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2.
Enferm. intensiva (Ed. impr.) ; 35(1): 13-22, ene.-mar. 2024. ilus, tab
Artículo en Español | IBECS | ID: ibc-EMG-550

RESUMEN

Introducción La púrpura fulminante (PF) es una complicación grave de la sepsis resultado de un conjunto de alteraciones caracterizadas por el desarrollo de lesiones hemorrágicas equimóticas y necrosis de la piel. Objetivo Analizar la eficacia y la seguridad de la aplicación tópica de un compuesto de ácidos grasos hiperoxigenados (AGHO) en la microcirculación de la PF en pacientes pediátricos afectados de sepsis. Material y métodos Se llevó a cabo un estudio prospectivo cuasiexperimental pretest-posttest de un solo grupo en una Unidad de Cuidados Intensivos Pediátrica (UCIP). Se incluyeron en el estudio pacientes con PF de 0 a 18 años. Para evaluar la efectividad del producto objeto de evaluación en la microcirculación de las lesiones por PF se determinaron los valores de oximetría somática antes y después de la aplicación de AGHO cada 4h durante los 3 primeros días de ingreso de los pacientes. Resultados Se reclutaron 4 pacientes, con una mediana de edad de 98 meses. Las lesiones purpúricas que se midieron estaban ubicadas, sobre todo, en ambos pies y manos y, en 2 pacientes, también en los maléolos laterales y gemelos de ambas extremidades inferiores. Se obtuvieron un total de 225 mediciones, observando unas puntuaciones medias preintervención de 71,17±15,65% versus los 73,68±14,83% postintervención. Se objetivó significación estadística (p<0,001) al comparar las mediciones pre- y postintervención. Conclusiones La aplicación precoz y continuada de AGHO en el manejo de la PF por sepsis es una práctica eficaz y segura en los casos de población pediátrica analizada. En más de la mitad de los episodios analizados se objetivó un aumento de microcirculación tisular tras la aplicación de los AGHO, sin eventos adversos. (AU)


Introduction Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis. Aim To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis. Material and methods A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4hours over the first three days of the patients’ hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined. Results Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements. Conclusions Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events. (AU)


Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Púrpura Fulminante/tratamiento farmacológico , Pediatría , Cuidados Críticos , Sepsis , Unidades de Cuidados Intensivos , Estudios Prospectivos , Ensayos Clínicos Controlados no Aleatorios como Asunto
3.
Enferm. intensiva (Ed. impr.) ; 35(1): 23-34, ene.-mar. 2024. tab
Artículo en Inglés | IBECS | ID: ibc-EMG-551

RESUMEN

Purpose This study examined the Jordanian registered nurses’ perceptions of the obstacles and supportive behaviors of End-of-Life Care in Intensive Care Units and examined the differences in the concepts based on the samples’ demographics. Methods A cross-sectional and comparative study was conducted using a convenience sample of 230 Intensive Care Unit registered nurses in Jordan. Data were analyzed descriptively, and differences were measured using the independent sample t-test, the one-way Analysis of Variance, and Scheffe’s post hoc test. Results The registered nurses’ scored moderately on obstacles (74.98 ± 14.54) and supportive behaviors (69.22 ± 4.84). The commonly perceived obstacle and supportive behaviors to End-of-Life Care in Intensive Care Units s were reported. The perceived obstacles differ based on the registered nurses’ certification as an Intensive Care Units nurse (3.04 ± 0.58 vs. 2.74 ± 0.49, p = 0.008), type of Intensive Care Unit (3.28 ± 0.34 vs. 2.86 ± 0.62, p < 0.001), type of facility (3.16 ± 0.59 vs. 2.77 ± 0.61, p < 0.001), number of beds in the unit (3.07 ± 0.48 vs. 2.69 ± 0.48, p = 0.020), and the number of hours worked per week (3.06 ± 0.56 vs. 2.81 ± 0.60, p = 0.005). In contrast, supportive behaviors only differ based on the registered nurses’ age (3.22 ± 0.69 vs. 2.90 ± 0.64, p = 0.019). Conclusions The common End-of-Life Care perceived obstacle in Intensive Care Units was the lack of nursing education and training regarding the studies concept, which warrants immediate intervention such as on-job training. The common End-of-Life Care perceived supportive behavior in Intensive Care Units was when family members accepted that the patient was dying when nurses offered support to family members; motivational interventions are needed to sustain such behavior. Differences in the perceived obstacles and supportive behaviors should be leveraged for the benefit of patients, nurses, and hospitals. (AU)


Propósito Este estudio examinó las percepciones de las enfermeras registradas jordanas sobre los obstáculos y comportamientos de apoyo de la atención al final de la vida en las Unidades de Cuidados Intensivos y examinó las diferencias en los conceptos basados en la demografía de las muestras. Métodos Se realizó un estudio transversal y comparativo utilizando una muestra de conveniencia de 230 enfermeras registradas en la Unidad de Cuidados Intensivos en Jordania. Los datos se analizaron descriptivamente y las diferencias se midieron mediante la prueba t de muestra independiente, el análisis unidireccional de varianza y la prueba post hoc de Scheffe. Resultados Las enfermeras registradas obtuvieron una puntuación moderada en obstáculos (74,98 ± 14,54) y comportamientos de apoyo (69,22 ± 4,84). Se informaron los obstáculos comúnmente percibidos y los comportamientos de apoyo a la atención al final de la vida en las Unidades de Cuidados Intensivos. Los obstáculos percibidos difieren según la certificación del enfermero registrado como enfermero de las Unidades de Terapia Intensiva (3,04 ± 0,58 vs. 2,74 ± 0,49, p < 0.001), tipo de Unidad de Cuidados Intensivos (3,28 ± 0,34 vs. 2,86 ± 0,62, p < 0.001), tipo de instalación (3,16 ± 0,59 vs. 2,77 ± 0,61, p < 0.001), número de camas en la unidad (3,07 ± 0,48 vs. 2,69 ± 0,48, p = 0,020), y número de horas trabajadas por semana (3,06 ± 0,56 vs. 2,81 ± 0,60, p = 0,005). En contraste, los comportamientos de apoyo solo difieren según la edad de las enfermeras registradas (3,22 ± 0,69 vs. 2,90 ± 0,64, p = 0,019). Conclusiones El obstáculo común percibido en la Atención al Final de la Vida en las Unidades de Terapia Intensiva fue la falta de educación y capacitación de enfermería sobre el concepto de estudios, lo que justifica una intervención inmediata, como la capacitación en el trabajo... (AU)


Asunto(s)
Humanos , Femenino , Unidades de Cuidados Intensivos , Cuidado Terminal , Enfermeras y Enfermeros , Estudios Transversales , Jordania
4.
Enferm. intensiva (Ed. impr.) ; 35(1): 35-44, ene.-mar. 2024. mapas, tab
Artículo en Español | IBECS | ID: ibc-EMG-552

RESUMEN

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)


Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)


Asunto(s)
Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Pandemias/estadística & datos numéricos , Unidades de Cuidados Intensivos/ética , Humanización de la Atención , Cuidados Críticos/ética , Cuidados Críticos/estadística & datos numéricos , Aislamiento de Pacientes/ética , Comunicación en Salud/ética , Epidemiología Descriptiva , Estudios Transversales , Estudios Multicéntricos como Asunto , España
5.
Enferm. intensiva (Ed. impr.) ; 35(1): 45-72, ene.-mar. 2024. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-EMG-553

RESUMEN

IntroducciónLa guía clínica para el manejo de la sepsis recomienda usar muestras de sangre arterial para el control glucémico. Un estudio multicéntrico en 86 unidades de cuidados intensivos españolas reveló que el 85,4% de estas utilizaban punción capilar.ObjetivoAnalizar la fiabilidad de la glucemia comparando diferentes muestras sanguíneas (arterial, venosa, capilar) e instrumentos (glucómetros, gasómetros, laboratorio central). Secundariamente, estimar el efecto de variables confusoras y el rendimiento de los instrumentos de medición determinados por las diferentes normas de calidad.MetodologíaRevisión sistemática y metanálisis con búsqueda en las bases de datos PubMed, CINAHL y Embase en septiembre-2021 y septiembre-2022, sin límites temporales ni idiomáticos. Fuentes de literatura gris: DART-Europe, OpenGrey y Google Académico. Resultados resumidos mediante síntesis cualitativa (descripción de resultados, características de los estudios) y cuantitativa (metanálisis para evaluar la diferencia de medias estandarizadas). Calidad metodológica de artículos evaluada con Quality Assessment of Diagnostic Accuracy Studies-2. Protocolo: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultadosSe incluyeron un total de 32 artículos y 5.451 pacientes. No se obtuvieron discrepancias entre muestras arteriales con glucómetro vs. laboratorio (sesgo [IC95%]: 0,01 [−0,12 a 0,14] mg/dL). En cambio, muestras arteriales con gasómetro sí sobreestimaron de forma significativa (sesgo [IC95%]: 0,12 [0,01 a 0,24] mg/dL). La misma tendencia presentan capilares con glucómetro, aunque no de forma significativa (sesgo [IC95%]: 0,07 [−0,02 a 0,15] mg/dL). Hay discrepancia entre los estudios sobre el efecto del hematocrito y el equilibrio ácido-base. El mayor consenso se da en la poca concordancia del glucómetro con muestras capilares vs. laboratorio en presencia de shock y soporte vasopresor, situación de fallo renal o durante el tratamiento con vitamina C.Conclusiones... (AU)


IntroductionThe clinical guideline for the management of sepsis recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units revealed that 85.4% of these used capillary puncture.ObjectiveTo analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards.MethodologySystematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2. Protocol: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultsA total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs. laboratory samples (bias [95%CI]: 0.01 [−0.12 to 0.14] mg/dL). In contrast, arterial samples with a gasometer did significantly overestimate (bias [95%CI]: 0.12 [0.01 to 0.24] mg/dL). The same trend is seen in capillaries with a glucometer, although not significantly (bias [95%CI]: 0.07 [−0.02 to 0.15] mg/dL). There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs. laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment.Conclusions... (AU)


Asunto(s)
Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , /métodos , /estadística & datos numéricos , Unidades de Cuidados Intensivos , Enfermedad Crítica , Exactitud de los Datos , España
9.
Enferm. intensiva (Ed. impr.) ; 35(1): 13-22, ene.-mar. 2024. ilus, tab
Artículo en Español | IBECS | ID: ibc-229930

RESUMEN

Introducción La púrpura fulminante (PF) es una complicación grave de la sepsis resultado de un conjunto de alteraciones caracterizadas por el desarrollo de lesiones hemorrágicas equimóticas y necrosis de la piel. Objetivo Analizar la eficacia y la seguridad de la aplicación tópica de un compuesto de ácidos grasos hiperoxigenados (AGHO) en la microcirculación de la PF en pacientes pediátricos afectados de sepsis. Material y métodos Se llevó a cabo un estudio prospectivo cuasiexperimental pretest-posttest de un solo grupo en una Unidad de Cuidados Intensivos Pediátrica (UCIP). Se incluyeron en el estudio pacientes con PF de 0 a 18 años. Para evaluar la efectividad del producto objeto de evaluación en la microcirculación de las lesiones por PF se determinaron los valores de oximetría somática antes y después de la aplicación de AGHO cada 4h durante los 3 primeros días de ingreso de los pacientes. Resultados Se reclutaron 4 pacientes, con una mediana de edad de 98 meses. Las lesiones purpúricas que se midieron estaban ubicadas, sobre todo, en ambos pies y manos y, en 2 pacientes, también en los maléolos laterales y gemelos de ambas extremidades inferiores. Se obtuvieron un total de 225 mediciones, observando unas puntuaciones medias preintervención de 71,17±15,65% versus los 73,68±14,83% postintervención. Se objetivó significación estadística (p<0,001) al comparar las mediciones pre- y postintervención. Conclusiones La aplicación precoz y continuada de AGHO en el manejo de la PF por sepsis es una práctica eficaz y segura en los casos de población pediátrica analizada. En más de la mitad de los episodios analizados se objetivó un aumento de microcirculación tisular tras la aplicación de los AGHO, sin eventos adversos. (AU)


Introduction Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis. Aim To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis. Material and methods A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4hours over the first three days of the patients’ hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined. Results Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements. Conclusions Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events. (AU)


Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Púrpura Fulminante/tratamiento farmacológico , Pediatría , Cuidados Críticos , Sepsis , Unidades de Cuidados Intensivos , Estudios Prospectivos , Ensayos Clínicos Controlados no Aleatorios como Asunto
10.
Enferm. intensiva (Ed. impr.) ; 35(1): 23-34, ene.-mar. 2024. tab
Artículo en Inglés | IBECS | ID: ibc-229931

RESUMEN

Purpose This study examined the Jordanian registered nurses’ perceptions of the obstacles and supportive behaviors of End-of-Life Care in Intensive Care Units and examined the differences in the concepts based on the samples’ demographics. Methods A cross-sectional and comparative study was conducted using a convenience sample of 230 Intensive Care Unit registered nurses in Jordan. Data were analyzed descriptively, and differences were measured using the independent sample t-test, the one-way Analysis of Variance, and Scheffe’s post hoc test. Results The registered nurses’ scored moderately on obstacles (74.98 ± 14.54) and supportive behaviors (69.22 ± 4.84). The commonly perceived obstacle and supportive behaviors to End-of-Life Care in Intensive Care Units s were reported. The perceived obstacles differ based on the registered nurses’ certification as an Intensive Care Units nurse (3.04 ± 0.58 vs. 2.74 ± 0.49, p = 0.008), type of Intensive Care Unit (3.28 ± 0.34 vs. 2.86 ± 0.62, p < 0.001), type of facility (3.16 ± 0.59 vs. 2.77 ± 0.61, p < 0.001), number of beds in the unit (3.07 ± 0.48 vs. 2.69 ± 0.48, p = 0.020), and the number of hours worked per week (3.06 ± 0.56 vs. 2.81 ± 0.60, p = 0.005). In contrast, supportive behaviors only differ based on the registered nurses’ age (3.22 ± 0.69 vs. 2.90 ± 0.64, p = 0.019). Conclusions The common End-of-Life Care perceived obstacle in Intensive Care Units was the lack of nursing education and training regarding the studies concept, which warrants immediate intervention such as on-job training. The common End-of-Life Care perceived supportive behavior in Intensive Care Units was when family members accepted that the patient was dying when nurses offered support to family members; motivational interventions are needed to sustain such behavior. Differences in the perceived obstacles and supportive behaviors should be leveraged for the benefit of patients, nurses, and hospitals. (AU)


Propósito Este estudio examinó las percepciones de las enfermeras registradas jordanas sobre los obstáculos y comportamientos de apoyo de la atención al final de la vida en las Unidades de Cuidados Intensivos y examinó las diferencias en los conceptos basados en la demografía de las muestras. Métodos Se realizó un estudio transversal y comparativo utilizando una muestra de conveniencia de 230 enfermeras registradas en la Unidad de Cuidados Intensivos en Jordania. Los datos se analizaron descriptivamente y las diferencias se midieron mediante la prueba t de muestra independiente, el análisis unidireccional de varianza y la prueba post hoc de Scheffe. Resultados Las enfermeras registradas obtuvieron una puntuación moderada en obstáculos (74,98 ± 14,54) y comportamientos de apoyo (69,22 ± 4,84). Se informaron los obstáculos comúnmente percibidos y los comportamientos de apoyo a la atención al final de la vida en las Unidades de Cuidados Intensivos. Los obstáculos percibidos difieren según la certificación del enfermero registrado como enfermero de las Unidades de Terapia Intensiva (3,04 ± 0,58 vs. 2,74 ± 0,49, p < 0.001), tipo de Unidad de Cuidados Intensivos (3,28 ± 0,34 vs. 2,86 ± 0,62, p < 0.001), tipo de instalación (3,16 ± 0,59 vs. 2,77 ± 0,61, p < 0.001), número de camas en la unidad (3,07 ± 0,48 vs. 2,69 ± 0,48, p = 0,020), y número de horas trabajadas por semana (3,06 ± 0,56 vs. 2,81 ± 0,60, p = 0,005). En contraste, los comportamientos de apoyo solo difieren según la edad de las enfermeras registradas (3,22 ± 0,69 vs. 2,90 ± 0,64, p = 0,019). Conclusiones El obstáculo común percibido en la Atención al Final de la Vida en las Unidades de Terapia Intensiva fue la falta de educación y capacitación de enfermería sobre el concepto de estudios, lo que justifica una intervención inmediata, como la capacitación en el trabajo... (AU)


Asunto(s)
Humanos , Femenino , Unidades de Cuidados Intensivos , Cuidado Terminal , Enfermeras y Enfermeros , Estudios Transversales , Jordania
11.
Enferm. intensiva (Ed. impr.) ; 35(1): 35-44, ene.-mar. 2024. mapas, tab
Artículo en Español | IBECS | ID: ibc-229932

RESUMEN

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)


Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)


Asunto(s)
Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Pandemias/estadística & datos numéricos , Unidades de Cuidados Intensivos/ética , Humanización de la Atención , Cuidados Críticos/ética , Cuidados Críticos/estadística & datos numéricos , Aislamiento de Pacientes/ética , Comunicación en Salud/ética , Epidemiología Descriptiva , Estudios Transversales , Estudios Multicéntricos como Asunto , España
12.
Enferm. intensiva (Ed. impr.) ; 35(1): 45-72, ene.-mar. 2024. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-229933

RESUMEN

IntroducciónLa guía clínica para el manejo de la sepsis recomienda usar muestras de sangre arterial para el control glucémico. Un estudio multicéntrico en 86 unidades de cuidados intensivos españolas reveló que el 85,4% de estas utilizaban punción capilar.ObjetivoAnalizar la fiabilidad de la glucemia comparando diferentes muestras sanguíneas (arterial, venosa, capilar) e instrumentos (glucómetros, gasómetros, laboratorio central). Secundariamente, estimar el efecto de variables confusoras y el rendimiento de los instrumentos de medición determinados por las diferentes normas de calidad.MetodologíaRevisión sistemática y metanálisis con búsqueda en las bases de datos PubMed, CINAHL y Embase en septiembre-2021 y septiembre-2022, sin límites temporales ni idiomáticos. Fuentes de literatura gris: DART-Europe, OpenGrey y Google Académico. Resultados resumidos mediante síntesis cualitativa (descripción de resultados, características de los estudios) y cuantitativa (metanálisis para evaluar la diferencia de medias estandarizadas). Calidad metodológica de artículos evaluada con Quality Assessment of Diagnostic Accuracy Studies-2. Protocolo: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultadosSe incluyeron un total de 32 artículos y 5.451 pacientes. No se obtuvieron discrepancias entre muestras arteriales con glucómetro vs. laboratorio (sesgo [IC95%]: 0,01 [−0,12 a 0,14] mg/dL). En cambio, muestras arteriales con gasómetro sí sobreestimaron de forma significativa (sesgo [IC95%]: 0,12 [0,01 a 0,24] mg/dL). La misma tendencia presentan capilares con glucómetro, aunque no de forma significativa (sesgo [IC95%]: 0,07 [−0,02 a 0,15] mg/dL). Hay discrepancia entre los estudios sobre el efecto del hematocrito y el equilibrio ácido-base. El mayor consenso se da en la poca concordancia del glucómetro con muestras capilares vs. laboratorio en presencia de shock y soporte vasopresor, situación de fallo renal o durante el tratamiento con vitamina C.Conclusiones... (AU)


IntroductionThe clinical guideline for the management of sepsis recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units revealed that 85.4% of these used capillary puncture.ObjectiveTo analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards.MethodologySystematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2. Protocol: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultsA total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs. laboratory samples (bias [95%CI]: 0.01 [−0.12 to 0.14] mg/dL). In contrast, arterial samples with a gasometer did significantly overestimate (bias [95%CI]: 0.12 [0.01 to 0.24] mg/dL). The same trend is seen in capillaries with a glucometer, although not significantly (bias [95%CI]: 0.07 [−0.02 to 0.15] mg/dL). There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs. laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment.Conclusions... (AU)


Asunto(s)
Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , /métodos , /estadística & datos numéricos , Unidades de Cuidados Intensivos , Enfermedad Crítica , Exactitud de los Datos , España
15.
Crit Care ; 28(1): 40, 2024 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-38317262

RESUMEN

BACKGROUND: Ventilator associated pneumonia (VAP) due to wild-type AmpC-producing Enterobacterales (wtAE) is frequent in intensive care unit (ICU) patients. Despite a low level of evidence, definitive antimicrobial therapy (AMT) with third generation cephalosporins (3GCs) or piperacillin is discouraged. METHODS: Observational prospective study including consecutive wtAE VAP patients in 20 French ICUs. The primary objective was to assess the association of the choice of definitive AMT, i.e. piperacillin ± tazobactam (PTZ), 3GCs or other molecule (4GCs, carbapenems, quinolones, cotrimoxazole; control group), with treatment success at day-7. Recurrence of infection was collected as a secondary outcome, and analyzed accounting for the competing risk of death. RESULTS: From February 2021 to June 2022, 274 patients were included. Enterobacter cloacae was the most prevalent specie (31%). Seventy-eight patients (28%) had PTZ as definitive AMT while 44 (16%) had 3GCs and 152 (56%) were classified in the control group. Day-7 success rate was similar between the 3 groups (74% vs. 73% vs. 68% respectively, p = 0.814). Recurrence probability at day-28 was 31% (95% CI 21-42), 40% (95% CI 26-55) and 21% (95% CI 15-28) for PTZ, 3GCs and control groups (p = 0.020). In multivariable analysis, choice of definitive AMT was not associated with clinical success, but definitive AMT with 3GCs was associated with recurrence at day-28 [csHR(95%CI) 10.9 (1.92-61.91)]. CONCLUSION: Choice of definitive antimicrobial therapy was not associated with treatment success at day 7. However, recurrence of pneumonia at day-28 was higher in patients treated with third generation cephalosporins with no differences in mortality or mechanical ventilation duration.


Asunto(s)
Antibacterianos , Neumonía Asociada al Ventilador , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Estudios Prospectivos , Neumonía Asociada al Ventilador/tratamiento farmacológico , Enfermedad Crítica/terapia , Piperacilina/uso terapéutico , Combinación Piperacilina y Tazobactam/uso terapéutico , Unidades de Cuidados Intensivos
16.
Sci Rep ; 14(1): 3170, 2024 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-38326383

RESUMEN

The alkaline phosphatase-to-albumin ratio (APAR) is correlated to worse prognosis in coronary artery disease, cancer, and acute renal failure. However, the relationship between APAR and sepsis prognosis has received little research. The content of this research was to investigate the prognostic relationship between APAR and sepsis. And validate the stability of the correlation in 90-days and 1-year mortality. Retrospective cohort research was conducted basing MIMIC-IV database (version 2.0). The hazard ratio (HR) and 95% confidence interval (Cl) were computed using multivariate Cox regression analysis. In addition, plots of survival curves and subgroup analyzes were conducted. Receiver operating characteristic (ROC) curves were also used. 9741 participants were included in this investigation. The 90-days mortality was 32.8%, and the 1-year mortality was 42.0%. After controlling for confounders, the adjusted HRs (95% CI) for tertile 2 (2.2-3.8) and tertile 3 (> 3.8) were 1.37 (1.25-1.51) and 1.74 (1.58-1.91), respectively. The Kaplan-Meier curve analysis showed a higher probability of 90-days death in the higher APAR group. The area under the curve (AUC) of APAR was 0.674 and could reach 0.709 after combining the Oxford Acute Severity of Illness Score (OASIS). This study demonstrates that APAR is significantly related to bad clinical outcomes in sepsis.


Asunto(s)
Fosfatasa Alcalina , Sepsis , Humanos , Estudios Retrospectivos , Pronóstico , Albúminas , Curva ROC , Unidades de Cuidados Intensivos
17.
Niger J Clin Pract ; 27(1): 62-67, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-38317036

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in global mortality rates. Numerous studies have been conducted to identify the factors associated with mortality in COVID-19 cases. In these studies, overall mortality was evaluated in patients, and no distinction was made as ward or intensive care mortality. AIM: This study aims to determine mortality-related factors in patients who died while in the ward. This could enable us to review the indications for intensive care hospitalization in possible pandemics. MATERIALS AND METHOD: This retrospective study was conducted on a cohort of 237 patients who applied to our institution between January 2020 and December 2021 with the diagnosis of COVID-19. Demographic characteristics, length of stay, type of admission (emergency ward or outpatient clinic), presence of comorbidities, thoracic computerized tomography (CT) findings, and laboratory findings were extracted from the hospital database. The demographic and laboratory results of both deceased and recovered patients were compared. RESULTS: While many demographic and laboratory findings were statistically significant in the initial analysis, multiple logistic regression analysis showed that decreased albumin levels (adjusted OR = 0.23, 95% CI = 0.09 - 0.57), increased troponin (adjusted OR = 1.03, 95% CI = 1.02 - 1.05), and procalcitonin (adjusted OR = 3.46, 95% CI = 1.04 - 11.47) levels and higher partial thromboplastin time (PTT) (adjusted OR = 1.18, 95% CI = 1.09 - 1.28) values, presence of diabetes mellitus (DM) in patients (adjusted OR = 2.18, 95% CI = 1.01 - 4.69, P = 0.047), and admission to hospital from the emergency department (adjusted OR = 5.15, 95% CI = 1.45 - 18.27, P = 0.011) were significantly associated with mortality when adjusted for age. When a predictive model is constructed with these variables, this model predicted mortality statistically significant (AUC = 0.904, 95% CI = 0.856 - 0.938, P < 0.001), with a sensitivity of 77.2% (95% CI, 67.8 - 85), a specificity of 91.2% (95% CI, 85.1 - 95.4), a positive predictive value (PPV) of 86.7% (95% CI, 72 - 85.3), and an negative predictive value (NPV) of 84.4% (95% CI, 79.4 - 89.6). CONCLUSION: In this study, we may predict mortality among COVID-19-diagnosed patients admitted to the ward via this model which has the potential to provide guidance for reconsidering the indications for intensive care unit (ICU) admission.


Asunto(s)
COVID-19 , Humanos , Estudios Retrospectivos , SARS-CoV-2 , Hospitalización , Comorbilidad , Unidades de Cuidados Intensivos , Mortalidad Hospitalaria
18.
BMC Med Inform Decis Mak ; 24(1): 35, 2024 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-38310256

RESUMEN

OBJECTIVE: Acute kidney injury (AKI) is a clinical syndrome that occurs as a result of a dramatic decline in kidney function caused by a variety of etiological factors. Its main biomarkers, serum creatinine and urine output, are not effective in diagnosing early AKI. For this reason, this study provides insight into this syndrome by exploring the comorbidities of AKI, which may facilitate the early diagnosis of AKI. In addition, organ crosstalk in AKI was systematically explored based on comorbidities to obtain clinically reliable results. METHODS: We collected data from the Medical Information Mart for Intensive Care-IV database on patients aged [Formula: see text] 18 years in intensive care units (ICU) who were diagnosed with AKI using the criteria proposed by Kidney Disease: Improving Global Outcomes. The Apriori algorithm was used to mine association rules on the diagnoses of 55,486 AKI and non-AKI patients in the ICU. The comorbidities of AKI mined were validated through the Electronic Intensive Care Unit database, the Colombian Open Health Database, and medical literature, after which comorbidity results were visualized using a disease network. Finally, organ diseases were identified and classified from comorbidities to investigate renal crosstalk with other distant organs in AKI. RESULTS: We found 579 AKI comorbidities, and the main ones were disorders of lipoprotein metabolism, essential hypertension, and disorders of fluid, electrolyte, and acid-base balance. Of the 579 comorbidities, 554 were verifiable and 25 were new and not previously reported. In addition, crosstalk between the kidneys and distant non-renal organs including the liver, heart, brain, lungs, and gut was observed in AKI with the strongest heart-kidney crosstalk, followed by lung-kidney crosstalk. CONCLUSION: The comorbidities mined in this study using association rules are scientific and may be used for the early diagnosis of AKI and the construction of AKI predictive models. Furthermore, the organ crosstalk results obtained through comorbidities may provide supporting information for the management of short- and long-term treatment practices for organ dysfunction.


Asunto(s)
Lesión Renal Aguda , Clasificación Internacional de Enfermedades , Humanos , Anciano , Estudios Prospectivos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Comorbilidad , Biomarcadores , Unidades de Cuidados Intensivos
19.
J Cardiothorac Surg ; 19(1): 46, 2024 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-38310273

RESUMEN

OBJECTIVE: To investigate the independent risk factors for postoperative prolonged ICU stay in patients with Stanford type A aortic dissection (TAAD) and assess the clinical outcomes of prolonged ICU stay. METHOD: The clinical data of 100 patients with TAAD admitted to the Department of Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University from December 2018 to September 2022 were retrospectively collected and analyzed. Patients were divided into two groups, based on the postoperative ICU stay (7 days as the threshold), regular ICU stay group (< 7 days) and prolonged ICU stay group (≥ 7 days). First, preoperative and intraoperative materials were collected for univariate analysis. Then, the significant variables after univariate analysis were analyzed using logistic regression, and the final independent risk factors for prolonged ICU stay were determined. Meanwhile, the postoperative clinical outcomes were analyzed with the aim of assessing the clinical outcomes due to prolonged ICU stay. RESULTS: There were 65 and 35 patients in the regular ICU stay group and the prolonged ICU stay group, respectively. In accordance with the result of univariate analysis in the two groups, emergency surgery (χ2 = 13.598; P < 0.001), preoperative urea nitrogen (t = 3.006; P = 0.004), cardiopulmonary bypass (CPB) time (t = 2.671; P = 0.001) and surgery time (t = 2.630; P = 0.010) were significant. All significant variates were analyzed through logistic regression, and it was found that emergency surgery (OR = 0.192; 95% CI: 0.065-0.561), preoperative urea nitrogen (OR = 0.775; 95% CI: 0.634-0.947) and cardiopulmonary time (OR = 0.988; 95% CI: 0.979-0.998) were independent risk factors for prolonged postoperative ICU stay. The Receiver Operating Characteristic (ROC) curves of these three factors were also effective in predicting postoperative prolonged ICU stay (Emergency surgery, AUC = 0.308, 95% CI: 0.201-0.415; Preoperative urea nitrogen, AUC = 0.288, 95% CI: 0.185-0.392; cardiopulmonary time, AUC = 0.340, 95% CI: 0.223-0.457). Moreover, compared with a single factor, the predictive value of combined factors was more significant (AUC = 0.810, 95% CI: 0.722-0.897). For the comparison of postoperative data in the two groups,, compared with the regular ICU stay group, the incidence of adverse events in the prolonged ICU stay group increased significantly, including limb disability of limbs (χ2 = 22.182; P < 0.001), severe organ injury (χ2 = 23.077; P < 0.001), tracheotomy (χ2 = 17.582; P < 0.001), reintubation (χ2 = 28.020; P < 0.001), 72 h tracheal extubation after surgery (χ2 = 29.335; P < 0.001), 12 h consciousness recovery after surgery (χ2 = 18.445; P < 0.001), ICU re-entering (χ2 = 9.496; P = 0.002) and irregular discharging (χ2 = 24.969; P < 0.001). CONCLUSION: Emergency surgery, preoperative urea nitrogen, and CPB time are risk factors for postoperative prolonged ICU stay after TAAD surgery. Furthermore, prolonged ICU stay is associated with worse clinical outcomes. Hence, a reasonable strategy should be adopted proactively focusing on the risk factors to shorten ICU stays and improve clinical outcomes.


Asunto(s)
Disección Aórtica , Azidas , Desoxiglucosa/análogos & derivados , Humanos , Estudios Retrospectivos , Disección Aórtica/cirugía , Factores de Riesgo , Unidades de Cuidados Intensivos , Nitrógeno , Urea , Tiempo de Internación
20.
J Cardiothorac Surg ; 19(1): 45, 2024 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-38310298

RESUMEN

BACKGROUND: Different risk factors affect the intensive care unit (ICU) stay after cardiac surgery. This study aimed to evaluate these risk factors. PATIENTS AND METHODS: A retrospective analysis was conducted on clinical, operative, and outcome data from 1070 patients (mean age: 59 ± 9.8 years) who underwent isolated coronary bypass grafting CABG surgery with cardiopulmonary bypass. The outcome variable was prolonged length of stay LOS in the CICU stay (> 3 nights after CABG). RESULTS: Univariate predictors of prolonged ICU stays included a left atrial diameter of > 4 cm (P < 0.001),chronic obstructive airway disease COPD (P = 0.005), hypertension (P = 0.006), diabetes mellitus (P = 0.009), having coronary stents (P = 0.006), B-blockers use before surgery (either because the surgery was done on urgent or emergency basis or the patients have contraindication to B-blockers use) (P = 0.005), receiving blood transfusion during surgery (P = 0.001), post-operative acute kidney injury (AKI) (P < 0.001), prolonged inotropic support of > 12 h (P < 0.001), and ventilation support of > 12 h (P < 0.001), post-operative sepsis or pneumonia (P < 0.001), post-operative stroke/TIA (P = 0.001), sternal wound infection (P = 0.002), and postoperative atrial fibrillation POAF (P < 0.001). Multivariate regression revealed that patients with anleft atrial LA diameter of > 4 cm (AOR 2.531, P = 0.003), patients who did not take B-blockers before surgery (AOR 1.1 P = 0.011), patients on ventilation support > 12 h (AOR 3.931, P = < 0.001), patients who developed pneumonia (AOR 20.363, P = < 0.001), and patients who developed post-operative atrial fibrillation (AOR 30.683, P = < 0.001) were more likely to stay in the ICU for > 3 nights after CABG. CONCLUSION: Our results showed that LA diameter > 4 cm, patients who did not take beta-blockers before surgery, on ventilation support > 12 h, developed pneumonia post-operatively, and developed POAF were more likely to have stays lasting > 3 nights. Efforts should be directed toward reducing these postoperative complications to shorten the duration of CICU stay, thereby reducing costs and improving bed availability.


Asunto(s)
Fibrilación Atrial , Neumonía , Humanos , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Fibrilación Atrial/etiología , Mortalidad Hospitalaria , Puente de Arteria Coronaria/efectos adversos , Factores de Riesgo , Unidades de Cuidados Intensivos , Complicaciones Posoperatorias/etiología , Neumonía/etiología , Tiempo de Internación
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