Diferencias en el pronóstico de los pacientes médicos y quirúrgicos que requirieron ventilación mecánica en una Unidad de Cuidados Intensivos / No disponible

No disponible

Rabdomiólisis tras la corrección de hiponatremia severa en una crisis de porfiria aguda intermitente / No disponible

No disponible

Pronóstico de los pacientes muy mayores ingresados en una Unidad de Cuidados Intensivos / No disponible

No disponible

[Needs of the family of intensive care patients: perception of the family and the professional]. / Necesidades de los familiares de pacientes de Cuidados Intensivos: percepción de los familiares y del profesional.

OBJECTIVE: Compare the degree of family satisfaction of patients admitted to our intensive care unit (ICU) with the perception of the professional on the care setting and information received. DESIGN: Prospective, descriptive study during 3 months. SETTING: ICU of the University Hospital Insular of the Canary Islands. SUBJECTS: Family of adult patients admitted to the ICU who were discharged to the ward and the professionals who treated them. INTERVENTION: Personal survey to direct family members of the patients when they are in the ward. The same survey, but modified for the professional, was used on the perception that they believed the family had. VARIABLES OF PRINCIPAL INTEREST: Demographic data of the patient, family, and professional interviewed were collected and they were asked questions on the environmental conditions, relationship and quality of the information by the staff and the organization of the visits. RESULTS: A total of 52 family members and 69 staff members were interviewed. The professional overestimated the needs of the family members in regards to noise, lighting, comfort, privacy, adequacy of the waiting room and information on the care received. The professional, on contrary to the family, thought that they were adequately informed about the apparatuses used and that they knew the name of the nurse. Both groups coincided that they knew the name of the doctors, that they were informed of the situation on admission, that the visiting hours were adequate, that more than 2 family members could go into the box and that they were more comfortable if they could be sitting down. CONCLUSIONS: Satisfaction of the family was greater than that of the professional interviewed. We stress the need to improve the waiting room, personalized care and the need to individually evaluate flexibility in the visiting hours.

Necesidades de los familiares de pacientes de Cuidados Intensivos: percepción de los familiares y del profesional / Needs of the family of intensive care patients: perception of the family and the professional

Objetivo. Comparar el grado de satisfacción de familiares de pacientes ingresados en nuestra Unidad de Cuidados Intensivos (UCI) con la percepción del profesional sobre el entorno asistencial y la información recibida. Diseño. Estudio prospectivo, descriptivo durante tres meses. Ámbito. UCI del Hospital Universitario Insular de Gran Canaria. Sujetos. Familiares de pacientes adultos ingresados en UCI que fueron dados de alta a planta y profesionales que los trataron. Intervención. Encuesta personal a familiares directos de los pacientes cuando se encontraban en planta; se utilizó la misma, modificada para el profesional, sobre la percepción que creían que tenía el familiar. Variables de interés principales. Se recogieron datos demográficos del paciente, familiar y profesional entrevistado y se les preguntó sobre las condiciones medioambientales, la relación y la calidad de la información prestada por el personal y la organización de las visitas. Resultados. Se entrevistaron 52 familiares y 69 miembros de la plantilla. El profesional sobreestima las necesidades de los familiares en aspectos como el ruido, iluminación, comodidad, intimidad, la adecuación de la sala de espera y la información sobre los cuidados recibidos. El profesional, a diferencia del familiar, pensaba que informaba adecuadamente sobre el aparataje utilizado y que conocía el nombre del personal de enfermería. Ambos grupos coincidían en que conocían el nombre de los médicos, eran informados de la situación al ingreso, el horario de visitas era adecuado, que pudieran pasar dos o más familiares al box y que estarían más cómodos si pudieran sentarse. Conclusiones. La satisfacción del familiar era mayor que la del profesional entrevistado. Detectamos la necesidad de mejorar la sala de espera, personalizar la atención y valorar individualmente la flexibilidad en el horario de visitas

Objective. Compare the degree of family satisfaction of patients admitted to our intensive care unit (ICU) with the perception of the professional on the care setting and information received. Design. Prospective, descriptive study during 3 months. Setting. ICU of the University Hospital Insular of the Canary Islands. Subjects. Family of adult patients admitted to the ICU who were discharged to the ward and the professionals who treated them. Intervention. Personal survey to direct family members of the patients when they are in the ward. The same survey, but modified for the professional, was used on the perception that they believed the family had. Variables of principal interest. Demographic data of the patient, family, and professional interviewed were collected and they were asked questions on the environmental conditions, relationship and quality of the information by the staff and the organization of the visits. Results. A total of 52 family members and 69 staff members were interviewed. The professional overestimated the needs of the family members in regards to noise, lighting, comfort, privacy, adequacy of the waiting room and information on the cares received. The professional, on the contrary to the family, thought that they adequately informed about the apparatuses used and that they knew the name of the nurse. Both groups coincided that they knew the name of the doctors, that they were informed of the situation on admission, that the visiting hours were adequate, that more than 2 family members could go into the box and that they were more comfortable if they could be sitting down. Conclusions. Satisfaction of the family was greater than that of the professional interviewed. We stress the need to improve the waiting room, personalized care and the need to individually evaluate flexibility in the visiting hours

Valoración de las necesidades de los pacientes ingresados en una Unidad de Cuidados Intensivos / Assessment of the needs of patients admitted to an Intensive Care Unit

No disponible

[Satisfaction survey administered to the relatives of critical patients]. / Encuesta de satisfacción a los familiares de pacientes críticos.

OBJECTIVE: To know the family needs of patients admitted to our Intensive Care Unit (ICU). DESIGN: Prospective, descriptive study performed over a 6-month period. SETTING: ICU of the Insular University Hospital in Gran Canary Islands. PARTICIPANTS: Adult patients admitted to the ICU for more than 48 hours who were discharged to the hospitalization ward. INTERVENTION: A modified Society of Critical Care Medicine Family Needs Assessment instrument was administered to the first-degree relatives of patients after discharge by face-to-face interviews by not-informing personnel. MAIN VARIABLES: Data were gathered on demographic information on the patients and their interviewed relatives, reason for admission, and evaluation on information, care, empathy with the personnel and comfort. RESULTS: Family members of 99 patients were interviewed. A total of 80% of those interviewed considered the information had been in terms that they could understand, that they understood what was happening to the patient and why things were being done. However, 74% answered that the personnel had never explained the equipment being used. About 90% thought that they had received sincere information and that adequate care was being given. Considering empathy with the personnel, almost all considered they were nice but that 73% of them had never been asked if they needed anything. A total of 85% of them were sure that someone would phone them if there was any significant change in their relative's condition, and they felt comfortable during the time of visit; 74% did not feel alone or isolation. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their relatives in the intensive care unit, but the need to improve some aspects of the communication with families was identified.

Encuesta de satisfacción a los familiares de pacientes críticos / Satisfaction survey administered to the relatives of critical patients

Objetivo. Conocer la satisfacción de los familiares de pacientes ingresados en nuestra Unidad de Cuidados Intensivos (UCI). Diseño. Estudio prospectivo descriptivo durante un período de 6 meses. Ámbito. UCI polivalente del Hospital Universitario Insular de Gran Canaria. Sujetos. Familiares de pacientes adultos ingresados en la UCI durante más de 48 horas y que fueron dados de alta a planta de hospitalización. Intervención. Se realizó una encuesta personal a los familiares directos de los pacientes, en el momento del alta de la unidad, llevada a cabo por personal médico no informador. Variables de interés principales. Se recogieron datos demográficos de los pacientes y de los familiares entrevistados, diagnóstico de ingreso, y la valoración acerca de la información, cuidados, empatía con el personal y la comodidad. Resultados. Se entrevistó a familiares de 99 pacientes. El 80% recibieron la información con terminología comprensible, entendían lo que le ocurría a su familiar y los medios que se estaban poniendo para su curación, a pesar de que al 74% nunca se les había explicado la tecnología utilizada. El 90% creían recibir una información sincera y que los cuidados eran los adecuados. A nivel de empatía con el personal médico, para casi todos eran amables; sin embargo, al 73% ninguno le preguntó si necesitaba algo. El 85% estaban seguros de que alguien les llamaría a casa si ocurría algún cambio en el estado de su familiar y se sentían cómodos durante el tiempo de visita; el 74% no tuvo sentimiento de soledad ni aislamiento. Conclusiones. La mayoría de los familiares estaban muy satisfechos con los cuidados recibidos por ellos y por sus familiares enfermos en la UCI, aunque detectamos la necesidad de mejorar en determinados aspectos de la comunicación con los familiares

Objective. To know the family needs of patients admitted to our Intensive Care Unit (ICU). Design. Prospective, descriptive study performed over a 6-month period. Setting. ICU of the Insular University Hospital in Gran Canary Islands. Participants. Adult patients admitted to the ICU for more than 48 hours who were discharged to the hospitalization ward. Intervention. A modified Society of Critical Care Medicine Family Needs Assessment instrument was administered to the first-degree relatives of patients after discharge by face-to-face interviews by not-informing personnel. Main variables. Data were gathered on demographic information on the patients and their interviewed relatives, reason for admission, and evaluation on information, care, empathy with the personnel and comfort. Results. Family members of 99 patients were interviewed. A total of 80% of those interviewed considered the information had been in terms that they could understand, that they understood what was happening to the patient and why things were being done. However, 74% answered that the personnel had never explained the equipment being used. About 90% thought that they had received sincere information and that adequate care was being given. Considering empathy with the personnel, almost all considered they were nice but that 73% of them had never been asked if they needed anything. A total of 85% of them were sure that someone would phone them if there was any significant change in their relative's condition, and they felt comfortable during the time of visit; 74% did not feel alone or isolation. Conclusions. Most family members were highly satisfied with the care provided to them and their relatives in the intensive care unit, but the need to improve some aspects of the communication with families was identified

[Quality of artificial nutritional support in an intensive care unit]. / Calidad del soporte nutricional artificial en una unidad de cuidados intensivos.

OBJECTIVES: To assess what are the reasons for discrepancies between the amount of nutrients delivered, prescribed and theoretical requirements, in an intensive care unit. DESIGN: Prospective cohort study over a 5 months period. SETTING: Intensive Care Unit of the Insular University Hospital in Gran Canaria. PATIENTS: Adult patients who were prescribed enteral and or parenteral nutrition for > or = 2 days and we followed them for the first 14 days of nutrition delivery. INTERVENTION: The prescribed and the delivered calories were calculated every day, whereas the theoretical requeriments were calculated after the ICU stay, by using the Harris-Benedict formula adjusted with a stress factor. Also the reason for cessation of enteral tube feeding > 1 hour in the days of artificial nutrition were analyzed. RESULTS: Fifty-nine consecutive patients, receiving nutritional support either enterally or intravenously, and 465 nutrition days analyzed. Nutrition was initiated within 48 hours after ICU admission. Enteral nutrition was the preferential route used. Seventy-nine percent of the mean caloric amount required was prescribed, and 66% was effectively delivered; also 88% of the amount prescribed was delivered. The low ratio of delivered-prescribed calories concerned principally enteral nutrition and was caused by gastrointestinal intolerance. We observe a wide variation in practice patterns among physicians to start, increase, reduce or stop enteral nutrition when symptoms of intolerance appear. CONCLUSIONS: In our ICU exists an important difference between the caloric theoretical requests and the quantity really delivered; this deficit is more clear in the enteral nutrition. The knowledge of this situation allows to take measures directed to optimizing the nutritional support of our patients. Possibly the motivation in the medical and nursery personnel in carrying out nutritional protocols it might be the most effective measurement, which it would be necessary to confirm in later studies.

Calidad del soporte nutricional artificial en una unidad de cuidados intensivos / Quality of artificial nutritional support in an intensive care unit

Objetivo: Evaluar cuáles son los factores que influyeron en las diferencias entre la cantidad de nutrientes administrados, pautados y teóricamente requeridos en una unidad de cuidados intensivos. Diseño: Estudio prospectivo de cohortes durante un período de 5 meses. Ámbito: UCI polivalente del Hospital Universitario Insular de Gran Canaria. Pacientes: Pacientes adultos a quienes se les prescribía nutrición enteral y/o parenteral durante ≥ 2 días, siguiéndolos durante los primeros 14 días. Intervención: Se calcularon diariamente las calorías pautadas y las administradas, mientras que los requerimientos calóricos teóricos se calcularon tras el alta de la Unidad, según la ecuación de Harris-Benedict a la que se le aplicaba un factor de estrés. Asimismo se recogieron las causas por las que se interrumpió la dieta durante más de 1 hora en los días de nutrición artificial analizados. Resultados: Se incluyeron 59 pacientes consecutivos que recibían soporte nutricional enteral (NET) y/o parenteral (NPT), lo que suponía un total de 465 días de nutrición. La nutrición artificial se inició en las primeras 48 horas del ingreso. La Nutrición Enteral fue la vía de administración más utilizada. De las calorías teóricamente requeridas se pautaron el 79% y se administraron el 66%; asimismo se administraron el 88% de las pautadas. El bajo ratio de calorías administradas-pautadas afectaban principalmente y de manera significativa a la Nutrición Enteral, debido principalmente a intolerancia gastrointestinal. Observamos una variablidad importante entre los miembros del staff en cuanto a tomar la decisión de comenzar, suspender, reiniciar o reducir la NET cuando aparecen síntomas de intolerancia. Conclusiones: En nuestra Unidad existe una diferencia importante entre los requerimientos calóricos teóricos y la cantidad efectivamente administrada; este déficit es más manifiesto en la nutrición enteral. El conocimiento de esta situación permite tomar medidas encaminadas a optimizar el soporte nutricional de nuestros pacientes. Posiblemente la motivación en el personal médico y de enfermería en llevar a cabo protocolos de nutrición que se establezcan podría ser la medida más efectiva, lo que habría que confirmar en estudios posteriores (AU)

Objectives: To assess what are the reasons for discrepancies between the amount of nutrients delivered, prescribed and theoretical requirements, in an intensive care unit. Design: Prospective cohort study over a 5 months period. Setting: Intensive Care Unit of the Insular University Hospital in Gran Canaria. Patients: Adult patients who were prescribed enteral and or parenteral nutrition for ≥ 2 days and we followed them for the first 14 days of nutrition delivery. Intervention: The prescribed and the delivered calories were calculated every day, whereas the theoretical requeriments were calculated after the ICU stay, by using the Harris-Benedict formula adjusted with a stress factor. Also the reason for cessation of enteral tube feeding> 1 hour in the days of artificial nutrition were analyzed. Results: Fifty-nine consecutive patients, receiving nutritional support either enterally or intravenously, and 465 nutrition days analyzed. Nutrition was initiated within 48 hours after ICU admission. Enteral nutrition was the preferential route used. Seventy-nine percent of the mean caloric amount required was prescribed, and 66% was effectively delivered; also 88% of the amount prescribed was delivered. The low ratio of delivered-prescribed calories concerned principally enteral nutrition and was caused by gastrointestinal intolerance. We observe a wide variation in practice patterns among physicians to start, increase, reduce or stop enteral nutrition when symptoms of intolerance appear. Conclusions: In our ICU exists an important difference between the caloric theoretical requests and the quantity really delivered; this deficit is more clear in the enteral nutrition. The knowledge of this situation allows to take measures directed to optimizing the nutritional support of our patients. Possibly the motivation in the medical and nursery personnel in carrying out nutritional protocols it might be the most effective measurement, which it would be necessary to confirm in later studies (AU)

[Acute coronary syndrome without ST elevation during pregnancy. A case report]. / Síndrome coronario agudo sin elevación del ST durante el embarazo. A propósito de un caso.

Ischemic heart disease in the young woman is rare, and even more so in the pregnant woman, but it is reasonable to expect an increase with the increasing average age of children bearing. The etiology of acute coronary syndrome during pregnancy can be divided into two main groups: atherosclerotic mechanisms, more common in older mothers, and non-atherosclerotic mechanisms like dissection, coronary spasm and thrombosis. Management of these patients remains difficult; the treatment should follow the usual principles of care for acute coronary syndrome but taking in account that many standard treatments, such the angiotensin converting enzyme inhibitors, are contraindicated. There is also little experience with many of the newer treatments such as clopidogrel and IIb/IIIa glycoprotein inhibitors or percutaneous coronary intervention. We describe a case of a 38-week pregnant woman who suffered an acute myocardial infarction without ST segment elevation and review the literature.

Síndrome coronario agudo sin elevación del ST durante el embarazo. A propósito de un caso / Acute coronary syndrome without ST elevation during pregnancy. A case report

La enfermedad isquémica en la mujer joven es rara, y es más infrecuente aún en la embarazada, aunque es razonable esperar un aumento de su incidencia ya que la edad de las gestantes aumenta. La etiología del síndrome coronario agudo durante el embarazo se divide en dos grupos: ateroesclerótica, más común en aquellas mujeres de mayor edad, y no ateroesclerótica como la disección, espasmo o trombosis coronaria. El manejo de estas pacientes continúa siendo complejo; deben utilizarse los mismos principios que en la población general, teniendo en cuenta que muchos de los tratamientos utilizados habitualmente como los inhibidores de la enzima convertidora de angiotensina están contraindicados en la embarazada y que existe poca experiencia con tratamientos más recientes como el clopidogrel, los inhibidores de la glucoproteína IIb/IIIa o la revascularización percutánea. Presentamos un caso de síndrome coronario agudo en una gestante de 38 semanas, y revisaremos la literatura más reciente

Ischemic heart disease in the young woman is rare, and even more so in the pregnant woman, but it is reasonable to expect an increase with the increasing average age of children bearing. The etiology of acute coronary syndrome during pregnancy can be divided into two main groups: atherosclerotic mechanisms, more common in older mothers, and non-atherosclerotic mechanisms like dissection, coronary spasm and thrombosis. Management of these patients remains difficult; the treatment should follow the usual principles of care for acute coronary syndrome but taking in account that many standard treatments, such the angiotensin converting enzyme inhibitors, are contraindicated. There is also little experience with many of the newer treatments such as clopidogrel and IIb/IIIa glycoprotein inhibitors or percutaneous coronary intervention. We describe a case of a 38-week pregnant woman who suffered an acute myocardial infarction without ST segment elevation and review the literature

Fracaso renal agudo causado por leptospirosis / Leptospirosis-induced acute renal failure

No disponible

Coma metabólico en paciente con polidipsia psicógena / Metabolic coma in a patient with psychogenic polydipsia

No disponible