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

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Pronóstico del paciente crítico según el sexo y la edad / Outcome of the critical patient according to the sex and the age

Objetivo. Determinar si la edad y el sexo tienen relación con diferencias en la mortalidad de los pacientes ingresados en la unidad de cuidados intensivos (UCI). Diseño. Estudio retrospectivo de datos recogidos prospectivamente durante 6 años consecutivos. Ámbito. UCI polivalente del Hospital Universitario Insular de Gran Canaria. Pacientes. Todos los pacientes ingresados en la UCI, diferenciados según el sexo y la edad < o ≥ 65 años. Principales variables de interés. Se recogieron datos demográficos y diagnósticos de los pacientes al ingreso, el APACHE II, los días que precisaron de ventilación mecánica y depuración extrarrenal y la mortalidad. Resultados. Durante el período de estudio ingresaron 3.786 pacientes en la UCI, de éstos. 2.526 (66,7%) eran varones y 2.469 (65,2%), menores de 65 años. La mortalidad en UCI del grupo con trastornos coronarios fue mayor en las mujeres (el 11,1 frente al 6,7%; p = 0,02), a pesar de que no había diferencias significativas entre ambos sexos en el índice de gravedad APACHE II (p = 0,56). No encontramos diferencias significativas entre los sexos, según la edad < o ≥ 65 años, en el APACHE II, la necesidad de ventilación mecánica o depuración extrarrenal ni en la mortalidad en la UCI. Tampoco encontramos diferencias en la mortalidad entre los grupos diagnósticos y el sexo, a pesar de tener incluso un APACHE II al ingreso significativamente mayor, como era el caso de las mujeres menores de 65 años del grupo con trastornos coronarios y traumatismos, y las mujeres del grupo quirúrgico de 65 años o más. Conclusiones. No hemos demostrado diferencias en el pronóstico relacionadas con el sexo, salvo en el grupo de trastornos coronarios, donde la mortalidad es mayor en las mujeres. La edad mayor o menor de 65 años no ha influido en la mortalidad de nuestros pacientes(AU)

Objective. To determine if gender and age are associated with differences in mortality in patients requiring critical care. Design. Retrospective analysis of prospectively collected data over 6 consecutive years. Setting. Polyvalent intensive care unit (ICU) of a tertiary hospital in the Canary Islands. Patients. Adult patients who were hospitalized in the ICU, divided on the basis of gender and age (< or ≥ 65 years). Primary variables of interest. Demographic and clinical diagnosis data on ICU admission, APACHE II, days of mechanical ventilation, days of renal replacement therapy (RRT) and the mortality were collected. Results. During the study period, 3786 patients were admitted to the ICU, 66.7% male and 2469 (65.2%) < 65 years. Mortality in the ICU of the coronary group was greater in women (11.1% vs 6.7%; p = 0.02), even though there were no significant differences between both genders in the APACHE II (p = 0.56). No statistically significant differences were found according to gender in age (< or ≥ 65 years), in the APACHE II, or in the need for mechanical ventilation or renal replacement therapy as well as in the ICU mortality. We also found no differences in the mortality between the diagnostic groups and gender even when the APACHE II was significantly greater on admission, as occurred for the women < 65 years of the coronary and traumas group and for women with surgery ≥ 65 years. Conclusions. No significant differences were demonstrated in the outcome in relationship with gender except for in the coronary group in which mortality was greater in women. Age above or below 65 years had no influence on mortality in our patients(AU)

Edema pulmonar recidivante en paciente con hemorragia intracraneal. A propósito de un caso / Recurrent pulmonary edema in a patient with intracranial bleeding. A case report

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[Physicians' attitudes and perceptions regarding the critical care and critical care specialty]. / Actitudes y percepciones del personal médico del hospital acerca de los Cuidados Intensivos y de la especialidad de Medicina Intensiva.

OBJECTIVE: To evaluate the attitudes and perceptions of the doctors of a hospital regarding critical care and the speciality of Intensive Medicine. DESIGN: Prospective, descriptive study during 3 months. SETTING: Insular University Hospital in Gran CanaRia, Canary Islands, Spain. PATIENTS: Medical specialists and residents. INTERVENTION: Anonymous survey. MAIN VARIABLES: Demographic data of the interviewed doctors were collected and they were asked about their labour or personal previous relation with the Intensive Care Unit (ICU), the attitudes of the critical care doctors' of their hospital and their perceptions regarding the critical care speciality. RESULTS: We interviewed 116 doctors, 75 staff and 41 residents. Less of the third part believed that the ICU was a ward for potentially critical patients. A high percentage of the doctors whom had been refused some admission were not to agree with the arguments that they received. More than 40% of the interviewed ones affirmed had not requested bed in the ICU for any patient who had benefited from it, especially because they were thinking that the admission would be refused. Some doctors think that the professio - nals employed at the ICU are doctors of different specialities. The speciality of Intensive Medicine is perceived by a high level of stress among the professionals. CONCLUSIONS: We detect the ignorance of other professionals about the function of a Service of Intensive Medicine and the model of ICU of our country. Also we find high rates of dissatisfaction among the professionals who was refused some admission in the unit, because of we believe that clinical guides about the criteria of admission must be elaborated and to announce them among the doctors of the hospital. The professionals perceive that we suffer a high level of stress.

Actitudes y percepciones del personal médico del hospital acerca de los Cuidados Intensivos y de la especialidad de Medicina Intensiva / Physicians¿ attitudes and perceptions regarding the critical care and critical care specialty

Objetivo. Evaluar las actitudes y percepciones de los médicos de un hospital respecto a la labor asistencial del Servicio de Medicina Intensiva en su hospital y a la especialidad de Medicina In ten - si va. Diseño. Se trata de un estudio prospectivo, des criptivo, de 3 meses de duración. Ámbito. Hospital Universitario Insular de Gran Canaria, Canarias, España. Pacientes.Médicos no intensivistas, adjuntos y residentes del hospital. Intervención.Se llevó a cabo una encuesta anónima. Variables de interés principales.Se recogieron datos demográficos de los médicos entrevistados, se les preguntó acerca de su relación laboral o per sonal previa con la Unidad de Cuidados In - tensivos (UCI), las actitudes de los médicos intensivistas de su hospital y su percepción de la especialidad de Medicina Intensiva. Resultados. Se entrevistaron 116 médicos, 75 adjuntos y 41 residentes. Menos de la tercera parte creía que la UCI era una sala para enfermos potencialmente críticos. Un porcentaje elevado de los médicos a los que se les había denegado algún ingreso no estaba conforme con los argumentos que se les dieron. Más del 40% de los entrevistados afirmó no haber solicitado cama en la UCI para algún paciente que probablemente se hubiese beneficiado de ella, sobre todo porque pensaba que se le iba a denegar. Todavía hay médicos en el hospital que piensan que los profesionales que trabajan en la UCI son médicos de distintas espe cialidades. La especialidad de Medicina In - ten siva es percibida con un alto nivel de estrés entre los profesionales. Conclusiones. Detectamos el desconocimiento de otros profesionales acerca de la función de un Servicio de Medicina Intensiva y del modelo de UCI de nuestro país. También encontramos unas elevadas tasas de insatisfacción entre los profesionales a los cuales se les denegó algún ingreso en la unidad, por lo que creemos que se deben elaborar unas guías clínicas sobre los criterios de ingreso y darlos a conocer entre los médicos del hospital. Los profesionales perciben que sufrimos un alto nivel de estrés

Objetive.To evaluate the attitudes and perceptions of the doctors of a hospital regarding critical care and the speciality of Intensive Medicine. Design.Prospective, descriptive study during 3 months. Setting.Insular University Hospital in Gran Ca - na ria, Canary Islands, Spain. Patients.Medical specialists and residents. Intervention.Anonymous survey. Main variables.Demographic data of the interviewed doctors were collected and they were asked about their labour or personal previous relation with the Intensive Care Unit (ICU), the attitudes of the critical care doctors¿ of their hospital and their perceptions regarding the critical care speciality. Results. We interviewed 116 doctors, 75 staff and 41 residents. Less of the third part believed that the ICU was a ward for potentially critical patients. A high percentage of the doctors whom had been refused some admission were not to agree with the arguments that they received. More than 40% of the interviewed ones affirmed had not requested bed in the ICU for any patient who had benefited from it, especially because they were thinking that the admission would be refused. Some doctors think that the professio - nals employed at the ICU are doctors of different specialities. The speciality of Intensive Medicine is perceived by a high level of stress among the professionals. Conclusions.We detect the ignorance of other professionals about the function of a Service of Intensive Medicine and the model of ICU of our country. Also we find high rates of dissatisfaction among the professionals who was refused some admission in the unit, because of we believe that clinical guides about the criteria of admission must be elaborated and to announce them among the doctors of the hospital. The professionals perceive that we suffer a high level of stress (AU)

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

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Características y pronóstico de los pacientes mayores con estancia muy prolongada en una Unidad de Cuidados Intensivos / Characteristics and prognosis of patients with very long stay in an intensive care unit

Objetivo. Describir las características y los factores pronósticos de los pacientes mayores ingresados de forma prolongada en nuestra Unidad de Cuidados Intensivos (UCI). Diseño. Se trata de un análisis retrospectivo de datos recogidos prospectivamente durante 6 años consecutivos. Ámbito. Una UCI polivalente del Hospital Universitario Insular de Gran Canaria. Pacientes. El estudio se centra en pacientes adultos mayores de 70 años que permanecieron ingresados en la UCI durante un período igual o superior a 30 días. Variables de interés principales. Se recogieron datos demográficos y diagnósticos de los pacientes al ingreso, Apache II y los días que precisaron de terapias de reemplazamiento renal (RRT) y de ventilación mecánica. También se estudió la mortalidad al año de los pacientes que sobrevivieron. Resultados. Durante el período de estudio ingresaron 3.786 pacientes en la UCI. Ochocientos cincuenta y tres (22,5%) tenían más de 70 años y sólo 42 (4,92%) de ellos permanecieron en la UCI durante 30 o más días. Comparamos estos últimos con los pacientes mayores de 70 años pero con una estancia en la UCI inferior a 30 días y no encontramos diferencias estadísticamente significativas ni en la mortalidad en la UCI, ni en el Apache II, la edad, el sexo o la necesidad de RRT. El análisis multivariado mostró como variables in- dependientes asociadas a la estancia prolongada solamente los días de ventilación mecánica (p < 0,05). Los pacientes de ≥ 70 años y con una estancia ≥ 30 días que sobrevivieron eran más mayores y 21 (65,62%) estaban vivos al año. Conclusiones. Los índices de mortalidad en los pacientes de ≥ 70 años con una estancia < o ≥ 30 días en la UCI fueron similares. La supervivencia al año de los pacientes de ≥ 70 años con una estancia ≥ 30 días en la UCI fue alta. Los resultados del estudio justifican el cuidado de los pacientes ancianos con estancias prolongadas en UCI (AU)

Objective. To describe the characteristics and prognostic factors of elderly patients hospitalized for ≥ 30 days in an Intensive Care Unit (ICU). Design. Retrospective analysis of prospectively collected simple data over 6 consecutive years. Setting. Polyvalent ICU of the Insular University Hospital in the Canary Islands (Spain). Patients. Adult patients ≥ 70 years who were hospitalized in the ICU for a period of 30 or more days. Primary variables of interest. Demographic data, clinical diagnosis on ICU admission, Apache II, days of renal replacement therapy (RRT), days of mechanical ventilation and the outcome of the survivors one year later were collected. Mortality at one year of the surviving patients was studied. Results. During the study period, 3,786 patients were admitted to the ICU. Of these, 853 (22.5%). patients were ≥ 70 years old and only 42 (4.92%) of these patients remained in the ICU for ≥ 30 days. We compared the latter with the ≥ 70 year old patients whose stay in the ICU stay was < 30 days. No statistically significant differences in ICU mortality, Apache II, age, gender and the need for RRT were found. As independent variables associated with the long stay, the multivariate analysis showed only the days of mechanical ventilation (p < 0.05). The surviving patients (≥ 70 years old and whose stay in the ICU was ≥ 30 days) were older and 21 (65.62%) were still alive one year later. Conclusions. ICU mortality rates in elderly patients with a stay < or ≥ 30 days in the ICU were comparable. Survival at one year of the ≥ 70 year- old patients whose long-term intensive care unit stay was ≥ 30 days was high. These results are sufficient in our unit to justify prolonged ICU care for elderly patients (AU)

[Characteristics and prognosis of patients with very long stay in an Intensive Care Unit]. / Características y pronóstico de los pacientes mayorescon estancia muy prolongadaen una Unidad de Cuidados Intensivos.

OBJECTIVE: To describe the characteristics and prognostic factors of elderly patients hospitalized for > or = 30 days in an Intensive Care Unit (ICU). DESIGN: Retrospective analysis of prospectively collected simple data over 6 consecutive years. SETTING: Polyvalent ICU of the Insular University Hospital in the Canary Islands (Spain). PATIENTS: Adult patients > or = 70 years who were hospitalized in the ICU for a period of 30 or more days. PRIMARY VARIABLES OF INTEREST: Demographic data, clinical diagnosis on ICU admission, Apache II, days of renal replacement therapy (RRT), days of mechanical ventilation and the outcome of the survivors one year later were collected. Mortality at one year of the surviving patients was studied. RESULTS: During the study period, 3,786 patients were admitted to the ICU. Of these, 853 (22.5%) patients were > or = 70 years old and only 42 (4.92%) of these patients remained in the ICU for > or = 30 days. We compared the latter with the > or = 70 year old patients whose stay in the ICU stay was < 30 days. No statistically significant differences in ICU mortality, Apache II, age, gender and the need for RRT were found. As independent variables associated with the long stay, the multivariate analysis showed only the days of mechanical ventilation (p < 0.05). The surviving patients (> or = 70 years old and whose stay in the ICU was > or = 30 days) were older and 21 (65.62%) were still alive one year later. CONCLUSIONS: ICU mortality rates in elderly patients with a stay < or > or = 30 days in the ICU were comparable. Survival at one year of the > or = 70 year-old patients whose long-term intensive care unit stay was > or = 30 days was high. These results are sufficient in our unit to justify prolonged ICU care for elderly patients.

Rabdomiólisis aguda asociada a inhalación de cocaína / Acute rhabdomyolysis associated with cocaine inhalation

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

[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