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4.
Euro Surveill ; 25(11)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32186277

RESUMEN

The cumulative incidence of coronavirus disease (COVID-19) cases is showing similar trends in European Union/European Economic Area countries and the United Kingdom confirming that, while at a different stage depending on the country, the COVID-19 pandemic is progressing rapidly in all countries. Based on the experience from Italy, countries, hospitals and intensive care units should increase their preparedness for a surge of patients with COVID-19 who will require healthcare, and in particular intensive care.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Notificación de Enfermedades/estadística & datos numéricos , Brotes de Enfermedades , Unidades de Cuidados Intensivos/organización & administración , Pandemias , Neumonía Viral/epidemiología , Betacoronavirus , Defensa Civil , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Europa (Continente)/epidemiología , Unión Europea , Humanos , Incidencia , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Neumonía Viral/virología , Vigilancia de la Población , Síndrome Respiratorio Agudo Grave/virología , Triaje , Reino Unido/epidemiología
5.
Curr Opin Anaesthesiol ; 33(2): 162-169, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32022730

RESUMEN

PURPOSE OF REVIEW: The availability of large datasets and computational power has prompted a revolution in Intensive Care. Data represent a great opportunity for clinical practice, benchmarking, and research. Machine learning algorithms can help predict events in a way the human brain can simply not process. This possibility comes with benefits and risks for the clinician, as finding associations does not mean proving causality. RECENT FINDINGS: Current applications of Data Science still focus on data documentation and visualization, and on basic rules to identify critical lab values. Recently, algorithms have been put in place for prediction of outcomes such as length of stay, mortality, and development of complications. These results have begun being implemented for more efficient allocation of resources and in benchmarking processes, to allow identification of successful practices and margins for improvement. In parallel, machine learning models are increasingly being applied in research to expand medical knowledge. SUMMARY: Data have always been part of the work of intensivists, but the current availability has not been completely exploited. The intensive care community has to embrace and guide the data science revolution in order to decline it in favor of patients' care.


Asunto(s)
Macrodatos , Cuidados Críticos/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Benchmarking , Humanos , Aprendizaje Automático
6.
Medicine (Baltimore) ; 99(4): e18843, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977881

RESUMEN

BACKGROUND: Prolonged hospitalization and immobility of critical care patients elevates the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. This systematic review and meta-analysis aims to assess the effects of early mobilization therapy for non-emergency cardiac surgery patients in the intensive care unit (ICU). METHODS: The following databases will be used to search for relevant keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library from inception to September 2018 by 2 researchers independently. Randomized controlled trials (RCTs), will be included if patients are adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who are treated with experimental physiotherapy initiated in the ICU (pre, post, or perioperative). The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous outcomes will be presented as the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence interval (CI), while dichotomous data will be expressed as relative risk (RR) with 95% CI. If the included studies have existing heterogeneity (P < 0.1), a random-effects model will be used. Otherwise, we will calculate using a fixed effects model. RESULTS: This review will evaluate the effects of early mobilization on length of ICU and hospital stay, physical function and adverse events in patients with cardiac surgery patients in the ICU. CONCLUSION: This systematic review will comprehensively provide conclusive evidence of the therapeutic effect of early mobilization on cardiac surgery patients in the ICU.PROSPERO Research registration identifying number: CRD42019135338.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/rehabilitación , Ambulación Precoz/métodos , Humanos , Unidades de Cuidados Intensivos/organización & administración , Tiempo de Internación , Metaanálisis en Red , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
7.
J Surg Res ; 246: 269-273, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31614324

RESUMEN

BACKGROUND: A structured family meeting (FM) is recommended within 72 h of admission for trauma patients with high risk of mortality or disability. Multidisciplinary FMs (MDFMs) may further facilitate decision-making. We hypothesized that FM within three hospital days (HDs) or MDFM would be associated with increased use of comfort measures. MATERIALS AND METHODS: We reviewed all adult trauma deaths at an academic level 1 trauma center from December 2014 to December 2017. Death in the first 24 h or on nonsurgical services were excluded. Demographics, injury characteristics, FM characteristics, and outcomes such as length of stay (LOS) were recorded. Early FM was defined as occurring within three HDs; MDFM required attendance by two or more specialty teams. RESULTS: A total of 177 patients were included. Median LOS was 6 d (interquartile range 4-12). FMs were documented in 166 patients (94%), with 57% occurring early. MDFM occurred in 49 (28%), but usually occurred later (median HD 5 and interquartile range 2-8). Early FM was associated with reduced LOS (5 versus 11 d, P < 0.001), ventilator days (4 versus 9 d, P < 0.001), and deaths during a code (1.2% versus 13.2%, P < 0.001). MDFM was associated with higher use of comfort measures (88% versus 68%, P < 0.05). Of patients who transitioned to comfort care status (n = 130, 73.4%), code status change occurred earlier if an early FM occurred (5 versus 13 d, P < 0.001). CONCLUSIONS: MDFM is associated with increased comfort care measures, whereas early FM is associated with reduced LOS, ventilator days, death during a code, and earlier comfort care transition.


Asunto(s)
Toma de Decisiones , Familia , Planificación de Atención al Paciente , Cuidado Terminal/organización & administración , Heridas y Traumatismos/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/organización & administración , Cuidados Paliativos/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Transferencia de Pacientes/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricos , Índices de Gravedad del Trauma , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/mortalidad
8.
Orv Hetil ; 160(49): 1957-1962, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31786938

RESUMEN

Introduction: Infections affect about 30-50% of intensive care unit patients resulting in substantial morbidity and mortality. Multimodal interventions proved to be successful in the prevention of healthcare-associated infections. Appropriate hand hygiene including correct disinfection technique and timing is essential. Aim: The aim of our study was to investigate the hand hygiene practice among the intensive care unit healthcare workers by immediate feedback system implementation and compliance study. Method: A 3-week-long observational study was conducted at the Department of Anaesthesiology and Intensive Therapy, Semmelweis University, during November and December, 2018. Data regarding hand hygiene technique were collected by using the Semmelweis Scanner technology, while compliance data were recorded by direct observations. Statistical analysis was performed by Kruskal-Wallis test, Fisher's exact test and χ2-test. Results: 604 measurements were recorded by the electronic system. Hand disinfection was appropriate in 86.5% of cases. The median value of coverage was 99.87%. The trend of these indices showed persistently high values. A lower error rate was observed in the physiotherapy group compared to others (doctors: p<0.01, nurses: p = 0.03, assistant nurses: p = 0.03). 162 opportunities were recorded during direct observations. The mean compliance rate was 60.49%, with the lowest among doctors (53.97%). The difference was non-significant compared to nurses (62.92%, p = 0.26). Conclusions: Hand hygiene technique during the study period was found to be highly and permanently appropriate, while compliance was lower than expected. The immediate feedback system may be useful in achieving appropriate hand disinfection technique, although further interventions are needed for higher compliance rates. Orv Hetil. 2019; 160(49): 1957-1962.


Asunto(s)
Adhesión a Directriz/estadística & datos numéricos , Desinfección de las Manos/normas , Higiene de las Manos , Personal de Salud/estadística & datos numéricos , Unidades de Cuidados Intensivos/organización & administración , Infección Hospitalaria/prevención & control , Personal de Salud/educación , Humanos
10.
Crit Care Resusc ; 21(4): 274-83, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31778634

RESUMEN

BACKGROUND: Clinically apparent cerebral oedema during diabetic ketoacidosis (DKA) is rare and more common in children and young adults. Subclinical oedema with mild brain dysfunction is more frequent, with unknown long term effects. Rapid tonicity changes may be a factor although not well studied. Guidelines recommend capping hypertonicity resolution at ≤ 3 mOsmol/kg/h. OBJECTIVES: To audit current DKA management in the emergency department (ED) and in the intensive care unit (ICU) for tonicity benchmark compliance, and to determine interactions between plasma tonicity, plasma glucose concentrations and blood haemoglobin concentrations. METHODS: Twenty-five adult DKA admissions from ED to ICU were studied retrospectively. Blood gas and electrolyte data were sequenced for 24 hours from first ED blood sample. RESULTS: Sampling was frequent (median, 11 times per day; range, 6-26). Tonicity reduction was largely accomplished by the first ICU blood sample and exceeded 3 mOsmol/ kg/h in 72% of admissions. Correlation with haemoglobin reduction (haemodilution) rates exceeded correlation with glucose rates (R2 = 0.52 v 0.38). In benchmark noncompliant admissions, haemodilution was more rapid (6.1 g/L/h v 2.1 g/L/h; P = 0.001). Although also true of glucose reduction (4.5 mmol/L/h v 2.2 mmol/L/h; P = 0.007), there was no interaction between haemodilution and glucose reduction (R2 = 0.09). CONCLUSIONS: Major tonicity reductions often exceeding guidelines were common by ICU admission. Correcting DKA-induced hypertonicity at ≤ 3 mOsmol/kg/h requires controlled hyperglycaemia correction and, based on our data, avoidance of high fluid replacement rates; for example, sufficient to reduce haemoglobin concentrations by > 3 g/L/h, unless there is evidence of intravascular hypovolaemia.


Asunto(s)
Cuidados Críticos/métodos , Enfermedad Crítica/terapia , Cetoacidosis Diabética/terapia , Hemodilución , Glucemia/metabolismo , Niño , Cetoacidosis Diabética/sangre , Cetoacidosis Diabética/metabolismo , Servicio de Urgencia en Hospital/organización & administración , Hospitalización , Humanos , Unidades de Cuidados Intensivos/organización & administración , Estudios Retrospectivos , Adulto Joven
11.
Hosp Pract (1995) ; 47(4): 177-180, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31594430

RESUMEN

Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data.Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California.Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group.Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0-1.2%, 5.3-44.8%, 0-0.3% and 0.6-16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL.Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.


Asunto(s)
Glucemia , Hospitales Rurales/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Monitoreo Fisiológico/normas , Sistemas de Atención de Punto/normas , Hospitales Rurales/normas , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Unidades de Cuidados Intensivos/normas , Estándares de Referencia , Índice de Severidad de la Enfermedad
12.
Rev Assoc Med Bras (1992) ; 65(9): 1168-1173, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31618332

RESUMEN

OBJECTIVE: Treatment limitation, as well as do-not-resuscitate (DNR) directives, are difficult but important to improve patients' quality of life and minimize dysthanasia. We aimed to study the approach to withholding, withdrawal, and DNR decisions, patients' characteristics, and process documentation in a general Intensive Care Unit (ICU) in Portugal. METHODS: A retrospective analysis of data regarding the limitation of treatment decisions collected from previously-designed forms and complemented by medical record consultation. RESULTS: A total of 1602 patients were admitted to the ICU between 2011 and 2016. DNR decisions were documented in 127 cases (7.9%). Patients with treatment limitations were older and had higher Simplified Acute Physiology Score II. The most frequent diagnosis preceding these decisions was sepsis (52.0%, n = 66); the most common main reason for limiting treatment was a poor prognosis of acute illness. Of the patients to whom a DNR was implemented, 117 (92.1%) died in the ICU (40.1% of the total number of ICU deaths), and hospital mortality was 100%. Participants in these decisions, as well as types of treatment withdrawn and their respective timings, were not registered in medical records. CONCLUSION: Treatment limitation and DNR decisions were relatively common, in line with other Southern European studies, but behind Northern European and North American centers. Patients with these limitations were older and more severely ill than patients without such decisions. Documentation of these processes should be clear and detailed, either in specific forms or computerized clinical records; there is room for improvement in this area.


Asunto(s)
Unidades de Cuidados Intensivos/organización & administración , Registros Médicos , Órdenes de Resucitación , Privación de Tratamiento/normas , Anciano , Anciano de 80 o más Años , Toma de Decisiones , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Portugal , Calidad de Vida , Estudios Retrospectivos , Sepsis/mortalidad
13.
Medicine (Baltimore) ; 98(37): e17090, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31517831

RESUMEN

The decision as to whether patients should be admitted to a medical intensive care unit (ICU), in the absence of information concerning survival rates or prognostic factors in survival, is often challenging. We analyzed survival trends in relation to hospital discharge and examined patient and hospital characteristics associated with survival following ICU care, using a sample of nationwide claims data in Korea from 2002 through 2013. The Korean government implements a compulsory social insurance program that covers the country's entire population, and the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) data from 2002 based on this program were used for this study. The NHIS-NSC is a stratified random sample of 1,025,340 subjects selected from around 46 million Koreans. We evaluated annual survival trends using the Kaplan-Meier test. Analyses of the relationship between survival and patient and hospital characteristics were performed using Cox regression analyses. Employing a multivariate model, variables were selected using the forward selection method to consider the multicollinearity of variables. A total of 32,553 patients admitted to an ICU between 2002 and 2013 were identified among the eligible beneficiaries. The number of patients who had histories of ICU admission steadily increased throughout the study period, and patients older than 80 years constituted a progressively increasing proportion of ICU admissions, from 7.3% in 2002 to 16.9% in 2007 to 23.1% in 2013. The mean number of mechanical equipment items applied consistently increased, while no difference was observed in the trend for overall 1-year survival in patients following ICU treatment across the study period: the 1-year survival rate ranged from 66.7% (year 2003) to 64.2% (year 2010). Advanced age, cancer, renal failure, pneumonia, and influenza were all associated with heightened risk of mortality within 1 year. Our results should prove useful to older patients and their clinicians in their decisions regarding whether to seek ICU care, with the goals of improving the end-of life care and optimizing resource utilization.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/economía , Unidades de Cuidados Intensivos/organización & administración , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Modelos de Riesgos Proporcionales , República de Corea , Análisis de Supervivencia
14.
Transplant Proc ; 51(7): 2183-2185, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474287

RESUMEN

PURPOSE: Nowadays, as the number of patients waiting for organ transplant is increasing, it is important to diagnose brain death in intensive care units and to provide good donor care. We aimed to share our experience of donor care with the diagnosis of brain death in our clinic. MATERIAL AND METHOD: One hundred and fifty-one patients diagnosed in our clinic with brain death between June 2006 to 2018 were studied retrospectively. FINDINGS: The mean age of the 151 patients was 46.6 (1-89) years. Fifty-seven (37.7%) of the 151 patients' families accepted donation. Ten out of 57 patients could not be organ donors for medical reasons. Eighty-four kidneys, 7 hearts, and 40 livers were transplanted to the patients. When the diagnosis at admission to the intensive care unit was examined, it was found that the most common diagnosis was intracranial hemorrhage (36.8%), followed by head trauma (21.05%), drowning in water (3.5%), and firearm injury (3.5%). The apnea test was applied to all cases, but 17 patients could not complete the apnea test. In order to support the diagnosis of brain death, in 63% of patients (n = 95) radiological methods were performed. Cranial computed tomography angiography was performed as a radiological method. All cases were found to have received at least 1 inotropic support. We used dopamine in 41 patients, noradrenaline in 36 patients, dobutamine in 8 patients, and adrenaline in 3 patients. During the 12 months when the organ transplant coordinator was not on duty, there were no organ donors. It is important to maintain an organ and tissue transplant coordinator and an intensive care unit team for organ donation. CONCLUSION: In order to increase the cadaver donor pool, it is necessary to increase the number of brain death diagnoses and decrease the rate of family rejection. Therefore, patients with poor neurologic prognosis should be carefully monitored for brain death. Successful family discussions by an experienced and trained organ transplant coordinator should try to increase donation rates by emphasizing the importance of organ donation and the fact that brain death is a real death.


Asunto(s)
Muerte Encefálica/diagnóstico , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Personal de Salud , Humanos , Lactante , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Obtención de Tejidos y Órganos/organización & administración , Adulto Joven
15.
J Clin Nurs ; 28(23-24): 4595-4605, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31491054

RESUMEN

AIMS AND OBJECTIVES: To compare the reliability and predictive validity of the Braden and Jackson/Cubbin PI risk assessment scales in intensive care unit patients. BACKGROUND: Risk assessment with a standardised tool is the usual intervention for preventing pressure injury. Therefore, tools used to assess pressure injury risk should be valid and reliable for the designated patient population. DESIGN: A prospective and cross-sectional study adheres to the STARD guideline. METHODS: This study was conducted between November 2017-April 2018 in the intensive care units of a tertiary level university hospital in Turkey. The study sample consisted of 176 patients admitted to three intensive care units. Risk assessment was performed once daily with the Braden scale, followed immediately with the Jackson/Cubbin scale. Risk assessment was terminated on the day of pressure injury development or upon patient discharge from the intensive care unit. Each patient's final risk assessment was considered in the data analysis. RESULTS: The Cronbach's alpha coefficient of the Jackson/Cubbin and Braden scales was .78 and .85, respectively. The predictive validity of the Jackson/Cubbin scale was confirmed by a sensitivity of .87, specificity of .84, positive predictive value of .47 and negative predictive value of .97. These values for the Braden scale were .95, .75, .38 and .99, respectively. CONCLUSION: Both the Jackson/Cubbin and Braden scales are reliable and valid scales for pressure injury risk assessment in intensive care unit patients. However, the predictive ability to determine patients at risk and not at risk for pressure injury was better for the Jackson/Cubbin scale than for the Braden scale. RELEVANCE TO CLINICAL PRACTICE: Both scales are reliable and valid scales for pressure injury risk assessment. Jackson/Cubbin scale's discriminative ability (between the patients at pressure injury risk and not at pressure injury risk) was better.


Asunto(s)
Úlcera por Presión/prevención & control , Medición de Riesgo/métodos , Anciano , Estudios Transversales , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Turquia
16.
BMC Health Serv Res ; 19(1): 640, 2019 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-31492188

RESUMEN

BACKGROUND: Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors. METHODS: This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3. RESULTS: The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate). CONCLUSIONS: Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.


Asunto(s)
Enfermería de Cuidados Críticos/normas , Conocimientos, Actitudes y Práctica en Salud , Errores de Medicación/enfermería , Preparaciones Farmacéuticas , Enfermedad Crítica/terapia , Femenino , Grupos Focales , Humanos , Unidades de Cuidados Intensivos/organización & administración , Intubación Gastrointestinal/enfermería , Intubación Gastrointestinal/normas , Masculino , Errores de Medicación/estadística & datos numéricos , Persona de Mediana Edad , Encuestas y Cuestionarios
17.
Crit Care ; 23(1): 278, 2019 08 09.
Artículo en Inglés | MEDLINE | ID: mdl-31399052

RESUMEN

BACKGROUND: As many as 90% of patients develop anemia by their third day in an intensive care unit (ICU). We evaluated the efficacy of interventions to reduce phlebotomy-related blood loss on the volume of blood lost, hemoglobin levels, transfusions, and incidence of anemia. METHODS: We conducted a systematic review and meta-analysis using the Laboratory Medicine Best Practices (LMBP) systematic review methods for rating study quality and assessing the body of evidence. Searches of PubMed, Embase, Cochrane, Web of Science, PsychINFO, and CINAHL identified 2564 published references. We included studies of the impact of interventions to reduce phlebotomy-related blood loss on blood loss, hemoglobin levels, transfusions, or anemia among hospital inpatients. We excluded studies not published in English and studies that did not have a comparison group, did not report an outcome of interest, or were rated as poor quality. Twenty-one studies met these criteria. We conducted a meta-analysis if > 2 homogenous studies reported sufficient information for analysis. RESULTS: We found moderate, consistent evidence that devices that return blood from flushing venous or arterial lines to the patient reduced blood loss by approximately 25% in both neonatal ICU (NICU) and adult ICU patients [pooled estimate in adults, 24.7 (95% CI = 12.1-37.3)]. Bundled interventions that included blood conservation devices appeared to reduce blood loss by at least 25% (suggestive evidence). The evidence was insufficient to determine if these devices reduced hemoglobin decline or risk of anemia. The evidence suggested that small volume tubes reduced the risk of anemia, but was insufficient to determine if they affected the volume of blood loss or the rate of hemoglobin decline. CONCLUSIONS: Moderate, consistent evidence indicated that devices that return blood from testing or flushing lines to the patient reduce the volume of blood loss by approximately 25% among ICU patients. The results of this systematic review support the use of blood conservation systems with arterial or venous catheters to eliminate blood waste when drawing blood for testing. The evidence was insufficient to conclude the devices impacted hemoglobin levels or transfusion rates. The use of small volume tubes may reduce the risk of anemia.


Asunto(s)
Anemia/prevención & control , Flebotomía/métodos , Anemia/epidemiología , Humanos , Enfermedad Iatrogénica/epidemiología , Enfermedad Iatrogénica/prevención & control , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Flebotomía/normas , Flebotomía/tendencias , Guías de Práctica Clínica como Asunto
18.
Crit Care Clin ; 35(4): 535-550, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31445603

RESUMEN

The "daily disasters" within the ebb and flow of routine critical care provide a foundation of preparedness for the less-frequent, larger events that affect most health care organizations at some time. Although large disasters can overwhelm, those who strengthen processes and habits through daily practice will be the best prepared to manage them.


Asunto(s)
Cuidados Críticos , Planificación en Desastres , Servicio de Urgencia en Hospital , Unidades de Cuidados Intensivos , Cuidados Críticos/organización & administración , Planificación en Desastres/organización & administración , Desastres , Servicio de Urgencia en Hospital/organización & administración , Humanos , Unidades de Cuidados Intensivos/organización & administración , Incidentes con Víctimas en Masa , Capacidad de Reacción/organización & administración , Triaje
19.
Crit Care Clin ; 35(4): 551-562, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31445604

RESUMEN

Critical care teams can face a dramatic surge in demand for ICU beds and organ support during a disaster. Through effective preparedness, teams can enable a more effective response and hasten recovery back to normal operations. Disaster preparedness needs to balance an all-hazards approach with focused hazard-specific preparation guided by a critical care-specific hazard-vulnerability analysis. Broad stakeholder input from within and outside the critical care team is necessary to avoid gaps in planning. Evaluation of critical care disaster plans require frequent exercises, with a mechanism in place to ensure lessons learned effectively prompt improvements in the plan.


Asunto(s)
Planificación en Desastres , Unidades de Cuidados Intensivos , Cuidados Críticos/organización & administración , Planificación en Desastres/organización & administración , Desastres , Humanos , Unidades de Cuidados Intensivos/organización & administración
20.
Crit Care Clin ; 35(4): 609-618, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31445608

RESUMEN

In the twenty-first century, severe acute respiratory syndrome (SARS), 2009 A(H1N1) influenza, and Ebola have all placed strains on critical care systems. In addition to the increased patient needs common to many disasters, epidemics may further degrade ICU capability when staff members fall ill, including in the course of direct patient care. In a large-scale pandemic, shortages of equipment and medications can further limit an ICU's ability to provide the normal standard of care. Hospital preparedness for epidemics must include strategies to maintain staff safety, secure adequate supplies, and have plans for triage and prioritization of care when necessary.


Asunto(s)
Planificación en Desastres , Unidades de Cuidados Intensivos , Pandemias , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/terapia , Humanos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Gripe Humana/terapia , Unidades de Cuidados Intensivos/organización & administración , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/terapia
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