[Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. / Recomendaciones de «hacer¼ y «no hacer¼ en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante de COVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC).

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.

Comentario a «En respuesta a la pregunta: ¿Jugamos todos en el mismo equipo?» / Comment to «In reply to the question: Are we really playing together in the same team?»

No disponible

Decisiones en los cuidados al final de la vida. ¿Jugamos en el mismo equipo? / Decision-making in end of life care. Are we really playing together in the same team?

Antecedentes: La limitación del tratamiento de soporte vital es cada vez más frecuente en las unidades de críticos, y la donación en asistolia controlada se está empezando a incluir como una opción dentro del plan de cuidados de los pacientes. La falta de conocimientos y los malos entendidos pueden suponer una barrera entre los profesionales sanitarios. Objetivo: Determinar la percepción, conocimientos y actitud de los médicos y enfermeras que trabajan en las unidades de críticos sobre la limitación del tratamiento de soporte vital y donación en asistolia controlada. Diseño, ajustes y participantes: Se llevó a cabo un estudio transversal en 13 hospitales españoles utilizando un cuestionario diseñado a tal efecto. Métodos: Para analizar las respuestas se utilizaron tablas de contingencia, el test de Chi cuadrado de Pearson, la «t» de Student y el test de Mann-Whitney para el análisis estadístico descriptivo bivariante y multivariante. Resultados: Aunque la limitación del tratamiento de soporte vital es una práctica muy extendida, el trabajo muestra cómo los enfermeros se sienten excluidos tanto del desarrollo de protocolos como de los procesos de decisión, mientras que la percepción de los médicos es que tienen mayores conocimientos y que las decisiones se toman conjuntamente. Conclusiones: Para solventar estas diferencias, los programas formativos multidisciplinares pueden ayudar a los profesionales de la salud a trabajar conjuntamente, con mayor coordinación, beneficiando tanto a pacientes como a sus familias, y proporcionando cuidados de calidad al final de la vida

Background: Limitation of life-sustaining treatment is increasingly common in critical care units, and controlled donation after circulatory death is starting to be included as an option within patient care plans. Lack of knowledge and misunderstandings can place a barrier between healthcare professionals. Objective: To determine the perceptions, knowledge and attitudes of physicians and nurses working in intensive care units regarding Limitation of life-sustaining treatment and controlled donation after circulatory death. Design, settings and participants: Cross-sectional study carried out in 13 Spanish hospitals by means of an ad hoc questionnaire. Methods: Contingency tables, Pearson's chi-squared test, Student's t-test and the Mann-Whitney u-test were used to carry out descriptive, bivariate and multivariate statistical analyses of responses. Results: Although Limitation of life-sustaining treatment is a widespread practice, the survey revealed that nurses feel excluded from the development of protocols and the decision-making process, whilst the perception of physicians is that they have greater knowledge of the topic, and decisions are reached in consensus. Conclusions: Multi-disciplinary training programmes can help critical healthcare providers to work together with greater coordination, thus benefitting patients and their next of kin by providing excellent end-of-life care

Decision-making in end of life care. Are we really playing together in the same team? / Decisiones en los cuidados al final de la vida. ¿Jugamos en el mismo equipo?

BACKGROUND: Limitation of life-sustaining treatment is increasingly common in critical care units, and controlled donation after circulatory death is starting to be included as an option within patient care plans. Lack of knowledge and misunderstandings can place a barrier between healthcare professionals. OBJECTIVE: To determine the perceptions, knowledge and attitudes of physicians and nurses working in intensive care units regarding Limitation of life-sustaining treatment and controlled donation after circulatory death. DESIGN, SETTINGS AND PARTICIPANTS: Cross-sectional study carried out in 13 Spanish hospitals by means of an ad hoc questionnaire. METHODS: Contingency tables, Pearson's chi-squared test, Student's t-test and the Mann-Whitney u-test were used to carry out descriptive, bivariate and multivariate statistical analyses of responses. RESULTS: Although Limitation of life-sustaining treatment is a widespread practice, the survey revealed that nurses feel excluded from the development of protocols and the decision-making process, whilst the perception of physicians is that they have greater knowledge of the topic, and decisions are reached in consensus. CONCLUSIONS: Multi-disciplinary training programmes can help critical healthcare providers to work together with greater coordination, thus benefitting patients and their next of kin by providing excellent end-of-life care.

[New strategy of actuation in central venous catheter and its influence in infection]. / Nueva estrategia de actuación en los accesos venosos centrales y su influencia en bacteriemias.

The authors inquire if in an educational process and a change in the management for the central venous catheters, have any effect in the decrease of the catheter-related infection (CRI). The strategy consist on doing a new protocol and its communication to the professional people twice per year. A population descriptive analysis is done with medians and description of the etiology. The percentages of CRI are compared between controls periods of one year and intervention periods of one year as well, using association measurements. A total number of 31 CRI's were diagnosed, 19 in the control process and 12 in the intervention process with a results of 8.17 and 4.29 per thousand days of central venous catheter (OR = 0.52; IC = 95%, 0.25 -1.03). In no case was death related with the CRI. The new strategy of handling the central veins access, based on the implications of the assistant staff, reduce the risk of CRI

Midazolam and 2% propofol in long-term sedation of traumatized critically ill patients: efficacy and safety comparison.

OBJECTIVE: We proposed to compare the efficacy and safety of midazolam and propofol in its new preparation (2% propofol) when used for prolonged, deep sedation in traumatized, critically ill patients. We also retrospectively compared 2% propofol with its original preparation, 1% propofol, used in a previous study in a similar and contemporary set of patients. DESIGN: A prospective, randomized, unblinded trial (midazolam and 2% propofol) and a retrospective, contemporary trial (2% propofol and 1% propofol). SETTINGS: A trauma intensive care unit in a tertiary university hospital. PATIENTS: A total of 63 consecutive trauma patients, admitted within a period of 5 months and requiring mechanical ventilatory support for >48 hrs, 43 of whom (73%) suffered severe head trauma. We also retrospectively compared the 2% propofol group with a series of patients in whom 1% propofol was used. INTERVENTIONS: For the prospective trial, we randomized two groups--a midazolam group with continuous administration of midazolam at dosages 0.1-0.35 mg/kg/hr, and a 2% propofol group with continuous infusion at dosages 1.5-6 mg/kg/hr. Equal dosages of analgesics were administered. Similar management protocols were applied in the 1% propofol group, used in the retrospective analysis with 2% propofol. MEASUREMENTS AND MAIN RESULTS: Epidemiologic and efficacy variables were recorded. Hemodynamic and biochemical variables were also monitored on a regular basis. Neuromonitoring was also performed on those patients with head trauma. Sedation adequacy was similar and patient behavior after drug discontinuation was not different in either prospective group (midazolam and 2% propofol). Hemodynamic or neuromonitoring variables were also similar for both groups. Triglyceride levels were significantly higher in the 2% propofol group compared with the midazolam group. A higher number of therapeutic failures because of sedative inefficacy was seen in the 2% propofol group compared with the midazolam group, especially during the first sedation days. When comparing 2% propofol and 1% propofol, a significantly higher number of therapeutic failures because of hypertriglyceridemia were found in the 1% propofol group, as opposed to a major number of therapeutic failures because of inefficacy, found in the 2% propofol group. CONCLUSIONS: Propofol's new preparation is safe when used in severely traumatized patients. Its more concentrated formula improves the lipid overload problem seen with the prolonged use of the previous preparation. Nevertheless, a major number of therapeutic failures were detected with 2% propofol because of the need for dosage increase. This fact could be caused by a different disposition and tissue distribution pattern of both propofol preparations. New studies will be needed to confirm these results.