Predictive validity of a pressure injury risk assessment tool at different time-points in patients admitted to the intensive care unit.

BACKGROUND: Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs. AIMS: The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay. STUDY DESIGN: This was an observational prospective study undertaken over a period of 1 year (July 2021-June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories. RESULTS: Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872-0.942); 0.881 (0.842-0.920); 0.877 (0.835-0.920) and 0.749 (0.667-0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high-risk group (>13 points). CONCLUSIONS: The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness. RELEVANCE FOR CLINICAL PRACTICE: Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level.

Family burden after critical illness: the forgotten caregivers / La sobrecarga familiar tras una enfermedad crítica: los cuidadores olvidados

Objective To determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients admitted to ICU and to identify risk factors related to its development in both the patient and the family member. Design Prospective observational cohort study was conducted for 24 months. Setting Hospital Universitario Clínico San Cecilio, Granada. Patients The sample was the primary caregivers of all patients with risk factors for development of PICS (Post-Intensive Care Syndrome). Interventions The follow-up protocol consisted of evaluation 3 months after discharge from the ICU in a specific consultation. Main variables of interest The scales used in patients were Barthel, SF-12, HADS, Pfeiffer, IES-6 and in relatives the Apgar and Zarit. Results A total of 93 patients and caregivers were included in the follow-up. 15 relatives did not complete the follow-up questionnaires and were excluded from the study. The incidence of PICS-F (Family Post Intensive Care Syndrome) defined by the presence of primary caregiver burden in our cohort of patients is 34.6% (n=27), 95% CI 25.0−45.7. The risk factors for the development of caregiver burden are the presence of physical impairment, anxiety or post-traumatic stress in the patient, with no relationship found with the characteristics studied in the family member. Conclusions One out of 3 relatives of patients with risk factors for the development of PICS presents at 3 months caregiver burden. This is related to factors dependent on the patient's state of health. (AU)

Objetivo Determinar la incidencia de la sobrecarga del cuidador principal en una cohorte de familiares de pacientes críticos ingresados en UCI e identificar los factores de riesgo relacionados con su desarrollo tanto en el paciente como en el familiar. Diseño Estudio de cohortes observacional prospectivo durante 24 meses. Ámbito Hospital Universitario Clínico San Cecilio de Granada. Pacientes La muestra estuvo compuesta por los cuidadores principales de todos los pacientes con factores de riesgo para el desarrollo de SPCI (Síndrome Post-Cuidados Intensivos). Intervenciones El protocolo de seguimiento consistió en la evaluación a los 3 meses del alta de la UCI en una consulta específica. Variables de interés principales Las escalas utilizadas fueron Barthel, SF-12, HADS, Pfeiffer, IES-6, Apgar y Zarit. Resultados Un total de 93 pacientes y cuidadores fueron incluidos en el seguimiento. 15 cuidadores no completaron los cuestionarios de seguimiento y fueron excluidos del estudio. La incidencia de PICS-F (Síndrome Post-Cuidados Intensivos Familiar) definido por la presencia de sobrecarga del cuidador en nuestra cohorte es del 34,6% (n=27), IC 95% 25,0–45,7. Los factores de riesgo para el desarrollo del mismo son la presencia de deterioro físico, ansiedad o estrés postraumático en el paciente, no encontrándose relación con las características estudiadas en el familiar. Conclusiones Uno de cada 3 familiares de pacientes con factores de riesgo para el desarrollo de SPCI presenta a los 3 meses sobrecarga del cuidador, relacionándose con factores dependientes del estado de salud del paciente. (AU)

Incidence of hypophosphataemia after ICU admission in mechanically ventilated patients and its relationship with risk factors for refeeding syndrome.

OBJECTIVE: To describe the incidence of hypophosphatemia in patients admitted to the ICU who have required mechanical ventilation. To analyze the presence of risk factors and its relationship with nutritional practice. DESIGN: Prospective observational study. SETTING: Polyvalent ICUs of 2 University Hospitals. PATIENTS OR PARTICIPANTS: Patients on invasive mechanical ventilation ≥72 h with normal level of phosphorus at admission. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Electrolyte levels (phosphorus, magnesium, potassium) were determined on admission to the ICU and at 96 h. Risk categories on admission, caloric intake, insulin doses and acid-base status during the first 4 days of admission were recorded. Incidence was calculated as the number of patients who developed hypophosphataemia after admission. Univariate analysis was performed for between-group comparison and multivariate analysis of potential risk factors. RESULTS: 89 patients were included. The incidence of hypophosphataemia was 32.6%. In these patients phosphorus decreased from 3.57 ±â€¯1.02 mmol/l to 1.87 ±â€¯0.65 mmol/l (52.3%). The mean kcal/kg/24 h provided in the first 4 days was 17.4 ±â€¯4.1, with no difference between the group that developed hypophosphataemia and the group that did not. Significant risk factors were insulin doses administered and pH and PaCO2 values. CONCLUSIONS: The incidence of hypophosphataemia at 96 h from admission in mechanically ventilated patients is high and unrelated to the risk category and hypocaloric nutritional practice used. Insulin dosis and acid-base status are the main determinants of its occurrence.

Assessment of pressure injury risk in intensive care using the COMHON index: An interrater reliability study.

OBJECTIVES: To assess the interrater reliability of the COMHON (level of COnciousness, Mobility, Haemodynamics, Oxygenation, Nutrition) Index pressure injury risk assessment tool. DESIGN: Interrater reliability was tested. Twenty-five intensive care patients were each assessed by five different nurse-raters from a pool of intensive care nurses who were available on the days of assessment. In total, 25 nurses participated. SETTING: Two general and one cardiovascular surgery intensive care units in Istanbul, Turkey. MAIN OUTCOME MEASURES: Interrater reliability was analysed using intraclass correlations, and standard errors of measurement (SEM) were calculated for sum scores, risk level and item scores. Minimally detectable change (MDC) was also calculated for sum score. Consistency between paired raters was analysed using Pearson's Product Moment Correlation (r) for sum score and Spearman's rho (rs) for ordinal variables. RESULTS: All assessments were completed in ≤5 min. Interrater reliability was very high [ICC (1,1) = 0.998 (95 % CI 0.996 - 0.999)] with a SEM of 0.14 and MDC of 0.39. Consistency between paired raters was strong for sum and item scores and risk levels (coefficients >0.6). All scale items showed correlations of >.3 with the sum score. CONCLUSION: The results demonstrate near-perfect interrater reliability. Further research into the psychometric properties of the COMHON Index and its impact on preventative intervention use is warranted. IMPLICATIONS FOR CLINICAL PRACTICE: Pressure injury risk assessment within intensive care should be setting-specific due to the unique risk factors inherent to the patient population, which are not considered by general pressure injury risk assessment tools. An intensive care-specific pressure injury risk assessment tool was tested and demonstrated high reliability between intensive care nurses. Further research is needed to understand how its use in practice affects preventative intervention implementation and, in turn, how it impacts pressure injury outcomes.

Family burden after critical illness: the forgotten caregivers.

OBJECTIVE: To determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients admitted to ICU and to identify risk factors related to its development in both the patient and the family member. DESIGN: Prospective observational cohort study was conducted for 24 months. SETTING: Hospital Universitario Clínico San Cecilio, Granada. PATIENTS: The sample was the primary caregivers of all patients with risk factors for development of PICS (Post-Intensive Care Syndrome). INTERVENTIONS: The follow-up protocol consisted of evaluation 3 months after discharge from the ICU in a specific consultation. MAIN VARIABLES OF INTEREST: The scales used in patients were Barthel, SF-12, HADS, Pfeiffer, IES-6 and in relatives the Apgar and Zarit. RESULTS: A total of 93 patients and caregivers were included in the follow-up. 15 relatives did not complete the follow-up questionnaires and were excluded from the study. The incidence of PICS-F (Family Post Intensive Care Syndrome) defined by the presence of primary caregiver burden in our cohort of patients is 34.6% (n=27), 95% CI 25.0-45.7. The risk factors for the development of caregiver burden are the presence of physical impairment, anxiety or post-traumatic stress in the patient, with no relationship found with the characteristics studied in the family member. CONCLUSIONS: One out of 3 relatives of patients with risk factors for the development of PICS presents at 3 months caregiver burden. This is related to factors dependent on the patient's state of health.

Gut Microbiota Composition Can Predict Colonization by Multidrug-Resistant Bacteria in SARS-CoV-2 Patients in Intensive Care Unit: A Pilot Study.

The SARS-CoV-2 infection has increased the number of patients entering Intensive Care Unit (ICU) facilities and antibiotic treatments. Concurrently, the multi-drug resistant bacteria (MDRB) colonization index has risen. Considering that most of these bacteria are derived from gut microbiota, the study of its composition is essential. Additionally, SARS-CoV-2 infection may promote gut dysbiosis, suggesting an effect on microbiota composition. This pilot study aims to determine bacteria biomarkers to predict MDRB colonization risk in SARS-CoV-2 patients in ICUs. Seventeen adult patients with an ICU stay >48 h and who tested positive for SARS-CoV-2 infection were enrolled in this study. Patients were assigned to two groups according to routine MDRB colonization surveillance: non-colonized and colonized. Stool samples were collected when entering ICUs, and microbiota composition was determined through Next Generation Sequencing techniques. Gut microbiota from colonized patients presented significantly lower bacterial diversity compared with non-colonized patients (p < 0.05). Microbiota in colonized subjects showed higher abundance of Anaerococcus, Dialister and Peptoniphilus, while higher levels of Enterococcus, Ochrobactrum and Staphylococcus were found in non-colonized ones. Moreover, LEfSe analysis suggests an initial detection of Dialister propionicifaciens as a biomarker of MDRB colonization risk. This pilot study shows that gut microbiota profile can become a predictor biomarker for MDRB colonization in SARS-CoV-2 patients.

Accuracy of Modified Blue-Dye Testing in Predicting Dysphagia in Tracheotomized Critically Ill Patients.

(1) Background: Diagnosis of dysphagia in critically ill patients with a tracheostomy is important to avoid aspiration pneumonia. The objective of this study was to analyze the validity of the modified blue-dye test (MBDT) on the diagnosis of dysphagia in these patients; (2) Methods: Comparative diagnostic test accuracy study. Tracheostomized patients admitted to the Intensive Care Unit (ICU) were studied with two tests for dysphagia diagnosis: MBDT and fiberoptic endoscopic evaluation of swallowing (FEES) as the reference standard. Comparing the results of both methods, all diagnostic measures were calculated, including the area under the receiver-operating-characteristic curve (AUC); (3) Results: 41 patients, 30 males and 11 females, mean age 61 ± 13.9 years. The prevalence of dysphagia was 70.7% (29 patients) using FEES as the reference test. Using MBDT, 24 patients were diagnosed with dysphagia (80.7%). The sensitivity and specificity of the MBDT were 0.79 (CI95%: 0.60-0.92) and 0.91 (CI95%: 0.61-0.99), respectively. Positive and negative predictive values were 0.95 (CI95%: 0.77-0.99) and 0.64 (CI95%: 0.46-0.79). AUC was 0.85 (CI95%: 0.72-0.98); (4) Conclusions: MBDT should be considered for the diagnosis of dysphagia in critically ill tracheostomized patients. Caution should be taken when using it as a screening test, but its use could avoid the need for an invasive procedure.

Lifestyle Behaviours Profile of Spanish Adolescents Who Actively Commute to School.

The aim of this study was to study different 'healthy profiles' through the impact of multiple lifestyle behaviours (sleep patterns, screen time and quality diet) on active commuting to school (ACS) in adolescents. Sixteen secondary schools from four Spanish cities were randomly selected. All participants filled in an "Ad-Hoc" questionnaire to measure their mode of commuting and distance from home to school and their lifestyle behaviours. A multivariate logistic regression model was performed to analyse the main predictor variables of ACS. The final sample was 301 adolescents (50.2% girls; mean age ± SD: 14.9 ± 0.48 years). The percentage of ACS was 64.5%. Multiple logistic regressions showed: boys were more active commuters than girls [OR = 2.28 (CI 95%: 1.12−4.64); p = 0.02]; adolescents who lived farther had lower probability to ACS [OR = 0.74 (CI 95%: 0.69−0.80); p < 0.001]; adolescents who met sleep duration recommendations were more likely to ACS [OR = 3.05 (CI 95%: 1.07−8.69); p = 0.04], while with each hour of sleep, the odds of ACS was reduced [OR = 0.51 (CI 95%: 0.30−0.89); p = 0.02]; higher odds were shown to ACS in adolescents who have more adherence to MD [OR = 1.16(CI 95%: 1.00−1.33); p = 0.05]; and habitual breakfast consumption was inversely associated with ACS [OR = 0.41 (CI: 95%: 0.18−0.96); p = 0.04]. ACS was associated with being a boy, living at a shorter distance to school, a daily sleep time ≥ 8 h and presented a higher adherence to MD.

Compliance with preventive measures recommended by an international study group for pressure injuries in adult critically ill patients.

The objective of this cross-sectional descriptive study is to analyse the degree of compliance with the preventive measures for pressure injuries reported by an International Study Group in a cohort of adult critically ill patients. The level of risk of developing pressure injuries was determined using the Conscious level, Mobility, Hemodynamics, Oxygenation and Nutrition (COMHON) index. According to the level of risk, the preventive measures applied to each patient and scores on the different components of the index were recorded. Number, location and degree of pressure injuries were registered. Seventy-three patients (male: 68%) with an acute physiology and chronic health evaluation (APACHE) II: 12,1 ± 6,2 and 56,1% of them with invasive mechanical ventilation. The prevalence of pressure injuries was 21,9%, with 43,7% of sacral location and 75% of grade II. The level of risk using the COMHON index was distributed between low 30,1%, intermediate 23,3% and high 46,6%. The compliance range from 0% (offloading heel devices) to the use of active mattress and incontinence pads (100%). Regarding repositioning the degree of compliance varies (from 20% to 80%) according if patients with contraindications (4 points in subscale of Mobility) or those with the capacity to mobilise themselves (2 points in subscale of Mobility) are included in the denominator. We have found that in our ICU there is a wide range of compliance with the use of the preventive measures recommended by the International Study Group. Some of them are related not by the general score of the COMHON scale, but to that obtained in its subscale components.

Higher independent mobility to school among adolescents: A secondary analysis using cross-sectional data between 2010 and 2017 in Spanish youth.

AIM: To describe and to analyse the associations between independent mobility to school (IM) with gender and age in Spanish youth aged 6-18 years old from 2010 to 2017. Moreover, to study the changes in the rates of IM from 2010 to 2017 by gender and age. METHODS: Cross-sectional data were obtained from 11 Spanish studies. The study sample comprised 3460 children and 1523 adolescents. Logistic regressions models (IM with gender and age) and multilevel logistic regressions (IM with time period) were used. RESULTS: Boys had higher odds ratio (OR) of IM than girls in children (OR = 1.86; CI: 1.50-2.28, p < 0.01). Adolescents showed higher IM than children: 12-14 years old (OR: 6.30; CI: 1.65-23.97) and 14-16 years old (OR: 7.33; CI: 1.18-45.39) had higher IM than 6-8 years old for boys (all, p < 0.05). Moreover, 12-14 years old (OR: 4.23; CI: 1.01-17.81) had higher IM than 6-8 years old for girls (p < 0.001). IM was not associated with the time period. CONCLUSION: The IM is higher in boys and in adolescents, highlighting the relevance to promote IM strategies targeting girls and children. In these strategies is essential the support of researchers, public health practitioners and families to achieve positive results.

Active Commuting to School among Spanish Preschool Children: A Temporal Change Study between 2013 and 2017.

BACKGROUND: Active commuting to school may increase the total daily physical activity and achieve health benefits among preschool children. Rates of active commuting to school among Spanish children and adolescents have been widely analysed, while the rates of active commuting to school among Spanish preschool children are unknown. AIM: The main objective of this study was to examine the changes in the rates of active commuting to school in a sample of Spanish preschool children between 3 and 6 years old from 2013 to 2017. METHODS: Data were found from five studies carried out across Spain. The study sample comprised 4787 preschool children (4.59 ± 0.77 years old; 51% males). The overall changes in active commuting to school were assessed using multilevel logistic regression analysis. RESULTS: The rates of active commuting to school in Spanish preschool children are around 52%, and the active commuting to school rates have stayed stable throughout the period assessed (odds ratio from 0.40 to 0.58, all p > 0.05). CONCLUSION: In preschool children, the present study obtained a favourable result on active commuting to school, showing a pattern stability in the examined period similar to other ages. It will be of great importance to promote this behaviour to obtain high levels of active commuting to school.

Testing the Mystic School Mobile Application to Promote Active Commuting to School in Spanish Adolescents: The PACO Study.

Active commuting to and/or from school (ACS) is an opportunity to increase daily physical activity (PA) levels in young people. Mobile-device interventions focused on promoting the practice of health-related PA can be more cost-effective than traditional interventions in this population. OBJECTIVE: To analyze the adolescents' opinion of the mobile application (app) Mystic School, which was designed to promote ACS in Spanish adolescents. METHODS: A total of 44 students (14-15 years old) from Granada and Jaén participated in the test of the Mystic School app during two phases: phase 1 (n = 10) for 2 weeks and phase 2 (n = 34) for 1 month. Each phase included an app presentation, a follow-up, and focus group sessions. The qualitative analysis was carried out through NVivo software. RESULTS: In phase 1, adolescents reported improvements in the design and functioning, such as the avatar movement, virtual steps utilities, and multiplayer function. These suggestions were included in phase 2. After phase 2, adolescents reported that it is important to add the possibility of playing without an Internet connection to the game, to include more competitive options, prizes, and to increase the difficulty of the levels. In both phases, problems with the step number counting remained. CONCLUSION: The Mystic School app can be a useful tool for the physical education teacher to integrate the content from this curriculum related to the promotion of PA, such as ACS.

Incidence and risk factors for postintensive care syndrome in a cohort of critically ill patients. / Incidência e fatores de risco associados à síndrome pós-cuidados intensivos em uma coorte de pacientes em estado crítico.

OBJECTIVE: To determine the incidence of postintensive care syndrome in a cohort of critically ill patients admitted to the intensive care unit and to identify risk factors related to its development in the physical, cognitive and mental health areas. METHODS: This was a prospective observational cohort study developed in the intensive care unit of a university hospital. Patients with intensive care unit stays equal to or longer than one week and the need for mechanical ventilation for more than 3 days, shock or delirium were included in the study. Demographic variables, reasons for admission, diagnoses, sedation, type of mechanical ventilation used, complications and length of stay were recorded. A univariate analysis was performed to identify risk factors related to postintensive care syndrome. The scales used for the assessment of the different spheres were Barthel, Pfeiffer, Hospital Anxiety and Depression Scale and Impact of Event Scale-6. The main variables of interest were postintensive care syndrome incidence overall and by domains. Risk factors were examined in each of the health domains (physical, cognitive and mental health). RESULTS: Eighty-seven patients were included. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. The mean number of intensive care unit days was 17. The incidence of global postintensive care syndrome was 56.3% (n = 49, 95%CI 45.8 - 66.2%). The incidence of postintensive care syndrome in each of the spheres was 32.1% (physical), 11.5% (cognitive), and 36.6% (mental health). CONCLUSIONS: The incidence of postintensive care syndrome is 56.3%. The mental health sphere is the most frequently involved. The risk factors are different depending on the area considered.

OBJETIVO: Determinar a incidência da síndrome pós-cuidados intensivos em uma coorte de pacientes em estado crítico admitidos à unidade de terapia intensiva e identificar fatores de risco relacionados ao seu desenvolvimento nas áreas de saúde física, cognitiva e mental. MÉTODOS: Este foi um estudo de coorte observacional prospectivo desenvolvido na unidade de terapia intensiva de um hospital universitário. Foram incluídos no estudo pacientes internados em unidade de terapia intensiva a partir de 1 semana e com necessidade de ventilação mecânica por mais de 3 dias, choque ou delirium. Foram registradas variáveis demográficas, motivo da admissão, diagnósticos, sedação, tipo de ventilação mecânica, complicações e tempo de internação. Realizou-se análise univariada para identificar os fatores de risco relacionados à síndrome pós-cuidados intensivos. As escalas utilizadas para a avaliação das diferentes esferas foram Barthel, Pfeiffer, Hospital Anxiety and Depression Scale e Impact of Event Scale-6. As principais variáveis de interesse foram incidência da síndrome pós-cuidados intensivos de modo geral e por domínios. Os fatores de risco foram examinados em cada um dos domínios da saúde (saúde física, cognitiva e mental). RESULTADOS: Participaram 87 pacientes. A Acute Physiology and Chronic Health Evaluation II média foi de 16,5. O número médio de dias na unidade de terapia intensiva foi 17. A incidência geral da síndrome pós-cuidados intensivos foi de 56,3% (n = 49; IC95% 45,8 - 66,2). A incidência da síndrome pós-cuidados intensivos em cada uma das esferas foi de 32,1% (física), 11,5% (cognitiva) e 36,6% (saúde mental). CONCLUSÃO: A incidência da síndrome pós-cuidados intensivos foi de 56,3%. A esfera da saúde mental foi a mais frequentemente envolvida. Os fatores de risco diferem, dependendo da área considerada.

The Effect of a School-Based Intervention on Children's Cycling Knowledge, Mode of Commuting and Perceived Barriers: A Randomized Controlled Trial.

The low rates of active commuting to/from school in Spain, especially by bike, and the wide range of cycling interventions in the literature show that this is a necessary research subject. The aims of this study were: (1) to assess the feasibility of a school-based cycling intervention program for adolescents, (2) to analyse the effectiveness of a school-based cycling intervention program on the rates of cycling and other forms of active commuting to/from school (ACS), and perceived barriers to active commuting in adolescents. A total of 122 adolescents from Granada, Jaén and Valencia (Spain) participated in the study. The cycling intervention group participated in a school-based intervention program to promote cycling to school during Physical Education (PE) sessions in order to analyse the changes in the dependent variables at baseline and follow up of the intervention. Wilcoxon, Signs and McNemar tests were undertaken. The association of the intervention program with commuting behaviour, and perceived barriers to commuting, were analysed by binary logistic regression. There were improvements in knowledge at follow-up and the cycling skill scores were medium-low. The rates of cycling to school and active commuting to/from school did not change, and only the "built environment (walk)" barrier increased in the cycling group at follow-up. School-based interventions may be feasibly effective tools to increase ACS behaviour, but it is necessary to implement a longer period and continue testing further school-based cycling interventions.