliary workers. Burnout was associated to lowprofessional satisfactions, relationship with regular colleagues, low work recognition andtime worked and experience in the ICU to high emotional tiredness, with a p < 0.05. In apolyvalent ICU, higher values of the following were obtained: TISS 42 ± 11, NEMS 35 ± 10,mortality 18%, stay 5 ± 9, isolation 21%, burnout syndrome 17%, elevated emotionaltiredness 49%, elevated depersonalization 63% and low professional performance 44%.Conclusions. The prevalence of the burnout syndrome in our sample was 14%, those beingaffected most being the nursing professionals. We detected elevated levels ofdepersonalization and middle levels of emotional tiredness and professional performance. (..) (AU)