Craniectomías descompresivas en el traumatismo craneoencefálico: la visión del intensivista / Decompressive craniectomy in traumatic brain injury: the intensivist's point of view

Objetivo Realizar una escala con parámetros clínicos y radiológicos precoces tras un TCE que identifique a los enfermos que en su evolución posterior van a someterse a una CD. Método Estudio observacional de una cohorte retrospectiva de pacientes que tras un TCE ingresan en la Sección de Neurocríticos del Servicio de Medicina Intensiva de nuestro hospital durante un periodo de 5 años (2014-2018). Detección de variables clínicas y radiológicas y creación de todos los modelos posibles con las variables significativas, clínicamente relevantes y de fácil detección precoz. Selección del que presentaba valores más bajos de criterios de información bayesiano y de Akaike para la creación de la escala. Calibración y validación interna mediante la prueba de bondad de ajuste de Hosmer-Lemeshow y análisis bootstrapping con 1.000 re-muestreos. Resultados Se realizaron 37 CD en 153 enfermos que ingresaron tras un TCE. El modelo final resultante incluía desviación de línea media, GCS y colapso ventricular con un área bajo la curva ROC de 0,84 (IC95% 0,78-0,91) y Hosmer-Lemeshow p=0,71. La escala desarrollada detectaba bien a los enfermos que iban a precisar una CD precoz (en las primeras 24horas) tras un TCE (2,5±0,5) pero no a aquellos que la necesitarían en una fase más tardía de su enfermedad (1,7±0,8). Sin embargo, parece prevenirnos sobre los enfermos que si bien no precisan inicialmente una CD sí tienen probabilidades de necesitarla posteriormente en su evolución (CD tardía vs. no precisan CD, 1,7±0,8 vs. 1±0,7; p=0,002). Conclusión Hemos desarrollado una escala pronóstica que permite detectar en nuestro medio, con una buena sensibilidad y especificidad y usando criterios clínico-radiológicos precoces, aquellos pacientes que tras un TCE van a precisar una CD (AU)

Objetive To perform a score with early clinical and radiological findings after a TBI that identifies the patients who in their subsequent evolution are going to undergo DC. Method Observational study of a retrospective cohort of patients who, after a TBI, enter the Neurocritical Section of the Intensive Care Unit of our hospital for a period of 5 years (2014-2018). Detection of clinical and radiological criteria and generation of all possible models with significant, clinically relevant and easy to detect early variables. Selection of the one with the lowest Bayesian Information Criterion and Akaike Information Criterion values for the creation of the score. Calibration and internal validation of the score using the Hosmer-Lemeshow and a bootstrapping analysis with 1,000 re-samples respectively. Results 37 DC were performed in 153 patients who were admitted after a TBI. The resulting final model included Cerebral Midline Deviation, GCS and Ventricular Collapse with an Area under ROC Curve: 0.84 (95% IC 0.78-0.91) and Hosmer-Lemeshow p=0.71. The developed score detected well those patients who were going to need an early DC (first 24hours) after a TBI (2.5±0.5) but not those who would need it in a later stage of their disease (1.7±0.8). However, it seems to advice us about the patients who, although not requiring an early DC are likely to need it later in their evolution (DC after 24hours vs do not require DC, 1.7±0.8 vs 1±0.7; p=0.002). Conclusion We have developed a prognostic score using early clinical-radiological criteria that, in our environment, detects with good sensitivity and specificity those patients who, after a TBI, will require a DC (AU)

Decompressive craniectomy in traumatic brain injury: The intensivist's point of view.

OBJETIVE: To perform a score with early clinical and radiological findings after a TBI that identifies the patients who in their subsequent evolution are going to undergo DC. METHOD: Observational study of a retrospective cohort of patients who, after a TBI, enter the Neurocritical Section of the Intensive Care Unit of our hospital for a period of 5 years (2014-2018). Detection of clinical and radiological criteria and generation of all possible models with significant, clinically relevant and easy to detect early variables. Selection of the one with the lowest Bayesian Information Criterion and Akaike Information Criterion values for the creation of the score. Calibration and internal validation of the score using the Hosmer-Lemeshow and a bootstrapping analysis with 1000 re-samples respectively. RESULTS: 37 DC were performed in 153 patients who were admitted after a TBI. The resulting final model included Cerebral Midline Deviation, GCS and Ventricular Collapse with an Area under ROC Curve: 0.84 (95% IC 0.78-0.91) and Hosmer-Lemeshow p=0.71. The developed score detected well those patients who were going to need an early DC (first 24h) after a TBI (2.5±0.5) but not those who would need it in a later stage of their disease (1.7±0.8). However, it seems to advice us about the patients who, although not requiring an early DC are likely to need it later in their evolution (DC after 24h vs. do not require DC, 1.7±0.8 vs. 1±0.7; p=0.002). CONCLUSION: We have developed a prognostic score using early clinical-radiological criteria that, in our environment, detects with good sensitivity and specificity those patients who, after a TBI, will require a DC.

Decompressive craniectomy in traumatic brain injury: the intensivist's point of view. / Craniectomías descompresivas en el traumatismo craneoencefálico: la visión del intensivista.

OBJETIVE: To perform a score with early clinical and radiological findings after a TBI that identifies the patients who in their subsequent evolution are going to undergo DC. METHOD: Observational study of a retrospective cohort of patients who, after a TBI, enter the Neurocritical Section of the Intensive Care Unit of our hospital for a period of 5 years (2014-2018). Detection of clinical and radiological criteria and generation of all possible models with significant, clinically relevant and easy to detect early variables. Selection of the one with the lowest Bayesian Information Criterion and Akaike Information Criterion values for the creation of the score. Calibration and internal validation of the score using the Hosmer-Lemeshow and a bootstrapping analysis with 1,000 re-samples respectively. RESULTS: 37 DC were performed in 153 patients who were admitted after a TBI. The resulting final model included Cerebral Midline Deviation, GCS and Ventricular Collapse with an Area under ROC Curve: 0.84 (95% IC 0.78-0.91) and Hosmer-Lemeshow p=0.71. The developed score detected well those patients who were going to need an early DC (first 24hours) after a TBI (2.5±0.5) but not those who would need it in a later stage of their disease (1.7±0.8). However, it seems to advice us about the patients who, although not requiring an early DC are likely to need it later in their evolution (DC after 24hours vs do not require DC, 1.7±0.8 vs 1±0.7; p=0.002). CONCLUSION: We have developed a prognostic score using early clinical-radiological criteria that, in our environment, detects with good sensitivity and specificity those patients who, after a TBI, will require a DC.

Big data and machine learning in critical care: Opportunities for collaborative research.

The introduction of clinical information systems (CIS) in Intensive Care Units (ICUs) offers the possibility of storing a huge amount of machine-ready clinical data that can be used to improve patient outcomes and the allocation of resources, as well as suggest topics for randomized clinical trials. Clinicians, however, usually lack the necessary training for the analysis of large databases. In addition, there are issues referred to patient privacy and consent, and data quality. Multidisciplinary collaboration among clinicians, data engineers, machine-learning experts, statisticians, epidemiologists and other information scientists may overcome these problems. A multidisciplinary event (Critical Care Datathon) was held in Madrid (Spain) from 1 to 3 December 2017. Under the auspices of the Spanish Critical Care Society (SEMICYUC), the event was organized by the Massachusetts Institute of Technology (MIT) Critical Data Group (Cambridge, MA, USA), the Innovation Unit and Critical Care Department of San Carlos Clinic Hospital, and the Life Supporting Technologies group of Madrid Polytechnic University. After presentations referred to big data in the critical care environment, clinicians, data scientists and other health data science enthusiasts and lawyers worked in collaboration using an anonymized database (MIMIC III). Eight groups were formed to answer different clinical research questions elaborated prior to the meeting. The event produced analyses for the questions posed and outlined several future clinical research opportunities. Foundations were laid to enable future use of ICU databases in Spain, and a timeline was established for future meetings, as an example of how big data analysis tools have tremendous potential in our field.

[Tube feeding monitoring as a clinical quality indicator at intensive care units]. / Monitorización de la nutrición enteral como indicador clínico para la evaluación de la calidad en unidades de cuidados intensivos.

BACKGROUND: Malnutrition is particularly prevalent among intensive care unit (ICU) patients, being associated with poor clinical results. Enteral nutrition (EN) offers multiple benefits on critically ill patients and its monitoring was established by the Spanish Society of Critical Care (SEMICYUC) as a clinical quality indicator (CQI; EN patients correctly monitorized / all EN patients, as %). However, no results have been published on its regulated monitoring. OBJECTIVES: Assessing CQI's compliance, identifying difficulties and possibilities for its use. METHODS: In a recent 18-month period, the CQI was assessed in ICU patients following SEMYCIUC criteria. RESULTS AND CONCLUSION: This CQI, although offered as a unique indicator, has different components, giving rise to multiple results. The settled standard (100%) was only reached by some of these components, i.e.: feeding tube position control plus verification of vomiting, regurgitation and aspiration. We propose to elaborate a daily checklist, including the different components that integrate this CQI, for its joint completion by nurses and physicians for all patients receiving EN.

INTRODUCCIÓN: la desnutrición es particularmente prevalente en unidades de cuidados intensivos (UCI), asociándose con malos resultados clínicos. La nutrición enteral (NE) presenta múltiples beneficios en pacientes críticos y su monitorización ha sido establecida por la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) como indicador clínico de calidad (ICC; pacientes con NE correctamente monitorizados/todos los pacientes con NE, en %). Sin embargo, no se han publicado resultados sobre su monitorización reglada. OBJETIVOS: evaluar el cumplimiento del ICC "monitorización de la NE", identificando dificultades y posibilidades para su utilización. METODOLOGÍA: durante 18 meses, el ICC fue monitorizado en pacientes de UCI según criterios de SEMICYUC. RESULTADOS Y CONCLUSIÓN: el ICC, aunque se presenta como único, tiene múltiples componentes, originando múltiples resultados difíciles de compilar. El estándar establecido (100%) solo fue alcanzado en control de la sonda y verificación de vómitos, regurgitación y broncoaspiración. Proponemos elaborar un listado de verificación diaria, incluyendo todos los aspectos contemplados, para su puesta en común entre los estamentos médicos y de enfermería, para cada paciente con NE.

Monitorización de la nutrición enteral como indicador clínico para la evaluación de la calidad en unidades de cuidados intensivos / Tube feeding monitoring as a clinical quality indicator at intensive care units

Introducción: la desnutrición es particularmente prevalente en unidades de cuidados intensivos (UCI), asociándose con malos resultados clínicos. La nutrición enteral (NE) presenta múltiples beneficios en pacientes críticos y su monitorización ha sido establecida por la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) como indicador clínico de calidad (ICC; pacientes con NE correctamente monitorizados/todos los pacientes con NE, en %). Sin embargo, no se han publicado resultados sobre su monitorización reglada. Objetivos: evaluar el cumplimiento del ICC "monitorización de la NE", identificando dificultades y posibilidades para su utilización. Metodología: durante 18 meses, el ICC fue monitorizado en pacientes de UCI según criterios de SEMICYUC. Resultados y conclusión: el ICC, aunque se presenta como único, tiene múltiples componentes, originando múltiples resultados difíciles de compilar. El estándar establecido (100%) solo fue alcanzado en control de la sonda y verificación de vómitos, regurgitación y broncoaspiración. Proponemos elaborar un listado de verificación diaria, incluyendo todos los aspectos contemplados, para su puesta en común entre los estamentos médicos y de enfermería, para cada paciente con NE (AU)

Background: Malnutrition is particularly prevalent among intensive care unit (ICU) patients, being associated with poor clinical results. Enteral nutrition (EN) offers multiple benefits on critically ill patients and its monitoring was established by the Spanish Society of Critical Care (SEMICYUC) as a clinical quality indicator (CQI; EN patients correctly monitorized / all EN patients, as %). However, no results have been published on its regulated monitoring. Objectives: Assessing CQI’s compliance, identifying difficulties and possibilities for its use. Methods: In a recent 18-month period, the CQI was assessed in ICU patients following SEMYCIUC criteria. Results and conclusion: This CQI, although offered as a unique indicator, has different components, giving rise to multiple results. The settled standard (100%) was only reached by some of these components, i.e.: feeding tube position control plus verification of vomiting, regurgitation and aspiration. We propose to elaborate a daily checklist, including the different components that integrate this CQI, for its joint completion by nurses and physicians for all patients receiving EN (AU)

Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study.

INTRODUCTION: Although standard enteral nutrition is universally accepted, the use of disease-specific formulas for hyperglycemic patients is still controversial. This study examines whether a high-protein diabetes-specific formula reduces insulin needs, improves glycemic control and reduces ICU-acquired infection in critically ill, hyperglycemic patients on mechanical ventilation (MV). METHODS: This was a prospective, open-label, randomized (web-based, blinded) study conducted at nine Spanish ICUs. The patient groups established according to the high-protein formula received were: group A, new-generation diabetes-specific formula; group B, standard control formula; group C, control diabetes-specific formula. Inclusion criteria were: expected enteral nutrition ≥5 days, MV, baseline glucose >126 mg/dL on admission or >200 mg/dL in the first 48 h. Exclusion criteria were: APACHE II ≤10, insulin-dependent diabetes, renal or hepatic failure, treatment with corticosteroids, immunosuppressants or lipid-lowering drugs and body mass index ≥40 kg/m(2). The targeted glucose level was 110-150 mg/dL. Glycemic variability was calculated as the standard deviation, glycemic lability index and coefficient of variation. Acquired infections were recorded using published consensus criteria for critically ill patients. Data analysis was on an intention-to-treat basis. RESULTS: Over a 2-year period, 157 patients were consecutively enrolled (A 52, B 53 and C 52). Compared with the standard control formula, the new formula gave rise to lower insulin requirement (19.1 ± 13.1 vs. 23.7 ± 40.1 IU/day, p <0.05), plasma glucose (138.6 ± 39.1 vs. 146.1 ± 49.9 mg/dL, p <0.01) and capillary blood glucose (146.1 ± 45.8 vs. 155.3 ± 63.6 mg/dL, p <0.001). Compared with the control diabetes-specific formula, only capillary glucose levels were significantly reduced (146.1 ± 45.8 vs. 150.1 ± 41.9, p <0.01). Both specific formulas reduced capillary glucose on ICU day 1 (p <0.01), glucose variability in the first week (p <0.05), and incidences of ventilator-associated tracheobronchitis (p <0.01) or pneumonia (p <0.05) compared with the standard formula. No effects of the nutrition formula were produced on hospital stay or mortality. CONCLUSIONS: In these high-risk ICU patients, both diabetes-specific formulas lowered insulin requirements, improved glycemic control and reduced the risk of acquired infections relative to the standard formula. Compared with the control-specific formula, the new-generation formula also improved capillary glycemia. TRIAL REGISTRATION: Clinicaltrials.gov NCT1233726 .

Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients.

BACKGROUND & AIMS: To assess the effect of an enteral diet enriched with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and anti-oxidants on the incidence of organ dysfunction and nosocomial infections in septic patients with acute lung injury or acute respiratory distress syndrome (ARDS) compared with a standard enteral diet. METHODS: This prospective, randomized, open-label study was performed in 11 Spanish intensive care units (ICU). Adult patients with sepsis and acute lung injury or ARDS were randomly allocated to receive either an EPA-GLA diet or a control diet. RESULTS: Of the 198 patients that were eligible, 160 were randomized and 132 were studied. Patient demographics, APACHE II and SOFA scores, and nutritional variables on admission were similar between the EPA-GLA diet and control diet groups. The EPA-GLA diet group showed a trend toward a decreased SOFA score, but it was not significant. No differences were observed in the PaO(2)/FiO(2) ratio or the days on mechanical ventilation between the groups. Incidence of infections was similar in the groups. The control group stayed longer in the ICU than the EPA-GLA diet group (16 vs. 18; p = 0.02). CONCLUSIONS: A diet enriched with EPA, GLA, and anti-oxidants does not improve gas exchange or decrease the incidence of novel organ failures in critically ill septic patients with acute lung injury or ARDS. Patients treated with the EPA-GLA diet stayed in the ICU for less time, but we did not find any differences in infectious complications.

[Care plan versus care protocol. Comparative analysis in patients subjected to cardiac catheterism]. / Plan de cuidados frente a protocolo asistencial. Análisis comparativo en pacientes sometidos a cateterismo cardíaco.

The nursing product marks the present and future of the nursing staff. The tools used in the nursing staff should be complete and favor their work. The importance of the cares, during the stay of the patients in the intensive care units, is justified by the obtaining of results and some levels of quality that are adequate for the health care setting. The project aims to know the efficacy of the registered nursing care procedure, care plan or care protocol in an intensive care unit, with a system of computerized clinical records. The resulting information shows a value for the time dedicated to work with the plan greater than that used with the protocol (p = 0.01). In turn, the quality indicators used in both systems are graded as acceptable, although they obtain better results in the care plan. The nursing staff that participate in the study consider that the utility of the care plan in the unit is limited or null for 42.9% and 21.4%, respectively. It should be remembered that the work system in forced in the unit for the nursing care is a care protocol In conclusion, we state that the care plan has better quality in the records than the care protocol, while it requires greater time to fill out the nursing records.

Plan de cuidados frente a protocolo asistencial. Análisis comparativo en pacientes sometidos a cateterismo cardíaco / Care plan versus care protocol. Comparative analysis in patients subjected to cardiac catheterism

El producto enfermero marca la actualidad y futuro de la enfermería. Las herramientas que emplea la enfermería deben ser completas y favorecer su trabajo. La importancia de los cuidados, durante la estancia del paciente en las unidades de cuidados intensivos, se justifica mediante la obtención de unos resultados y de unos niveles de calidad adecuados a su entorno sanitario. El proyecto tiene como objetivo conocer cuál es la eficacia del procedimiento asistencial de enfermería registrado, plan de cuidados o protocolo asistencial, en una unidad de cuidados intensivos, con un sistema de registro clínico informatizado. La información resultante muestra un valor para el tiempo destinado al trabajo con el plan superior al empleado con el protocolo (p = 0,01). A la vez, los indicadores de calidad utilizados en ambos sistemas se califican como aceptables, aunque obtienen mejores resultados en el plan de cuidados. La enfermería que participa en el estudio, opina que la utilidad del plan de cuidados en la unidad es escasa o nula para el 42,9 y el 21,4%, respectivamente. Conviene recordar, que el sistema de trabajo vigente en la unidad para la asistencia de enfermería, es el protocolo asistencial. En conclusión, el plan de cuidados presenta mejor calidad en los registros que el protocolo asistencial, a la vez que requiere una mayor inversión de tiempo para cumplimentar los registros de enfermería

The nursing product marks the present and future of the nursing staff. The tools used in the nursing staff should be complete and favor their work. The importance of the cares, during the stay of the patients in the intensive care units, is justified by the obtaining of results and some levels of quality that are adequate for the health care setting. The project aims to know the efficacy of the registered nursing care procedure, care plan or care protocol in an intensive care unit, with a system of computerized clinical records. The resulting information shows a value for the time dedicated to work with the plan greater than that used with the protocol (p = 0.01). In turn, the quality indicators used in both systems are graded as acceptable, although they obtain better results in the care plan. The nursing staff that participate in the study consider that the utility of the care plan in the unit is limited or null for 42.9% and 21.4%, respectively. It should be remembered that the work system in forced in the unit for the nursing care is a care protocol In conclusion, we state that the care plan has better quality in the records than the care protocol, while it requires greater time to fill out the nursing records

[Job stressors and satisfaction in the nursing staff of a critical unit]. / Estresores laborales y satisfacción en la enfermería de una unidad de críticos.

OBJECTIVES: The objectives of our study were: to identify the stressor agents of the nursing staff according to the sociodemographical and professional characteristics; to know if the frequency of exposure to job stressors is modified based on sociodemographical characteristics; and to know if there is a relationship between job stress and satisfaction. MATERIAL AND METHOD: The study sample was made up of 71 nurses (N) and 48 nursing assistants (NA). Information was collected with a self-administrated questionnaire. Satisfaction was assessed with the Warr, Cook and Wall survey and job stressors with the <> Demographic and professional variables were collected. RESULTS: The percentage of responses was 88.2%. Mean stress in SD was significantly higher than in the NA, 38 (10.7) and 27.9 (9.2) respectively; p < 0.001. The stressor mean is higher based on age and type of contract in both categories. We have not found any differences in relationship to satisfaction. Both categories identified as main stressors those related with the patient's suffering, death and job excess. CONCLUSIONS: 1) The most frequently identified job stressors in both categories are those related with patient suffering, death and job excess. 2) The Ns have a significantly greater exposure to job stressors. 3) Young age and insecurity in the job increase exposure to job stressors. 4) We have not found any relationship between the job stressors and satisfaction.

Estresores laborales y satisfacción en la enfermería de una unidad de críticos / Job stressors and satisfaction in the nursing staff of a critical unit

Objetivos. Los objetivos de nuestro estudio han sido: identificar los agentes estresores del personal de enfermería, según sus características sociodemográficas y profesionales; conocer si la frecuencia de exposición a estresores laborales se modifica en función de las características sociodemográficas, y conocer si hay relación entre el estrés laboral y la satisfacción. Material y método. La muestra de estudio ha sido 71 enfermeras/os (DE) y 48 auxiliares de enfermería(AE). La información se recogió mediante un cuestionario autoadministrado. La satisfacción se valoró mediante la encuesta de Warr, Cook y Wall, y los estresores laborales mediante la escala Nursing Stress Scale. Se recogieron variables demográficas y profesionales. Resultados. El porcentaje de respuesta fue del 88,2%. La media de estrés en DE fue significativamente más alto que en AE, 38 (10,7) y 27,9 (9,2),respectivamente; p < 0,001. La media de estresores es más alta en función de la edad y el tipo de contrato en ambas categorías. No hemos encontrado diferencias con relación a la satisfacción. Ambas categorías identificaron como principales estresores los relacionados con el sufrimiento del paciente, la muerte y la sobre carga de trabajo. Conclusiones. 1) Los estresores laborales mas frecuentemente identificados en ambas categorías, son los relacionados con el sufrimiento del paciente, la muerte y la sobrecarga de trabajo. 2) Las DE tienen de forma significativa una mayor exposición a estresores laborales. 3) La juventud y la inseguridad en el puesto de trabajo aumentan la exposición a estresores laborales. 4) No hemos encontrado relación entre los estresores laborales y la satisfacción

Objectives. The objectives of our study were: to identify the stressor agents of the nursing staff according to the socio demographical and professional characteristics; to know if the frequency of exposure to job stressors is modified based on socio demographical characteristics; and to know if there is a relationship between job stress and satisfaction. Material and method. The study sample was made up of 71 nurses (N) and 48 nursing assistants (NA). Information was collected with a self-administrated questionnaire. Satisfaction was assessed with the Warr, Cook and Wall survey and job stressors with the «Nursing Stress Scale.» Demographic and professional variables were collected. Results: The percentage of responses was 88.2%. Mean stress in SD was significantly higher than in the NA, 38(10.7) and 27.9 (9.2) respectively; p < 0.001. The stressor mean is higher based on age and type of contract in both categories. We have not found any differences in relationship to satisfaction. Both categories identified as main stressors those related with the patient’s suffering, death and job excess. Conclusions. 1) The most frequently identified job stressors in both categories are those related withpatient suffering, death and job excess. 2) The Ns have a significantly greater exposure to job stressors. 3) Young age and insecurity in the job increase exposure to job stressors. 4) We have not found any relation ship between the job stressors and satisfaction

[Nursing records: conventional versus computerized. Critical care unit]. / Registros de enfermería: convencional frente a informatizado. Unidad de cuidados críticos.

In these recent years, electronic clinical data systems have been incorporated into the daily nursing work for the use of records in the hospitalization units. Between 2001 and 2002, the computer program that has presently become the work tool in the Critical Unit I was designed. This project aims to know the opinion of the nursing staff on the use of the computerized record versus the previous pen and paper. The surveys designed were filled out by 90.5% of the unit staff and it was found that for nursing group, the computerized record is a better work system than the pen and paper. Further, the computerized record is characterized by being more complete, by making it possible to better gather the work and by adjusting more reliably to the nursing work. In conclusion, we would say that the perception of nursing after the initiation of the clinical record computerized system is that it has improved versus the pen-paper. The perception of the time aimed at filling out the records is greater, although paradoxically, it generates more time for the patient's care according to the staff opinion. Even so, it is considered to be a good work system.

Registros de enfermería: convencional frente a informatizado. Unidad de cuidados críticos / Nursing records: conventional versus computerized.Critical care unit

En estos últimos años, se han incorporado al trabajo diario de la enfermería los sistemas de información clínica electrónica, para el empleo de registros en las unidades de hospitalización. Entre los años 2001 y 2002 se configuró la aplicación informática que en la actualidad se ha convertido en la herramienta de trabajo en la unidad de Críticos I. Este proyecto tiene como objetivo conocer la opinión del personal de enfermería sobre el empleo del registro informatizado respecto del previo, "bolígrafo y papel". Las encuestas diseñadas fueron cumplimentadas en un 90,5 por ciento por el personal de la unidad, y se obtuvo que para la enfermería el registro informatizado es mejor sistema de trabajo que el "bolígrafo y papel". Además, el registro informatizado se caracteriza por ser más completo, por permitir recoger mejor el trabajo y por ajustarse más fielmente a la labor de enfermería. En conclusión, diremos que la percepción de enfermería tras la puesta en marcha del sistema informatizado de registros clínicos es haber mejorado frente al bolígrafo-papel. La percepción del tiempo destinado a cumplimentar los registros es mayor aunque paradójicamente genera más tiempo para la asistencia del paciente, según la opinión del personal; aun así es considerado un buen sistema de trabajo (AU)

[Repercussion on respiratory and hemodynamic parameters with a closed system of aspiration of secretion]. / Repercusión sobre parámetros respiratorios y hemodinámicos con un sistema cerrado de aspiración de secreciones.

Aspiration of bronchial secretions is a usual technique that may have an affect on hemodynamic and respiratory parameters of the patient. Our objects has been to assess if there are changes in these parameters based on two different aspiration systems: closed (CS) or open (OS) and to also compare the times used in the process. A clinical trial was performed using the crossing over method in which aspirations were performed to the same patient with the two systems. The onset system was randomized and, after a wash-out period of 3 hours, an alternative system was established. We recorded ventilatory, gasometric (baseline and at five minutes of finishing the technique) and hemodynamic (baseline, during the procedure and at five minutes) variables. The time used in each procedure was recorded. The aspiration was always performed with preoxygenation at 100% during one minute. A total of 26 patients subjected to mechanical ventilation in the assisted/controlled way entered the study and 52 aspirations were studied. We analyzed the data with the Student's t test for paired samples and ANOVA. There were no differences in the comparisons between the different determinations for the hemodynamic and gasometric variables. In the ventilatory ones, we only found a significant increase in the respiratory frequency posterior to the OS in regards to the baseline of the same system (p = 0.016). The time used in the technique was greater for the OS (p < 0.001). It can be concluded from the results that: 1. The aspiration technique does not produce clinically important alterations in the parameters studied. 2. There are no differences between the two aspiration systems. 3. The technique with CS is faster.

Repercusión sobre parámetros respiratorios y hemodinámicos con un sistema cerrado de aspiración de secreciones / Repercussion on respiratory and hemodynamic parameters with a closed system of aspiration of secretion

La aspiración de secreciones bronquiales es una técnica habitual que puede repercutir en los parámetros hemodinámicos y respiratorios del paciente. Nuestro objetivo, ha sido valorar si existen cambios en dichos parámetros, en función de 2 sistemas distintos de aspiración: cerrado (SC) o abierto (SA); y secundariamente, comparar los tiempos empleados en el proceso. Se realizó un ensayo clínico con el método de entrecruzamiento, en el cual, al mismo paciente se le realizaron aspiraciones con los 2 sistemas. Se aleatorizó el sistema de inicio; tras un período de lavado de 3 h, se instauro el sistema alternativo. Registramos variables ventilatorias, gasométricas (basales y a los 5 min de finalizada la técnica) y hemodinámicas (basales, durante el procedimiento y a los 5 min). Se registró el tiempo empleado en cada procedimiento. La aspiración se realizó siempre con preoxigenación al 100 por ciento, durante 1 min. Para el estudio, se seleccionaron 26 pacientes sometidos a ventilación mecánica en el modo asistida/controlada, y se estudiaron 52 aspiraciones. Analizamos los datos mediante la t de Student para muestras pareadas y Anova. En las comparaciones entre las distintas determinaciones, no hubo diferencias para las variables hemodinámicas y gasométricas. En las ventilatorias, sólo encontramos un aumento significativo en la frecuencia respiratoria posterior del SA, con respecto a la basal del mismo sistema (p = 0,016). El tiempo empleado en la técnica fue mayor para el SA (p < 0,001).De los resultados se desprende que: a) la técnica de aspiración no produce alteraciones clínicamente relevantes en los parámetros estudiados; b) no existen diferencias entre los 2 sistemas de aspiración, y c) es más rápida la técnica con el SC (AU)