[Frecuency of adverse events during the hygiene of the critical care patient]. / Frecuencia de eventos adversos durante el aseo del paciente crítico.

The hygiene of the patient in critical condition is a common nursing technique in the intensive care unit, which does not mean that doing it is exempt of risk for the patient's state. We carry out a study to measure the frequency of the appearance of certain adverse events during the hygiene care and their clinical repercussion.Hygiene of the critical patients was monitored, measuring the appearance of certain events at the time of hygiene and until one hour after to assess if the complications were at the moment or had a greater repercussion on the state of the patient.During the study period, some adverse event appeared in 48% (CI 95%: 43-52) of the hygiene performed while none appeared in 52% (CI 95%: 48-56) of it. The events that appeared most frequently were: desaturation in 18% (CI 95%: 15-21) of the hygiene performed, the deadaptation of the mechanical ventilation in 11% (CI 95%: 9-14), arterial hypertension in 21% (CI 95%: 18-25) and arterial hypotension in 11% (CI 95%: 9-14). The intracranial hypertension appeared in 42% (CI 95%: 26-61) of the hygiene performed to patients who were carriers of intraventricular catheter, 9% (CI 95%: 2-25) continued with elevated values 1 hour after concluding the hygiene. The rest of the events monitored presented a lower frequency, although the appearance of one episode of cardiorespiratory arrest and two of auricular fibrillation with rapid ventricular response, one of which required cardioversion, stand out. We conclude that it is an essential job of the nursing staff to correctly assess the risks that the performance of hygiene means for the critical patient, so that the technique should be applied rationally and under strict monitoring and control.

Frecuencia de eventos adversos durante el aseo del paciente crítico / Frecuency of the adverse events during the hygiene of the critical care patients

El aseo del paciente en estado crítico es una técnica de enfermería habitual en la unidad de cuidados intensivos, lo que no implica que su realización esté exenta de riesgos para el estado del paciente. Elaboramos un estudio para medir la frecuencia de aparición de determinados eventos adversos durante el aseo y la repercusión clínica de éstos. Se monitorizó el aseo de los pacientes críticos, midiendo la aparición de determinados eventos en el momento del aseo y hasta una hora después, para valorar si las complicaciones eran puntuales o tenían mayor repercusión en el estado del paciente. Durante el período de estudio apareció algún evento adverso en el 48% (IC 95%: 43-52) de los aseos realizados, mientras que en el 52% (IC 95%: 48-56) no. Los eventos que aparecieron con mayor frecuencia fueron: la desaturación en el 18% (IC 95%: 15-21) de los aseos realizados, la desadaptación de la ventilación mecánica en el 11% (IC 95%: 9-14), la hipertensión arterial en el 21% (IC 95%: 18-25) y la hipotensión arterial 11% (IC 95%: 9-14). La hipertensión intracraneal apareció en los 42% (IC 95%: 26-61) de los aseos realizados a pacientes portadores de catéter intraventricular, un 9% (IC 95%: 2-25) continuaba con valores elevados una hora después de concluir el aseo. El resto de eventos monitorizados presentaron menor frecuencia, aunque destaca la aparición de un episodio de parada cardiorrespiratoria y dos de fibrilación auricular con respuesta ventricular rápida, uno de los cuales precisó cardioversión. Concluimos que es labor fundamental del personal de enfermería valorar correctamente los riesgos que para el paciente crítico supone la realización del aseo, por lo que la técnica debe aplicarse de forma racional y bajo estricta monitorización y control (AU)

The hygiene of the patient in critical condition is a common nursing technique in the intensive care unit, which does not mean that doing it is exempt of risk for the patient's state. We carry out a study to measure the frequency of the appearance of certain adverse events during the hygiene care and their clinical repercussion. Hygiene of the critical patients was monitored, measuring the appearance of certain events at the time of hygiene and until one hour after to assess if the complications were at the moment or had a greater repercussion on the state of the patient. During the study period, some adverse event appeared in 48% (CI 95%: 43-52) of the hygiene performed while none appeared in 52% (CI 95%: 48-56) of it. The events that appeared most frequently were: desaturation in 18% (CI 95%: 15-21) of the hygiene performed, the deadaptation of the mechanical ventilation in 11% (CI 95%: 9-14), arterial hypertension in 21% (CI 95%: 18-25) and arterial hypotension in 11% (CI 95%: 9-14). The intracranial hypertension appeared in 42% (CI 95%: 26-61) of the hygiene performed to patients who were carriers of intraventricular catheter, 9% (CI 95%: 2-25) continued with elevated values 1 hour after concluding the hygiene. The rest of the events monitored presented a lower frequency, although the appearance of one episode of cardiorespiratory arrest and two of auricular fibrillation with rapid ventricular response, one of which required cardioversion, stand out. We conclude that it is an essential job of the nursing staff to correctly assess the risks that the performance of hygiene means for the critical patient, so that the technique should be applied rationally and under strict monitoring and control (AU