Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Analgésicos Opioides/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Pandemias , Síndrome Respiratória Aguda Grave/terapia , Intubação Intratraqueal , Estudos Retrospectivos , Estudos de CoortesRESUMO
Objetivo: Conocer la práctica clínica real de las UCI españolas en relación con la analgosedación y delirium, y valorar cómo se ajusta a las recomendaciones actuales. Diseño: Estudio transversal descriptivo elaborado mediante encuesta nacional sobre prácticas de analgosedación y delirium de los pacientes ingresados en UCI los días 16 de noviembre de 2013 y 16 de octubre de 2014. Se envió un cuestionario a través de Internet con el aval de la SEMICYUC. Ámbito: UCI tanto públicas como privadas de todo el territorio nacional. Resultados: Se incluyeron un total de 166 UCI y a 1.567 pacientes. El 61,4% de las UCI contaban con un protocolo de sedación. El 75% de las UCI monitorizaban la sedación y agitación, con RASS como la escala empleada con mayor frecuencia. El dolor se monitorizaba en algo más de la mitad de las UCI, pero las escalas conductuales eran de muy baja implantación. El delirium también presentaba un bajo nivel diagnóstico. Entre los pacientes en ventilación mecánica el midazolam continuaba siendo un sedante de muy amplio uso. Conclusiones: Esta encuesta es la primera realizada en España sobre analgosedación y delirium y nos muestra una fotografía sobre estas prácticas, señala algunos aspectos como los relacionados con la monitorización y usos de escalas, junto con el manejo del delirium, en los que los resultados del estudio animan a desarrollar proyectos docentes que acerquen la práctica clínica real a las recomendaciones nacionales e internacionales
Objective: To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations. Design: A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC. Setting: Spanish ICUs in public and private hospitals. Results: A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent. Conclusions: This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Sedação Profunda/métodos , Delírio/tratamento farmacológico , Unidades de Terapia Intensiva/estatística & dados numéricos , Cuidados Críticos/métodos , Estudos Transversais , Inquéritos e Questionários , Internet/estatística & dados numéricos , Agitação Psicomotora/tratamento farmacológico , Sociedades Médicas/normas , Propofol , Fentanila , Acetaminofen , Dipirona , EspanhaRESUMO
OBJECTIVE: To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations. DESIGN: A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC. SETTING: Spanish ICUs in public and private hospitals. RESULTS: A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent. CONCLUSIONS: This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.
Assuntos
Analgesia , Sedação Profunda , Delírio/terapia , Idoso , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
No disponible
Assuntos
Humanos , Sedação Profunda , Respiração Artificial , Neoplasias , Encéfalo , CogniçãoRESUMO
Despite major advances in our understanding of the physiopathology of brain death (BD), there are important controversies as to which protocol is the most appropriate for organ donor management. Many recent reviews on this subject offer recommendations that are sometimes contradictory and in some cases are not applied to other critically ill patients. This article offers a review of the publications (many of them recent) with an impact upon these controversial measures and which can help to confirm, refute or open new areas of research into the most appropriate measures for the management of organ donors in BD, and which should contribute to discard certain established recommendations based on preconceived ideas, that lead to actions lacking a physiopathological basis. Aspects such as catecholamine storm management, use of vasoactive drugs, hemodynamic objectives and monitoring, assessment of the heart for donation, and general care of the donor in BD are reviewed (AU)
A pesar de los avances en la comprensión de la fisiopatología de la muerte encefálica, existen controversias importantes sobre el protocolo más adecuado para el tratamiento del donante de órganos. En muchas revisiones recientes aparecen recomendaciones, a veces contradictorias, y a veces no aplicadas a otros pacientes críticos. Este artículo revisa publicaciones, muchas de ellas recientes, que tienen un impacto en estas medidas controvertidas y que pueden ayudar a confirmar, refutar o abrir nuevas áreas de investigación sobre las medidas más apropiadas para el tratamiento del donante y que deberían hacer olvidar algunas recomendaciones habituales basadas en ideas preconcebidas, que conducen a acciones carentes de una base fisiopatológica. Se revisan aspectos como: el control de la tormenta catecolamínica, el uso de fármacos vasoactivos y de hormonas, los objetivos hemodinámicos y su monitorización, la evaluación del corazón para donación y otros aspectos generales del tratamiento del donante en muerte encefálica (AU)
Assuntos
Humanos , Doadores de Tecidos , Lesões Encefálicas Traumáticas/mortalidade , Respiração Artificial/métodos , Nutrição Enteral/métodos , Vasoconstritores/uso terapêutico , Morte Encefálica/diagnóstico , Hemodinâmica/fisiologia , Morte Encefálica/fisiopatologiaRESUMO
Despite major advances in our understanding of the physiopathology of brain death (BD), there are important controversies as to which protocol is the most appropriate for organ donor management. Many recent reviews on this subject offer recommendations that are sometimes contradictory and in some cases are not applied to other critically ill patients. This article offers a review of the publications (many of them recent) with an impact upon these controversial measures and which can help to confirm, refute or open new areas of research into the most appropriate measures for the management of organ donors in BD, and which should contribute to discard certain established recommendations based on preconceived ideas, that lead to actions lacking a physiopathological basis. Aspects such as catecholamine storm management, use of vasoactive drugs, hemodynamic objectives and monitoring, assessment of the heart for donation, and general care of the donor in BD are reviewed.
Assuntos
Morte Encefálica , Guias de Prática Clínica como Assunto , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Morte Encefálica/diagnóstico , Catecolaminas/metabolismo , Cuidados Críticos/normas , Nutrição Enteral , Hemodinâmica , Humanos , Assistência Terminal/normas , Hormônios Tireóideos/uso terapêutico , Coleta de Tecidos e Órgãos , Obtenção de Tecidos e Órgãos/normas , Vasoconstritores/uso terapêuticoRESUMO
Recientemente, la dexmedetomidina se ha comercializado en España y en otros países europeos. La experiencia publicada permite dar unas recomendaciones y situar este fármaco en las actuales tendencias de sedoanalgesia del paciente crítico adulto. La dexmedetomidina tiene efectos sedantes y analgésicos, sin causar depresión respiratoria, e induce un nivel de sedación donde el paciente puede abrir los ojos a la estimulación verbal, obedecer órdenes sencillas y cooperar en los cuidados de enfermería. Por tanto, es muy útil en enfermos ventilados que pueden ser mantenidos con estos niveles de sedación, evitando los efectos deletéreos de la sobresedación o la infrasedación. Por su acción sobre los α2-receptores, es eficaz en la prevención y en el control de los cuadros de tolerancia y/o abstinencia a otros sedantes y psicotrópicos. Comparada con otros sedantes, la dexmedetomidina se ha asociado con una menor incidencia de delirio. Además, puede ser útil en la sedación durante la ventilación no invasiva
Recently, dexmedetomidine has been marketed in Spain and other European countries. The published experience regarding its use has placed dexmedetomidine on current trends in sedo-analgesic strategies in the adult critically ill patient. Dexmedetomidine has sedative and analgesic properties, without respiratory depressant effects, inducing a degree of depth of sedation in which the patient can open its eyes to verbal stimulation, obey simple commands and cooperate in nursing care. It is therefore a very useful drug in patients who can be maintained on mechanical ventilation with these levels of sedation avoiding the deleterious effects of over or infrasedation. Because of its effects on α2-receptors, it's very useful for the control and prevention of tolerance and withdrawal to other sedatives and psychotropic drugs. The use of dexmedetomidine has been associated with lower incidence of delirium when compared with other sedatives. Moreover, it's a potentially useful drug for sedation of patients in non-invasive ventilation
Assuntos
Humanos , Dexmedetomidina/uso terapêutico , Sedação Profunda , Analgesia/métodos , Respiração Artificial/métodos , Agonistas alfa-Adrenérgicos/uso terapêutico , Cuidados Críticos/métodos , Estado TerminalRESUMO
Recently, dexmedetomidine has been marketed in Spain and other European countries. The published experience regarding its use has placed dexmedetomidine on current trends in sedo-analgesic strategies in the adult critically ill patient. Dexmedetomidine has sedative and analgesic properties, without respiratory depressant effects, inducing a degree of depth of sedation in which the patient can open its eyes to verbal stimulation, obey simple commands and cooperate in nursing care. It is therefore a very useful drug in patients who can be maintained on mechanical ventilation with these levels of sedation avoiding the deleterious effects of over or infrasedation. Because of its effects on α2-receptors, it's very useful for the control and prevention of tolerance and withdrawal to other sedatives and psychotropic drugs. The use of dexmedetomidine has been associated with lower incidence of delirium when compared with other sedatives. Moreover, it's a potentially useful drug for sedation of patients in non-invasive ventilation.
Assuntos
Analgesia , Analgésicos/uso terapêutico , Sedação Consciente , Estado Terminal , Sedação Profunda , Dexmedetomidina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , HumanosRESUMO
Adequate monitoring of analgesia and sedation should be one of the main goals in the Intensive Care Units. Once the analgesia is assured, the correct dosage of the sedatives will depend on the correct monitoring of the sedation level. For years, clinical scales have been used to evaluate the sedation level. These scales are appropriate for the evaluation of mild sedation but they cannot correctly evaluate deeply sedated patients or those patients who require continuous intravenous administration of neuromuscular blockade agents. In this chapter, we review the most used monitor to control the adequate level of sedation in the Intensive Care Units as well as the BIS(R) Monitor, which is the one recommended by the Analgesia and Sedation Work Group of the Spanish Society of Critical Care Medicine (SEMICYUC).