Asociación entre Glucemia inestable, tiempo de estancia y mortalidad de pacientes en estado críticos: Estudio de cohorte / Associação Entre Glicemia Instável, Tempo de Permanência e Mortalidade de Pacientes Críticos: Estudo de Coorte / Relationships between unstable Glycemia, Hospital Length Of Stay, and mortality In Critically Ill patients: A cohort study

Resumen Introducción: El control y la evaluación de los niveles glucémicos de pacientes en estado críticos es un desafío y una competencia del equipo de enfermería. Por lo que, determinar las consecuencias de esta durante la hospitalización es clave para evidenciar la importancia del oportuno manejo. Objetivo: Determinar la asociación entre la glucemia inestable (hiperglucemia e hipoglucemia), el resultado de la hospitalización y la duración de la estancia de los pacientes en una unidad de cuidados intensivos. Metodología: Estudio de cohorte prospectivo realizado con 62 pacientes a conveniencia en estado crítico entre marzo y julio de 2017. Se recogieron muestras diarias de sangre para medir la glucemia. Se evaluó la asociación de la glucemia inestable con la duración de la estancia y el resultado de la hospitalización mediante ji al cuadrado de Pearson. El valor de p<0.05 fue considerado significativo. Resultados: De las 62 personas participantes, 50 % eran hombres y 50 % mujeres. La edad media fue de 63.3 años (±21.4 años). La incidencia de glucemia inestable fue del 45.2 % y se asoció con una mayor duración de la estancia en la UCI (p<0.001) y una progresión a la muerte como resultado de la hospitalización (p=0.03). Conclusión: Entre quienes participaron, la glucemia inestable se asoció con una mayor duración de la estancia más prolongada y con progresión hacia la muerte, lo que refuerza la importancia de la actuación de enfermería para prevenir su aparición.

Resumo Introdução: O controle e avaliação dos níveis glicêmicos em pacientes críticos é um desafio e uma competência da equipe de enfermagem. Portanto, determinar as consequências da glicemia instável durante a hospitalização é chave para evidenciar a importância da gestão oportuna. Objetivo: Determinar a associação entre glicemia instável (hiperglicemia e hipoglicemia), os desfechos hospitalares e o tempo de permanência dos pacientes em uma unidade de terapia intensiva. Métodos: Um estudo de coorte prospectivo realizado com 62 pacientes a conveniência em estado crítico entre março e julho de 2017. Foram coletadas amostras diariamente de sangue para medir a glicemia. A associação entre a glicemia instável com o tempo de permanência e o desfecho da hospitalização foi avaliada pelo teste qui-quadrado de Pearson. O valor de p <0,05 foi considerado significativo. Resultados: Das 62 pessoas participantes, 50% eram homens e 50% mulheres. A idade média foi de 63,3 anos (±21,4 anos). A incidência de glicemia instável foi de 45,2% e se associou a um tempo de permanência mais prolongado na UTI (p <0,001) e uma progressão para óbito como desfecho da hospitalização (p = 0,03). Conclusão: Entre os participantes, a glicemia instável se associou a um tempo mais longo de permanência e com progressão para óbito, enfatizando a importância da actuação da equipe de enfermagem para prevenir sua ocorrência.

Abstract Introduction: The control and evaluation of glycemic levels in critically ill patients is a challenge and a responsibility of the nursing team; therefore, determining the consequences of this during hospitalization is key to demonstrate the importance of timely management. Objective: To determine the relationship between unstable glycemia (hyperglycemia and hypoglycemia), hospital length of stay, and the hospitalization outcome of patients in an Intensive Care Unit (ICU). Methods: A prospective cohort study conducted with 62 critically ill patients by convenience sampling between March and July 2017. Daily blood samples were collected to measure glycemia. The correlation of unstable glycemia with the hospital length of stay and the hospitalization outcome was assessed using Pearson's chi-square. A p-value <0.05 was considered significant. Results: Among the 62 patients, 50% were male and 50% were female. The mean age was 63.3 years (±21.4 years). The incidence of unstable glycemia was 45.2% and was associated with a longer ICU stay (p<0.001) and a progression to death as a hospitalization outcome (p=0.03). Conclusion: Among critically ill patients, unstable glycemia was associated with an extended hospital length of stay and a progression to death, emphasizing the importance of nursing intervention to prevent its occurrence.

Cultura de segurança em unidades de terapia intensiva na perspectiva da equipe multiprofissional: Estudo multicêntrico / Cultura de seguridad en unidades de terapia intensiva en la perspectiva del equipo multiprofesional: Estudio multicéntrico / Safety Culture in intensive care units from multiprofessional team perspective: A multicenter study

Resumo Introdução: A Cultura de Segurança do Paciente é considerada um importante componente estrutural dos serviços, que favorece a implantação de práticas seguras e a diminuição da ocorrência de eventos adversos. Objetivo: Identificar os fatores associados à cultura de segurança do paciente nas unidades de terapia intensiva adulto em hospitais de grande porte da região Sudeste do Brasil. Método: Estudo transversal do tipo survey e multicêntrico. Participaram 168 profissionais de saúde de quatro unidades (A, B, C e D) de terapia intensiva adulto. Foi utilizado o questionário "Hospital Survey on Patient Safety Culture". Considerou-se como variável dependente o nível de cultura de segurança do paciente e variáveis independentes aspectos sociodemográficos e laborais. Foram usadas estatísticas descritivas e para a análise dos fatores associados foi elaborado um modelo de regressão logística múltipla. Resultados: Identificou-se associação entre tipo de hospital com onze dimensões da cultura de segurança, quanto à função a categoria profissional médico, técnico de enfermagem e enfermeiro foram relacionadas com três dimensões; o gênero com duas dimensões e tempo de atuação no setor com uma dimensão. Conclusão: Evidenciou-se que o tipo de hospital, categoria profissional, tempo de atuação no setor e gênero foram associados às dimensões de cultura de segurança do paciente.

Resumen Introducción: La cultura de seguridad del paciente se considera un componente estructural importante de los servicios, que favorece la aplicación de prácticas seguras y la reducción de la aparición de acontecimientos adversos. Objetivo: Identificar los factores asociados a la cultura de seguridad del paciente en unidades de terapia intensiva adulto en hospitales de la región Sudeste del Brasil. Metodología: Estudio transversal de tipo encuesta y multicéntrico. Participaron 168 profesionales de salud de cuatro unidades (A, B, C y D) de terapia intensiva adulto. Se utilizó el cuestionario "Hospital Survey on Patient Safety Culture". Se consideró como variable dependiente el nivel de cultura de seguridad del paciente y variables independientes los aspectos sociodemográficos y laborales. Fueron usadas estadísticas descriptivas y, para analizar los factores asociados, fue elaborado un modelo de regresión logística múltiple. Resultados: Se identificó asociación entre tipo de hospital con once dimensiones de cultura de seguridad del paciente. En relación a la función, personal médico, técnicos de enfermería y personal de enfermería fueron asociados con tres dimensiones, el género con dos dimensiones y tiempo de actuación con una dimensión en el modelo de regresión. Conclusión: Se evidenció que el tipo de hospital, función, tiempo de actuación en el sector y género fueron asociados a las dimensiones de la cultura de seguridad del paciente.

Abstract Introduction: Patient safety culture is considered an important structural component of the services, which promotes the implementation of safe practices and the reduction of adverse events. Objective: To identify the factors associated with patient safety culture in adult intensive care units in large hospitals in Belo Horizonte. Method: Cross-sectional survey and multicenter study. A total of 168 health professionals from four units (A, B, C and D) of adult intensive care participated. The questionnaire "Hospital Survey on Patient Safety Culture" was used. The patient's level of safety culture was considered as a dependent variable, and sociodemographic and labor aspects were the independent variables. Descriptive statistics were used and a multiple logistic regression model was developed to analyze the associated factors. Results: An association was identified between the type of hospital and eleven dimensions of the safety culture. In terms of function, the doctors, nursing technicians, and nurse were related to three dimensions; gender with two dimensions, and time working in the sector with one dimension. Conclusion: It was evidenced that the type of hospital, function, time working in the sector, and gender were associated with the dimensions of patient safety culture.

Prediction and simulation of PEEP setting effects with machine learning models / Predicción y simulación de los efectos de la configuración de la PEEP con modelos de aprendizaje automático

Objective To establish a new machine learning-based method to adjust positive end-expiratory pressure (PEEP) using only already routinely measured data. Design Retrospective observational study. Setting Intensive care unit (ICU). Patients or participants 51811 mechanically ventilated patients in multiple ICUs in the USA (data from MIMIC-III and eICU databases). Interventions No interventions. Main variables of interest Success parameters of ventilation (arterial partial pressures of oxygen and carbon dioxide and respiratory system compliance). Results The multi-tasking neural network model performed significantly best for all target tasks in the primary test set. The model predicts arterial partial pressures of oxygen and carbon dioxide and respiratory system compliance about 45 min into the future with mean absolute percentage errors of about 21.7%, 10.0% and 15.8%, respectively. The proposed use of the model was demonstrated in case scenarios, where we simulated possible effects of PEEP adjustments for individual cases. Conclusions Our study implies that machine learning approach to PEEP titration is a promising new method which comes with no extra cost once the infrastructure is in place. Availability of databases with most recent ICU patient data is crucial for the refinement of prediction performance. (AU)

Objetivo Establecer un nuevo método basado en el aprendizaje automático para ajustar la presión positiva al final de la espiración (PEEP según sus siglas en inglés) utilizando únicamente datos ya obtenidos de forma rutinaria. Diseño Estudio retrospectivo de observación. Ámbito Unidad de cuidados intesivos (UCI) Pacientes o participantes 51811 pacientes ventilados mecánicamente en múltiples UCIs de EE.UU. (tomados de las bases de datos MIMIC-III y eICU). Intervenciones Sin intervenciones. Variables de interés principales Parametros de éxito de la ventilación (presiones parciales arteriales de oxígeno y dióxido de carbono y distensibilidad del sistema respiratorio). Resultados El modelo de red neuronal multitarea obtuvo los mejores resultados en todos los objetivos del conjunto de pruebas primario. El modelo predice las presiones parciales arteriales de oxígeno y dióxido de carbono así como la distensibilidad del sistema respiratorio con aproximadamente 45 minutos de anticipación, mostrando errores porcentuales absolutos medios de aproximadamente 21.7%, 10.0% y 15.8%, respectivamente. El uso propuesto del modelo se demostró en situaciones hipotéticas en las que se simularon los posibles efectos de los ajustes de PEEP para casos individuales. Conclusiones Nuestro estudio implica que el enfoque de aprendizaje automático para el ajuste de la PEEP es un método nuevo y prometedor que no supone ningún coste adicional una vez que se dispone de la infraestructura necesaria. La disponibilidad de bases de datos con información de pacientes de UCI más recientes es crucial para perfeccionar el rendimiento de la predicción. (AU)

Síndrome de burnout y factores asociados en enfermeras de cuidados intensivos: un estudio transversal / Síndrome de burnout e fatores associados em enfermeiros de terapia intensiva: um estudo transversal / Burnout syndrome and associated factors in intensive care nurses: a cross-sectional study

Introducción: El Síndrome de Burnout (SB) surge en el contexto de condiciones laborales precarias, y se manifiesta a través de un conjunto de signos y síntomas que afectan la psicología del trabajador debido a la exposición a factores estresantes en el ambiente laboral.Objetivo: Analizar la prevalencia y los factores asociados al Síndrome de Burnout (SB) en enfermeras de cuidados intensivos. Método: Estudio transversal y analítico, realizado con 94 enfermeros asistenciales en unidades de cuidados intensivos de un hospital público en el estado de Bahía. Se utilizó el Inventario de Burnout de Maslach (MBI) y un cuestionario que contenía aspectos sociodemográficos, culturales y ocupacionales. Resultados: El 62,8% mostró alto agotamiento emocional; 64,9% alta despersonalización y 77,7% alta reducción de la realización profesional. Los factores asociados al SB fueron: edad hasta 38 años (RP: 2,38; IC 95%: 1,44-3,94), no tener pareja (RP: 1,97; IC 95%: 1,17-3,32), insatisfacción laboral (RP: 1,78; IC 95%: 1,15 -2,75), tener dolor de espalda (RP: 3,33; IC 95%: 1,72 -6,42), ansiedad (RP: 2,33; IC 95%: 1,22-4,46) y patrón de sueño hasta 5 horas (RP: 1,67; IC 95%: 1,08-2,59). Se encontró que tener hijos es un índice protector (RP: 0,55; IC 95%: 0,33-0,90). Enfermería GlobalNº 74 Abril 2024Página 224Conclusión: Se considera alto el porcentaje de enfermeros con diagnóstico sugestivo del síndrome (43,6%), así como la existencia de factores asociados. Es fundamental que la institución ofrezca un ambiente de trabajo sano, en el que la prevención sea la mejor vía para que estos profesionales no se conviertan en blancos del síndrome. (AU)

Introdução: A Síndrome de Burnout (SB) emerge no contexto das condições laborais precárias, e se manifesta por meio de um conjunto de sinais e sintomas que afetam o psicológico do trabalhador devido à exposição a estressores no ambiente de trabalho.Objetivo: Analisar a prevalência e fatores a Síndrome de Burnout em enfermeiros de terapia intensiva. Método: Estudo transversal e analítico, realizado com 94 enfermeiros assistenciais de unidades de terapia intensiva de um hospital público do estado da Bahia, Brasil. Utilizou-se o Maslach Burnout Inventory (MBI) e um questionário contendo questões sociodemográficos, culturais e ocupacionais. Resultados: 62,8% apresentaram alta exaustão emocional; 64,9%, alta despersonalização; e 77,7%, alta redução da realização profissional. Os fatores associados à SB foram: idade até 38 anos (RP: 2,38; IC 95%: 1,44-3,94), não ter companheiro (RP: 1,97; IC 95%: 1,17-3,32), insatisfação com o trabalho (RP: 1,78; IC 95%: 1,15 -2,75), apresentar dores dorsais (RP: 3,33; IC 95%: 1,72 -6,42), ansiedade (RP: 2,33; IC 95%: 1,22-4,46) e padrão de sono até 05 horas (RP: 1,67; IC 95%: 1,08-2,59). Verificou-se que ter filhos é um índice protetor (RP: 0,55; IC 95%: 0,33-0,90). Conclusão: Existe um percentual considerado elevado de enfermeiros com diagnóstico sugestivo da síndrome (43,6%), assim como a existência de fatores associados. É imprescindível que a instituição ofereça um ambiente de trabalho sadio, no qual, a prevenção é a melhor maneira para que os profissionais não se tornem alvos da síndrome. (AU)

Introduction: Burnout Syndrome (BS) emerges in the context of precarious working conditions, and manifests itself through a set of signs and symptoms that affect the worker's psychology due to exposure to stressors in the work environment. Objective: to analyze the prevalence and factors associated with Burnout Syndrome (BS) in intensive care nurses. Method: cross-sectional and analytical study, carried out with 94 nurses in intensive care units of a public hospital in the state of Bahia. The Maslach Burnout Inventory (MBI) and a questionnaire containing sociodemographic, cultural and occupational issues were used. Results: 62.8% showed high emotional exhaustion; 64.9% high depersonalization and 77.7% high reduction in professional achievement. The factors associated with BS were: age up to 38 years (PR: 2.38; 95% CI: 1.44-3.94), not having a partner (PR: 1.97; 95% CI: 1.17-3.32), job dissatisfaction (PR: 1.78; 95% CI: 1.15 -2.75), having back pain (PR: 3.33; 95% CI: 1.72 -6.42), anxiety (PR: 2.33; 95% CI: 1.22-4.46) and sleep pattern up to 5 hours (PR: 1.67; 95% CI: 1.08-2.59). It was found that having children is a protective index (PR: 0.55; 95% CI: 0.33-0.90). Conclusion: there is a considered high percentage of nurses with a diagnosis suggestive of the syndrome (43.6%), as well as the existence of associated factors. It is essential that the institution offers a healthy work environment, in which prevention is the best way for these professionals not to become targets of the syndrome. (AU)

The comfort perception in the critically ill patient from the Kolcaba theoretical model.

BACKGROUND: The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ). OBJECTIVES: To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors. METHODS: Cross-sectional descriptive observational prospective study. POPULATION: 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16. RESULTS: The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0-4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2-7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184-8,707], mild pain (p = 0,000) OR 4,007 CI [2,068-7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328-5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316-0,705]. CONCLUSIONS: The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.

Gender perspective in the implementation of hygiene in cardiology intensive care.

INTRODUCTION: Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS: Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS: Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION: Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.

Eficacia y seguridad de un compuesto de ácidos grasos hiperoxigenados en la mejora de la microcirculación de la púrpura fulminante en pacientes pediátricos con sepsis: estudio piloto / Efficacy and safety of a hyperoxygenated fatty acid compound in improving the microcirculation of purpura fulminans in paediatric patients with sepsis: a pilot study

Introducción La púrpura fulminante (PF) es una complicación grave de la sepsis resultado de un conjunto de alteraciones caracterizadas por el desarrollo de lesiones hemorrágicas equimóticas y necrosis de la piel. Objetivo Analizar la eficacia y la seguridad de la aplicación tópica de un compuesto de ácidos grasos hiperoxigenados (AGHO) en la microcirculación de la PF en pacientes pediátricos afectados de sepsis. Material y métodos Se llevó a cabo un estudio prospectivo cuasiexperimental pretest-posttest de un solo grupo en una Unidad de Cuidados Intensivos Pediátrica (UCIP). Se incluyeron en el estudio pacientes con PF de 0 a 18 años. Para evaluar la efectividad del producto objeto de evaluación en la microcirculación de las lesiones por PF se determinaron los valores de oximetría somática antes y después de la aplicación de AGHO cada 4h durante los 3 primeros días de ingreso de los pacientes. Resultados Se reclutaron 4 pacientes, con una mediana de edad de 98 meses. Las lesiones purpúricas que se midieron estaban ubicadas, sobre todo, en ambos pies y manos y, en 2 pacientes, también en los maléolos laterales y gemelos de ambas extremidades inferiores. Se obtuvieron un total de 225 mediciones, observando unas puntuaciones medias preintervención de 71,17±15,65% versus los 73,68±14,83% postintervención. Se objetivó significación estadística (p<0,001) al comparar las mediciones pre- y postintervención. Conclusiones La aplicación precoz y continuada de AGHO en el manejo de la PF por sepsis es una práctica eficaz y segura en los casos de población pediátrica analizada. En más de la mitad de los episodios analizados se objetivó un aumento de microcirculación tisular tras la aplicación de los AGHO, sin eventos adversos. (AU)

Introduction Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis. Aim To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis. Material and methods A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4hours over the first three days of the patients’ hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined. Results Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements. Conclusions Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events. (AU)

Nurses’ perceptions of the obstacles and supportive behaviors of end-of-life care in intensive care units / Percepciones de los enfermeros sobre los obstáculos y comportamientos de apoyo de la atención al final de la vida en unidades de cuidados intensivos

Purpose This study examined the Jordanian registered nurses’ perceptions of the obstacles and supportive behaviors of End-of-Life Care in Intensive Care Units and examined the differences in the concepts based on the samples’ demographics. Methods A cross-sectional and comparative study was conducted using a convenience sample of 230 Intensive Care Unit registered nurses in Jordan. Data were analyzed descriptively, and differences were measured using the independent sample t-test, the one-way Analysis of Variance, and Scheffe’s post hoc test. Results The registered nurses’ scored moderately on obstacles (74.98 ± 14.54) and supportive behaviors (69.22 ± 4.84). The commonly perceived obstacle and supportive behaviors to End-of-Life Care in Intensive Care Units s were reported. The perceived obstacles differ based on the registered nurses’ certification as an Intensive Care Units nurse (3.04 ± 0.58 vs. 2.74 ± 0.49, p = 0.008), type of Intensive Care Unit (3.28 ± 0.34 vs. 2.86 ± 0.62, p < 0.001), type of facility (3.16 ± 0.59 vs. 2.77 ± 0.61, p < 0.001), number of beds in the unit (3.07 ± 0.48 vs. 2.69 ± 0.48, p = 0.020), and the number of hours worked per week (3.06 ± 0.56 vs. 2.81 ± 0.60, p = 0.005). In contrast, supportive behaviors only differ based on the registered nurses’ age (3.22 ± 0.69 vs. 2.90 ± 0.64, p = 0.019). Conclusions The common End-of-Life Care perceived obstacle in Intensive Care Units was the lack of nursing education and training regarding the studies concept, which warrants immediate intervention such as on-job training. The common End-of-Life Care perceived supportive behavior in Intensive Care Units was when family members accepted that the patient was dying when nurses offered support to family members; motivational interventions are needed to sustain such behavior. Differences in the perceived obstacles and supportive behaviors should be leveraged for the benefit of patients, nurses, and hospitals. (AU)

Propósito Este estudio examinó las percepciones de las enfermeras registradas jordanas sobre los obstáculos y comportamientos de apoyo de la atención al final de la vida en las Unidades de Cuidados Intensivos y examinó las diferencias en los conceptos basados en la demografía de las muestras. Métodos Se realizó un estudio transversal y comparativo utilizando una muestra de conveniencia de 230 enfermeras registradas en la Unidad de Cuidados Intensivos en Jordania. Los datos se analizaron descriptivamente y las diferencias se midieron mediante la prueba t de muestra independiente, el análisis unidireccional de varianza y la prueba post hoc de Scheffe. Resultados Las enfermeras registradas obtuvieron una puntuación moderada en obstáculos (74,98 ± 14,54) y comportamientos de apoyo (69,22 ± 4,84). Se informaron los obstáculos comúnmente percibidos y los comportamientos de apoyo a la atención al final de la vida en las Unidades de Cuidados Intensivos. Los obstáculos percibidos difieren según la certificación del enfermero registrado como enfermero de las Unidades de Terapia Intensiva (3,04 ± 0,58 vs. 2,74 ± 0,49, p < 0.001), tipo de Unidad de Cuidados Intensivos (3,28 ± 0,34 vs. 2,86 ± 0,62, p < 0.001), tipo de instalación (3,16 ± 0,59 vs. 2,77 ± 0,61, p < 0.001), número de camas en la unidad (3,07 ± 0,48 vs. 2,69 ± 0,48, p = 0,020), y número de horas trabajadas por semana (3,06 ± 0,56 vs. 2,81 ± 0,60, p = 0,005). En contraste, los comportamientos de apoyo solo difieren según la edad de las enfermeras registradas (3,22 ± 0,69 vs. 2,90 ± 0,64, p = 0,019). Conclusiones El obstáculo común percibido en la Atención al Final de la Vida en las Unidades de Terapia Intensiva fue la falta de educación y capacitación de enfermería sobre el concepto de estudios, lo que justifica una intervención inmediata, como la capacitación en el trabajo... (AU)

Encuesta nacional sobre cambios en las políticas de comunicación, visitas y cuidados al final de la vida en las unidades de cuidados intensivos durante las diferentes olas de la pandemia de COVID-19 (estudio COVIFAUCI) / National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study)

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)

Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)

Monitorización de la glucemia en el paciente crítico adulto: tipo de muestra y método de análisis. Revisión sistemática y metanálisis / Blood glucose monitoring in critically ill adult patients: Type of sample and method of analysis. Systematic review and meta-analysis

IntroducciónLa guía clínica para el manejo de la sepsis recomienda usar muestras de sangre arterial para el control glucémico. Un estudio multicéntrico en 86 unidades de cuidados intensivos españolas reveló que el 85,4% de estas utilizaban punción capilar.ObjetivoAnalizar la fiabilidad de la glucemia comparando diferentes muestras sanguíneas (arterial, venosa, capilar) e instrumentos (glucómetros, gasómetros, laboratorio central). Secundariamente, estimar el efecto de variables confusoras y el rendimiento de los instrumentos de medición determinados por las diferentes normas de calidad.MetodologíaRevisión sistemática y metanálisis con búsqueda en las bases de datos PubMed, CINAHL y Embase en septiembre-2021 y septiembre-2022, sin límites temporales ni idiomáticos. Fuentes de literatura gris: DART-Europe, OpenGrey y Google Académico. Resultados resumidos mediante síntesis cualitativa (descripción de resultados, características de los estudios) y cuantitativa (metanálisis para evaluar la diferencia de medias estandarizadas). Calidad metodológica de artículos evaluada con Quality Assessment of Diagnostic Accuracy Studies-2. Protocolo: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultadosSe incluyeron un total de 32 artículos y 5.451 pacientes. No se obtuvieron discrepancias entre muestras arteriales con glucómetro vs. laboratorio (sesgo [IC95%]: 0,01 [−0,12 a 0,14] mg/dL). En cambio, muestras arteriales con gasómetro sí sobreestimaron de forma significativa (sesgo [IC95%]: 0,12 [0,01 a 0,24] mg/dL). La misma tendencia presentan capilares con glucómetro, aunque no de forma significativa (sesgo [IC95%]: 0,07 [−0,02 a 0,15] mg/dL). Hay discrepancia entre los estudios sobre el efecto del hematocrito y el equilibrio ácido-base. El mayor consenso se da en la poca concordancia del glucómetro con muestras capilares vs. laboratorio en presencia de shock y soporte vasopresor, situación de fallo renal o durante el tratamiento con vitamina C.Conclusiones... (AU)

IntroductionThe clinical guideline for the management of sepsis recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units revealed that 85.4% of these used capillary puncture.ObjectiveTo analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards.MethodologySystematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2. Protocol: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultsA total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs. laboratory samples (bias [95%CI]: 0.01 [−0.12 to 0.14] mg/dL). In contrast, arterial samples with a gasometer did significantly overestimate (bias [95%CI]: 0.12 [0.01 to 0.24] mg/dL). The same trend is seen in capillaries with a glucometer, although not significantly (bias [95%CI]: 0.07 [−0.02 to 0.15] mg/dL). There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs. laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment.Conclusions... (AU)

Eficacia y seguridad de un compuesto de ácidos grasos hiperoxigenados en la mejora de la microcirculación de la púrpura fulminante en pacientes pediátricos con sepsis: estudio piloto / Efficacy and safety of a hyperoxygenated fatty acid compound in improving the microcirculation of purpura fulminans in paediatric patients with sepsis: a pilot study

Introducción La púrpura fulminante (PF) es una complicación grave de la sepsis resultado de un conjunto de alteraciones caracterizadas por el desarrollo de lesiones hemorrágicas equimóticas y necrosis de la piel. Objetivo Analizar la eficacia y la seguridad de la aplicación tópica de un compuesto de ácidos grasos hiperoxigenados (AGHO) en la microcirculación de la PF en pacientes pediátricos afectados de sepsis. Material y métodos Se llevó a cabo un estudio prospectivo cuasiexperimental pretest-posttest de un solo grupo en una Unidad de Cuidados Intensivos Pediátrica (UCIP). Se incluyeron en el estudio pacientes con PF de 0 a 18 años. Para evaluar la efectividad del producto objeto de evaluación en la microcirculación de las lesiones por PF se determinaron los valores de oximetría somática antes y después de la aplicación de AGHO cada 4h durante los 3 primeros días de ingreso de los pacientes. Resultados Se reclutaron 4 pacientes, con una mediana de edad de 98 meses. Las lesiones purpúricas que se midieron estaban ubicadas, sobre todo, en ambos pies y manos y, en 2 pacientes, también en los maléolos laterales y gemelos de ambas extremidades inferiores. Se obtuvieron un total de 225 mediciones, observando unas puntuaciones medias preintervención de 71,17±15,65% versus los 73,68±14,83% postintervención. Se objetivó significación estadística (p<0,001) al comparar las mediciones pre- y postintervención. Conclusiones La aplicación precoz y continuada de AGHO en el manejo de la PF por sepsis es una práctica eficaz y segura en los casos de población pediátrica analizada. En más de la mitad de los episodios analizados se objetivó un aumento de microcirculación tisular tras la aplicación de los AGHO, sin eventos adversos. (AU)

Introduction Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis. Aim To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis. Material and methods A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4hours over the first three days of the patients’ hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined. Results Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements. Conclusions Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events. (AU)

Nurses’ perceptions of the obstacles and supportive behaviors of end-of-life care in intensive care units / Percepciones de los enfermeros sobre los obstáculos y comportamientos de apoyo de la atención al final de la vida en unidades de cuidados intensivos

Purpose This study examined the Jordanian registered nurses’ perceptions of the obstacles and supportive behaviors of End-of-Life Care in Intensive Care Units and examined the differences in the concepts based on the samples’ demographics. Methods A cross-sectional and comparative study was conducted using a convenience sample of 230 Intensive Care Unit registered nurses in Jordan. Data were analyzed descriptively, and differences were measured using the independent sample t-test, the one-way Analysis of Variance, and Scheffe’s post hoc test. Results The registered nurses’ scored moderately on obstacles (74.98 ± 14.54) and supportive behaviors (69.22 ± 4.84). The commonly perceived obstacle and supportive behaviors to End-of-Life Care in Intensive Care Units s were reported. The perceived obstacles differ based on the registered nurses’ certification as an Intensive Care Units nurse (3.04 ± 0.58 vs. 2.74 ± 0.49, p = 0.008), type of Intensive Care Unit (3.28 ± 0.34 vs. 2.86 ± 0.62, p < 0.001), type of facility (3.16 ± 0.59 vs. 2.77 ± 0.61, p < 0.001), number of beds in the unit (3.07 ± 0.48 vs. 2.69 ± 0.48, p = 0.020), and the number of hours worked per week (3.06 ± 0.56 vs. 2.81 ± 0.60, p = 0.005). In contrast, supportive behaviors only differ based on the registered nurses’ age (3.22 ± 0.69 vs. 2.90 ± 0.64, p = 0.019). Conclusions The common End-of-Life Care perceived obstacle in Intensive Care Units was the lack of nursing education and training regarding the studies concept, which warrants immediate intervention such as on-job training. The common End-of-Life Care perceived supportive behavior in Intensive Care Units was when family members accepted that the patient was dying when nurses offered support to family members; motivational interventions are needed to sustain such behavior. Differences in the perceived obstacles and supportive behaviors should be leveraged for the benefit of patients, nurses, and hospitals. (AU)

Propósito Este estudio examinó las percepciones de las enfermeras registradas jordanas sobre los obstáculos y comportamientos de apoyo de la atención al final de la vida en las Unidades de Cuidados Intensivos y examinó las diferencias en los conceptos basados en la demografía de las muestras. Métodos Se realizó un estudio transversal y comparativo utilizando una muestra de conveniencia de 230 enfermeras registradas en la Unidad de Cuidados Intensivos en Jordania. Los datos se analizaron descriptivamente y las diferencias se midieron mediante la prueba t de muestra independiente, el análisis unidireccional de varianza y la prueba post hoc de Scheffe. Resultados Las enfermeras registradas obtuvieron una puntuación moderada en obstáculos (74,98 ± 14,54) y comportamientos de apoyo (69,22 ± 4,84). Se informaron los obstáculos comúnmente percibidos y los comportamientos de apoyo a la atención al final de la vida en las Unidades de Cuidados Intensivos. Los obstáculos percibidos difieren según la certificación del enfermero registrado como enfermero de las Unidades de Terapia Intensiva (3,04 ± 0,58 vs. 2,74 ± 0,49, p < 0.001), tipo de Unidad de Cuidados Intensivos (3,28 ± 0,34 vs. 2,86 ± 0,62, p < 0.001), tipo de instalación (3,16 ± 0,59 vs. 2,77 ± 0,61, p < 0.001), número de camas en la unidad (3,07 ± 0,48 vs. 2,69 ± 0,48, p = 0,020), y número de horas trabajadas por semana (3,06 ± 0,56 vs. 2,81 ± 0,60, p = 0,005). En contraste, los comportamientos de apoyo solo difieren según la edad de las enfermeras registradas (3,22 ± 0,69 vs. 2,90 ± 0,64, p = 0,019). Conclusiones El obstáculo común percibido en la Atención al Final de la Vida en las Unidades de Terapia Intensiva fue la falta de educación y capacitación de enfermería sobre el concepto de estudios, lo que justifica una intervención inmediata, como la capacitación en el trabajo... (AU)

Encuesta nacional sobre cambios en las políticas de comunicación, visitas y cuidados al final de la vida en las unidades de cuidados intensivos durante las diferentes olas de la pandemia de COVID-19 (estudio COVIFAUCI) / National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study)

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)

Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)

Monitorización de la glucemia en el paciente crítico adulto: tipo de muestra y método de análisis. Revisión sistemática y metanálisis / Blood glucose monitoring in critically ill adult patients: Type of sample and method of analysis. Systematic review and meta-analysis

IntroducciónLa guía clínica para el manejo de la sepsis recomienda usar muestras de sangre arterial para el control glucémico. Un estudio multicéntrico en 86 unidades de cuidados intensivos españolas reveló que el 85,4% de estas utilizaban punción capilar.ObjetivoAnalizar la fiabilidad de la glucemia comparando diferentes muestras sanguíneas (arterial, venosa, capilar) e instrumentos (glucómetros, gasómetros, laboratorio central). Secundariamente, estimar el efecto de variables confusoras y el rendimiento de los instrumentos de medición determinados por las diferentes normas de calidad.MetodologíaRevisión sistemática y metanálisis con búsqueda en las bases de datos PubMed, CINAHL y Embase en septiembre-2021 y septiembre-2022, sin límites temporales ni idiomáticos. Fuentes de literatura gris: DART-Europe, OpenGrey y Google Académico. Resultados resumidos mediante síntesis cualitativa (descripción de resultados, características de los estudios) y cuantitativa (metanálisis para evaluar la diferencia de medias estandarizadas). Calidad metodológica de artículos evaluada con Quality Assessment of Diagnostic Accuracy Studies-2. Protocolo: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultadosSe incluyeron un total de 32 artículos y 5.451 pacientes. No se obtuvieron discrepancias entre muestras arteriales con glucómetro vs. laboratorio (sesgo [IC95%]: 0,01 [−0,12 a 0,14] mg/dL). En cambio, muestras arteriales con gasómetro sí sobreestimaron de forma significativa (sesgo [IC95%]: 0,12 [0,01 a 0,24] mg/dL). La misma tendencia presentan capilares con glucómetro, aunque no de forma significativa (sesgo [IC95%]: 0,07 [−0,02 a 0,15] mg/dL). Hay discrepancia entre los estudios sobre el efecto del hematocrito y el equilibrio ácido-base. El mayor consenso se da en la poca concordancia del glucómetro con muestras capilares vs. laboratorio en presencia de shock y soporte vasopresor, situación de fallo renal o durante el tratamiento con vitamina C.Conclusiones... (AU)

IntroductionThe clinical guideline for the management of sepsis recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units revealed that 85.4% of these used capillary puncture.ObjectiveTo analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards.MethodologySystematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2. Protocol: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultsA total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs. laboratory samples (bias [95%CI]: 0.01 [−0.12 to 0.14] mg/dL). In contrast, arterial samples with a gasometer did significantly overestimate (bias [95%CI]: 0.12 [0.01 to 0.24] mg/dL). The same trend is seen in capillaries with a glucometer, although not significantly (bias [95%CI]: 0.07 [−0.02 to 0.15] mg/dL). There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs. laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment.Conclusions... (AU)

Non-pharmacological interventions to reduce physical restraints in critical care units.

Physical restraint use in critical care units is a frequent low-value care practice influenced by numerous factors creating a local culture. The translation of evidence-based recommendations into clinical practice is scarce so, the analysis of interventions to de-adopt this practice is needed. This update aims to describe and identify nonpharmacological interventions that contribute to minimising the use of physical restraints in adult critically ill patients. Interventions are classified into two groups: those that include education alone and those that combine training with one or more components (multicomponent interventions). These components include less restrictive restraint alternatives, use of physical and cognitive stimulation, decision support tools, institutional multidisciplinary committees, and team involvement. The heterogeneity in the design of the programmes and the low quality of the evidence of the interventions do not allow us to establish recommendations on their effectiveness. However, multicomponent interventions including training, physical and cognitive stimulation of the patient and a culture change of professionals and the organisations towards making restraints visible might be the most effective. The implementation of these programmes should underpin on a prior analysis of each local context to design the most effective-tailored combination of interventions to help reduce or eliminate them from clinical practice.

Análisis del estado nutricional en pacientes adultos mayoreshospitalizados por COVID-19 en unidades de cuidadosintensivos, Perú, 2020 / Analysis of nutritional status in older adult patients hospitalized for COVID-19 in intensive care units, Perú, 2020

Introducción: El estado nutricional es un indicador del estado de salud y es un elemento de resistencia del organismo frente a enfermedades intercurrentes, incluyendo la COVID-19. Objetivo: Analizar el estado nutricional en pacientes adultos mayores hospitalizados en UCI diagnosticados de COVID-19. Métodos: Se llevó a cabo un estudio transversal entre los meses abril y mayo de 2020. Se determinó y comparó el estado nutricional de un grupo de 83 pacientes adultos mayores con COVID-19. Los datos fueron analizados mediante pruebas de Chi-cuadrado y t-student, considerando un nivel de significancia del 5%. Resultados: Aproximadamente el 42,2% de los pacientes presentaban exceso de peso corporal. La anemia (46,9% vs. 9,8%, p < 0,001) y el riesgo de sarcopenia (45,7% vs. 33,3%, p = 0,011) fueron mayores en las mujeres en comparación a los hombres que presentaban COVID-19. También, los niveles de urea fueron significativamente más bajos en los pacientes con desnutrición en comparación con aquellos que no presentaban desnutrición (37,9 mg/dL vs. 44,1 mg/dL, p = 0,020). Del mismo modo, se encontró que la concentración de leucocitos estuvo más baja en los pacientes con COVID-19 que presentaban desnutrición 9,6 WBC (x10g

Background: Nutritional status is an indicator of healthstatus and an element of the body’s resistance to intercurrentdiseases, including COVID-19.Objective: To analyze the nutritional status in hospitalizedolder adult ICU patients diagnosed with COVID-19.Methods: A cross-sectional study was conducted in aNational Hospital in Metropolitan Lima during the months of April and May 2020. The nutritional status of a group of 83older adult patients with COVID-19 was determined and com-pared. The data were analyzed using Chi-square and t-stu-dent tests, considering a significance level of 5%. Results: Approximately 42.2% of the patients had ex-cess body weight. Anemia (46.9% vs. 9.8%, p < 0.001)and risk of sarcopenia (45.7% vs. 33.3%, p = 0.011) werehigher in women compared to men presenting COVID-19.Furthermore, urea levels were significantly lower in patientswith malnutrition compared to those without malnutrition(37.9 mg/dL vs. 44.1 mg/dL, p = 0.020). Similarly, leuko-cyte concentration was found to be lower in COVID-19 pa-tients with malnutrition 9.6 WBC (x10g

Validez de contenido de la propuesta del diagnóstico de enfermería Sequedad ocular en pacientes adultos internados en la Unidad de Cuidados Intensivos / Content validity of the nursing diagnosis proposal Ocular dryness in adult patients admitted to the intensive care unit

Objetivo: Verificar la validez de contenido de la propuesta del diagnóstico de enfermería “Sequedad ocular” en pacientes adultos internados en una Unidad de Cuidados Intensivos. Materiales y métodos: Se trata de un estudio metodológico de validación de contenido de la propuesta del diagnóstico de enfermería “Sequedad ocular”, operacionalizado a través de un grupo focal. La selección de especialistas tuvo en cuenta la experiencia clínica y/o académica en el área de diagnósticos de enfermería y/o sequedad ocular y/o ojo seco y/o salud ocular, así como el tiempo de actuación con el tema. Fueron invitados 13 enfermeros que cumplieron con los criterios descritos anteriormente, de los cuales 10 aceptaron participar. El enfoque de validación fue por consenso. Los datos fueron analizados mediante estadística descriptiva, nivel de especialización y análisis de elementos diagnósticos. Resultados: Luego del consenso final de los jueces de enfermería en relación a los elementos diagnósticos, se definió una propuesta del diagnóstico “Sequedad ocular” basada en la validez de contenido con una nueva definición, 14 características definitorias, 9 factores relacionados, 2 poblaciones en riesgo y 20 problemas asociados. Además, luego de juzgar la coherencia de los elementos en relación a la estructura diagnóstica, los jueces emitieron el consenso en relación a las definiciones conceptuales y operativas (AU)

Objetivo: Verificar a validade de conteúdo da proposição diagnóstica de enfermagem Ressecamento ocular em pacientes adultos internados em Unidade de Terapia Intensiva. Materiais e métodos: Trata-se de um estudo metodológico de validação de conteúdo da proposição diagnóstica de enfermagem Ressecamento ocular, operacionalizado mediante grupo focal. A seleção dos especialistas levou em consideração a experiência clínica e/ou acadêmica na área de diagnósticos de enfermagem e/ou ressecamento ocular e/ou olho seco e/ou saúde ocular, bem como o tempo de atuação na temática. Foram convidados 13 enfermeiros que se enquadravam nos critérios acima descritos, dos quais 10 aceitaram participar. A abordagem de validação foi por consenso. Os dados foram analisados mediante estatística descritiva, nível de expertise e análise dos elementos diagnósticos. Resultados: Após o consenso final dos enfermeiros juízes em relação aos elementos diagnósticos, foi definida uma proposta do diagnóstico Ressecamento ocular a partir da validade de conteúdo com nova definição, 14 características definidoras, 9 fatores relacionados, 2 populações em risco e 20 condições associadas. Após julgar a coerência dos elementos em relação a estrutura diagnóstica, os juízes emitiram o consenso sobre as definições conceituais e operacionais. Conclusões: O estudo permitiu verificar a validade do conteúdo por juízes da proposição diagnóstica de enfermagem Ressecamento ocular em pacientes em unidades de terapia intensiva, o que favorece o raciocínio diagnóstico do enfermeiro e o planejamento de intervenções efetivas relacionadas a esse diagnóstico, permitindo o manejo do paciente de maneira a proporcionar a integridade ocular (AU)

Objective: to verify the content validity of the nursing diagnosis proposal Ocular dryness in adult patients admitted to an intensive care unit. Materials and methods: this is a methodological study of content validation of the nursing diagnosis proposal Ocular dryness, operationalized through a focus group. The selection of specialists took into account the clinical and/or academic experience in the area of nursing diagnoses and/or ocular dryness and/or dry eye and/or ocular health, as well as the time of performance with the theme. Thirteen nurses who met the criteria described above were invited, of whom 10 agreed to participate. The validation approach was by consensus. Data were analyzed using descriptive statistics, level of expertise and analysis of diagnostic elements. Results: after the final consensus of the nurse judges in relation to the diagnostic elements, a proposal of the diagnosis Ocular dryness was defined based on the validity of content with a new definition, 14 defining characteristics, 9 related factors, 2 populations at risk and 20 associated conditions. In addition, after judging the coherence of the elements in relation to the diagnostic structure, the judges issued the consensus in relation to the conceptual and operational definitions. Conclusions: the study allowed verifying the validity of the content by judges of the nursing diagnosis proposal Ocular dryness in patients in intensive care units, which favors the diagnostic reasoning of nurses and the planning of effective interventions related to this diagnosis, allowing the management of the patients in order to provide ocular integrity (AU)

National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study).

INTRODUCTION: The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies. of communication between family members, patients and professionals. METHODS: Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. RESULTS: 29% of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. CONCLUSIONS: The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context.

Efficacy and safety of a hyperoxygenated fatty acid compound in improving the microcirculation of purpura fulminans in paediatric patients with sepsis: a pilot study.

INTRODUCTION: Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis. AIM: To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis. MATERIAL AND METHODS: A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4h over the first three days of the patients' hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined. RESULTS: Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements. CONCLUSIONS: Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events.

Blood glucose monitoring in critically ill adult patients: type of sample and method of analysis. Systematic review and meta-analysis.

INTRODUCTION: The clinical guideline for the management of sepsis, recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units (ICU) revealed that 85.4% of ICUs used capillary puncture. OBJECTIVE: To analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards. METHODOLOGY: Systematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). PROTOCOL: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP. RESULTS: A total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs laboratory samples [bias (95%CI): 0.01 (-0.12 to 0.14) mg/dL]. In contrast, arterial samples with a gasometer did significantly overestimate [bias (95%CI): 0.12 (0.01 to 0.24) mg/dL]. The same trend is seen in capillaries with a glucometer, although not significantly [bias (95%CI): 0.07 (--0.02 to 0.15) mg/dL]. There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment. CONCLUSIONS: The evidence to date recommends the use of arterial blood with a blood glucose meter for better reliability of glycaemic analysis and less effect of possible confounding variables, frequently present in the critically ill adult patient.