[Improving the care of critical patient family members: Agreed on strategies]. / Mejorando el cuidado a los familiares del paciente crítico: estrategias consensuadas.

INTRODUCTION: Within the context of participatory action research (PAR), a 4-stage process was established with the general aim of promoting improvements in the care offered to families of patients in the Intensive Care Unit (ICU). The 4 stages consisted of a situational diagnosis, proposals for change, the design and implementation of the proposals, and an evaluation. This paper presents the first 2 stages. OBJECTIVES: To define the attention given to families of patients in the Intensive Care Unit. To reach a consensus on areas for action/intervention in the unit. MATERIALS AND METHOD: A qualitative methodology. DESIGN: PAR. Data-collection technique: 4 focus groups made up of 10 professionals, and consensus with support groups made up of 30 members. Content analysis was performed. The theoretical saturation point was reached. RESULTS: Two documents were drawn up: 1) A situational diagnosis, describing the current situation of the attention given to families and 2) 10 proposals for change, 5 of which were given priority. They were: a session to familiarize professionals with evidence concerning families of patients in the ICU and the handing out of informative leaflets, the improvement of (nurse-family and intra-team) informative procedures, more privacy for patients and a reduction in environmental noise, a training plan for professionals, and change in the visiting policy. CONCLUSION: By using consensus-based methodologies, strategies for change can be prioritized and designed, adapted to the context in which they will be applied.

[Comparison of gastric aspirate volume after intubation in patients with and without symptoms of gastroesophageal reflux disease]. / Comparación del volumen gástrico tras intubación entre pacientes con y sin síntomas de enfermedad por reflujo gastroesofágico.

OBJECTIVES: To compare the postintubation gastric aspirate volume of patients with and without symptoms of gastroesophageal reflux disease (GERD). METHODS: Prospective randomized study of 331 physical status ASA I-II adults scheduled for surgery. Patients with GERD symptoms (heartburn and regurgitation) were assigned to group A (n=83); asymptomatic patients (n=248) were assigned to groups B (n=85), C (n=70), and D (n=93). Group A was subdivided: group A1 received outpatients treatment for GERD and group A2 did not. Groups A, B, and C received prophylaxis with omeprazole 40 mg and metoclopramide 10 mg, respectively. Group D received no prophylaxis. Groups A and B patients received 1 mg x kg(-1) of succinylcholine, and groups C and D received 0.2 mg x kg(-1) of cisatracurium. After intubation, gastric content was aspirated and measured. The results were compared with Pearson's chi2 and Student t tests, analysis of variance, and Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The gastric aspirate volumes in each group were as follows: 36.6 (SD 5) mL in group A; 9.98 (4.9) mL in group B; 10.8 (5.5) mL in group C; 15.62 (6.3) mL in group D; 32.7 (5.1) mL in group A1; and 39.08 (3.6) mL in group A2. Volumes were significantly greater in group A than in groups B, C, and D (P<0.0001), and in subgroup A2 than in subgroup A1 (P<0.001). The percentages of patients from whom a volume greater than 25 mL was aspirated in each group were as follows: 98.9% of group A, 1.2% of group B, 2.8% of group C, and 8.6% of group D (P<0.001). CONCLUSION: Patients with chronic heartburn and regurgitation have greater postintubation gastric aspirate volumes than do asymptomatic patients, attributable to the gastroesophageal motility dysfunction characteristic of GERD that can favor aspiration. GERD questions should be included in preanesthetic medical history taking, and symptomatic patients should be prescribed outpatient proton pump inhibitor therapy.

Comparación del volumen gástrico tras intubación entre pacientes con y sin síntomas de enfermedad por reflujo gastroesofágico / Comparison of gastric aspirate volume after intubation in patients with and without symptoms of gastroesophageal reflux disease

OBJETIVOS: Comparar el volumen gástrico postintubación entre pacientes con y sin síntomas de enfermedad por reflujo gastroesofágico (ERGE). MÉTODOS: Estudio prospectivo, aleatorio en 331 adultos, ASA I-II, cirugía programada. Los pacientes sintomáticos para ERGE (pirosis y regurgitación) se asignaron al Grupo A (n=83); los asintomáticos (n=248) a los grupos B (n=85), C (n=70) y D (n=93). El grupo A se subdividió en A1: tomaban tratamiento ambulatorio para la ERGE y A2: sin tratamiento. Los grupos A, B y C recibieron profilaxis con omeprazol 40 mg y metoclopramida 10 mg, el grupo D no recibió profilaxis. Se administró 1 mg·Kg-1 de succinilcolina en los grupos A y B y 0,2 mg.Kg-1 de cisatracurio en los grupos C y D. Se aspiró y cuantificó el contenido gástrico postintubación. Los resultados se analizaron con las pruebas de χ2 de Pearson, t de Student, ANOVA, Kruskal-Wallis y U de Mann-Whitney. RESULTADOS: Los volúmenes de contenido gástrico aspirados en cada grupo fueron: A: 36,6 ± 5 ml, B: 9,98 ± 4,9 mL, C: 10,8 ± 5,5 mL, D: 15,62 ± 6,3 mL; A1: 32,7 ± 5,1 mL y A2: 39,08 ± 3,6 ml; fueron significativamente mayores en el grupo A que en los grupos B, C y D (p<0,0001); y en el subgrupo A2 respecto al A1 (p<0,001). El porcentaje de volumen gástrico mayor de 25 mL en cada grupo fue: A: 98,8%, B: 1,2%, C: 2,8% y D: 8,6% (p<0,001). CONCLUSIÓN: Los pacientes sintomáticos (pirosis y regurgitación habituales) presentan un volumen gástrico postintubación mayor que los asintomáticos, atribuible al trastorno motor esofagogástrico característico de la ERGE que puede favorecer la aspiración. La anamnesis sobre la ERGE debe realizarse en la consulta preanestésica y tratar a los pacientes sintomáticos con un inhibidor de la bomba de protones ambulatorio

OBJECTIVES: To compare the postintubation gastric aspirate volume of patients with and without symptoms of gastroesophageal reflux disease (GERD). METHODS: Prospective randomized study of 331 physical status ASA I-II adults scheduled for surgery. Patients with GERD symptoms (heartburn and regurgitation) were assigned to group A(n=83); asymptomatic patients (n=248) were assigned to groups B (n=85), C (n=70), and D (n=93). Group Awas subdivided: group A1 received outpatients treatment for GERD and group A2 did not. Groups A, B, and C received prophylaxis with omeprazole 40 mg and metoclopramide 10 mg, respectively. Group D received no prophylaxis. Groups A and B patients received 1 mg·kg-1 of succinylcholine, and groups C and D received 0.2 mg·kg-1 of cisatracurium. After intubation, gastric content was aspirated and measured. The results were compared with Pearson’s χ2 and Student t tests, analysis of variance, and Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The gastric aspirate volumes in each group were as follows: 36.6 (SD 5) mL in group A; 9.98 (4.9) mL in group B; 10.8 (5.5) mL in group C; 15.62 (6.3) mL in group D; 32.7 (5.1) mL in group A1; and 39.08 (3.6) mL in group A2. Volumes were significantly greater in group A than in groups B, C, and D (P<0.0001), and in subgroup A2 than in subgroup A1 (P<0.001). The percentages of patients from whom a volume greater than 25 mL was aspirated in each group were as follows: 98.9% of group A, 1.2% of group B, 2.8% of group C, and 8.6% of group D (P<0.001). CONCLUSION: Patients with chronic heartburn and regurgitation have greater postintubation gastric aspirate volumes than do asymptomatic patients, attributable to the gastroesophageal motility dysfunction characteristic of GERD that can favor aspiration. GERD questions should be included in preanesthetic medical history taking, and symptomatic patients should be prescribed outpatient proton pump inhibitor therapy