Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone. / Satisfacción en la Unidad de Cuidados Intensivos (UCI): la opinión del paciente como piedra angular.

OBJECTIVE: To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN: A prospective, 5-month observational and descriptive study was carried out. SETTING: ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS: Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. INTERVENTION: Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS: An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS: The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.

[Measuring the satisfaction of patients admitted to the intensive care unit and of their families]. / Medición de la satisfacción de los pacientes ingresados en unidad de cuidados intensivos y sus familiares.

OBJECTIVE: To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU. DESIGN: A prospective, observational and descriptive study with a duration of 5 months was carried out. SETTING: The ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS: Family members of adult patients admitted to the ICU and patients discharged to the ward. INSTRUMENT: Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients. RESULTS: A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46 ± 11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85). CONCLUSIONS: The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative.

[EICS (Extended Intensive Care Service): looking outside the ICU]. / SECI (Servicio Extendido de Cuidados Intensivos): mirando fuera de la UCI.

Early warning systems (EWS) identify patients at risk with a view to improving morbidity and mortality rates using early therapeutic and transfer actions. We have recently implemented an EWS that focuses on two main aspects: the guidance of care after discharge from the ICU, and recognition of the onset of deteriorating health among adult patients in general wards through physiologically based early warning scores.

[Varicella pneumonia in adults: 30 cases]. / Neumonía varicelosa en adultos: 30 casos.

OBJECTIVES: During the past 10 years, 30 adults (age > 15 years) were treated for varicella pneumonia in our centre. METHODS: There were 16 males and 14 females. Ages ranged from 15 to 58 years (mean, 32.73+/-7.67 years). Twenty-seven patients (90%) were non-pregnant adult smokers and three patients (10%) were pregnant women. The hospital stay ranged from 4 to 57 days (mean, 14.96+/-12.02 days). RESULTS: Seven patients (23.3%) were managed in the intensive care unit and two patients (6,6%) required mechanical ventilation. The most common radiographic findings were interstitial infiltrates in twenty-one patients (70%) and interstitial-alveolar infiltrates in seven patients (23.3%). Physical examination of the chest did not reveal abnormalities in twenty patients (66,6%). Fifteen patients (50%) were severely hipoxic with pO2/FiO2 ratio less than 300. Twelve patients (40%) presented thrombocytopenia and fifteen (50%) presented hyponatremia. The most frequent clinical features included: fever (100%), dry cough (86.6%), dysnea (66.6%) and chest pain (50%). One patient (3.3%) died. Three patients (10%) developed asthma and one other patient developed pulmonary fibrosis. CONCLUSIONS: Smoking is associated with an increase incidence of varicella pneumonia in adults. A chest x-ray should be practised in all cases of varicella in adults and they all should also be admitted to hospital. Intravenous aciclovir is recommended for treatment of varicella pneumonia in adults and in seriously ill patients the association of corticosteroids should be considered.