[Frecuency of adverse events during the hygiene of the critical care patient]. / Frecuencia de eventos adversos durante el aseo del paciente crítico.

The hygiene of the patient in critical condition is a common nursing technique in the intensive care unit, which does not mean that doing it is exempt of risk for the patient's state. We carry out a study to measure the frequency of the appearance of certain adverse events during the hygiene care and their clinical repercussion.Hygiene of the critical patients was monitored, measuring the appearance of certain events at the time of hygiene and until one hour after to assess if the complications were at the moment or had a greater repercussion on the state of the patient.During the study period, some adverse event appeared in 48% (CI 95%: 43-52) of the hygiene performed while none appeared in 52% (CI 95%: 48-56) of it. The events that appeared most frequently were: desaturation in 18% (CI 95%: 15-21) of the hygiene performed, the deadaptation of the mechanical ventilation in 11% (CI 95%: 9-14), arterial hypertension in 21% (CI 95%: 18-25) and arterial hypotension in 11% (CI 95%: 9-14). The intracranial hypertension appeared in 42% (CI 95%: 26-61) of the hygiene performed to patients who were carriers of intraventricular catheter, 9% (CI 95%: 2-25) continued with elevated values 1 hour after concluding the hygiene. The rest of the events monitored presented a lower frequency, although the appearance of one episode of cardiorespiratory arrest and two of auricular fibrillation with rapid ventricular response, one of which required cardioversion, stand out. We conclude that it is an essential job of the nursing staff to correctly assess the risks that the performance of hygiene means for the critical patient, so that the technique should be applied rationally and under strict monitoring and control.

[Analysis of costs and cost per diagnostic group of critically burned patients in the Spanish public health care system]. / Análisis de la financiación y del coste por proceso de los enfermos quemados críticos en el sistema público de salud español.

The financing of the National Institute of Health (INSALUD) of Spain will soon be based on Diagnosis-Related Groups (DRGs). Knowledge of the real cost of different DRGs is fundamental to ensure adequate financing and to establish criteria for comparisons between centers. Our public health system has no data on the real cost of critically burned patients and their DRGs. This retrospective descriptive study was carried out in a Major Burns Unit (MBU) and included all patients admitted between January and December 1996. Real total cost of the care of critical burned patients, cost per patient, and cost per DRG related with critical burn patients were calculated for the study period. Financing by Weighed Care Units (WCU) was compared with real costs. The total cost of the care of critical burn patients was 346,298,872 Spanish pesetas and the cost per patient was 4,439,729 ptas. WCU financing was 322,021,616 ptas and 4,128,482 ptas, respectively. The DRG with the highest total cost was 458 (non-extensive burns with skin grafts, 106,372,016 ptas). The DRG with the highest average cost was 472 (extensive burns with surgical procedure, 5,401,119 ptas). The DRG with the highest cost per stay was 457 (extensive burns without surgical procedure, 404,683 ptas). For the first time in Spain, the cost of DRGs related with critical burn patients is described. This information is necessary for DRG-based allocation of funds and for establishing criteria to compare centers. The real cost of critical burn patients exceeded WCU financing.

[Incidence of pneumonia due to mechanical ventilators in relation to external circuit changes in the respirator]. / Incidencia de neumonía asociada a ventilación mecánica en relación al cambio de circuitos externos del respirador.

Pneumonia is one of the infections of highest relevancy in Intensive Care Units, and according to the incidence of pneumonia associated to mechanical ventilation, the frequence of the ventilator external circuits change is still a topic of discussion. We decided to modify the protocol of change in our unit, from doing it every 48 hours to every 7 days. We performed a prospective study in 108 patients attended in a Polyvalent ICU who underwent mechanical ventilation during more than 24 hours. We formed two groups, in Group 1 we changed circuits every 48 hours and in Group 2 the circuits were changed every 7 days, without using bacterian filters in any of the groups. The results obtained in Group 1 were of an accumulated incidence of pneumonia associated to mechanical ventilation of 18% and density of incidence of 21.1 pneumonias per 1000 days of mechanical ventilation. In Group 2 we obtained an accumulated incidence of pneumonia associated to mechanical ventilation of 19% and a density of incidence of 20.5 pneumonias per 1000 days of mechanical ventilation. In the analysis of data there were no significant statistic differences between both groups. The cost of respirator external circuits was diminished in 27% in Group 2. We conclude that the circuits change every 7 days does not produce an increase in the frequence of pneumonia associated to mechanical ventilation, with the expense of the respirator external circuits being remarkably reduced.