[Detection of risks for the safety of the patients in the implementation of continuous techniques of extracorporeal depuration (CTED)]. / Detección de riesgos para la seguridad del paciente en la implementación de técnicas continuas de depuración extracorpórea.

INTRODUCTION: Continuous techniques of extracorporeal depuration (CTED) manage high volumes of fluid exchange and extensive control of its safety is required. OBJECTIVE: To detect the risks of CTED and to determine its frequency per patient. MATERIAL AND METHODS: An observational, retrospective study was performed. Inclusion criteria were patients admitted from January 2009 to December 2009, with CTED in the Polyvalent Intensive Care Unit (ICU) of the Hospital 12 de Octubre. We previously identified 10 risks that were detectable in the clinical records. We analyzed demographic and treatment variables. The quantitative variables were expressed as mean±SD and the qualitative ones as absolute and relative frequencies. ANALYSIS: SPSS 15.0(®). RESULTS: A total of 54 patients (11.7%), with ages 59.78±14.8, 42 men (77.8%) were included. In 81.4%, the indication was acute kidney failure; 80.3% were treated with hemodiafiltration. Mean hours of CTED were 112.9±139.9 and the medium of 2 filters per patient (recommended intakes 0-31). Risk/patient rate was: 100% of patients without monitoring of the Mg and P, and 3.7% (n=2) urea; in 16 (29.6%), there was coagulation of the circuit prior to 24 hours and in 25 (46.3%) the blood could not be returned; in 14 (29.3%), written regime was always lacking on the order for treatment. The dose was not reflected on the patient's chart in 2 (3.7%); in 3 patients (5.6%) with coagulation disorder, anticoagulants were prescribed in the circuit. In 1 (1.9%) bleeding was observed and in 10 (18.5%) there was mild hypothermia (35-32°C). CONCLUSIONS: A standardized monitoring of the Mg and P is required. The therapy should be prescribed in the medical treatment. The technique needs to be improved in order to prolong its duration and avoid blood losses.

[Evaluation of the compliance of semirecumbent position between 30-45° in intubated patients]. / Evaluación del cumplimiento de cabeceros elevados entre 30-45° en pacientes intubados.

AIMS: To determine compliance of the standard "semirecumbent position between 30-45° in patients with artificial airway (AA)". To know the opinion of the professionals on this issue. MATERIAL AND METHODS: An observational, prospective study was carried out in December 2009 in the ICU department of a tertiary hospital that excluded the limitation of therapeutic effort, prone position and antitrendelemburg. DATA COLLECTED: headrest angle, professional experience of the nurse, shift, perception of the auditor, diagnostic, type of AA (tracheostomy or endotracheal tube), mechanical ventilation (MV) (yes/no) and enteral nutrition (EN). Nurses were surveyed to verify if they knew the standard, if they complied with it, the method used and their suggestions. We used the Student's t test and ANOVA for multivariable analysis, and Fisher's χ2; p<0.05=significant. RESULTS: A total of 546 valid measurements were obtained from 53 patients, of which 40.9% had the correct semirecumbent position (30-45°). Professionals with <1 year of experience were those who raised the headrest the least, with only 26.4% of these measurements over 30°. The standard was met in only 34.8% of the neurocritical patients (NC) vs non NC (46.7%) (p<0.05). It was <30° in 29.2% of patients with tracheostomy vs 44% measurements performed on patients with TOT (p<0.05). There were no differences between shifts, the use of MV or EN. Diagnostic accuracy of the auditor: sensitivity: 91.6%; specificity: 72.5%; positive predictive value: 70.2%; negative predictive value (NPV): 92.4%. 97.9% of responders know the standard. Visual judgment was used in 97.2% of the cases. CONCLUSIONS: Measured compliance was less than 50% although the standard is well known by the nursing team. Even though the subjective perception has a high NPV, it does not achieve the standard.

[Pressure monitoring in continuous renal replacement therapy]. / Monitorización de presiones en técnicas continuas de depuración extrarrenal.

INTRODUCTION: Continuous renal replacement therapy (CRRT) has experienced significant advances that have lead to an increase of its indications and improved the technology used in continued pressures monitoring. AIM: This study has aimed to discover if there are any associations between the increase of the circuit pressures and their duration. MATERIALS AND METHODS: A prospective, longitudinal analytic pilot study was conducted in an Intensive Care Unit of a university hospital from October 2008 to April 2009. The study analyzed the patient's information with CRRT and the hourly values of entry pressure (EP), comeback pressure (CP), transmembrane pressure (TMP) and pre-filter pressure (PFP). The Spearman correlation and the Student's T test were used. RESULTS: The study analyzed 44 sets corresponding to 11 patients (45.5% men and 54.5% women) with a life expectancy of 62 years. The same light catheter GamCath (11 French) and Continuous Venovenous Hemodiafiltration (CVVHDF) therapy were used in all patients. The mean duration of the circuits was 39 h. Mean, median, maximum and minimum values of the sample pressures were: EP:-52.17; -52.57; 160; -256 (millimeters of mercury) mmHg]; CP: (98.6; 95.3; 323; -2 mmHg); TMP: (58.57; 58.52; 245; -20 mmHg) and PFP: (161.76; 159.42; 375; -13 mmHg), respectively. CONCLUSIONS: A negative correlation was demonstrated between the duration of the sets and the mean CP and PFP. The sample obtained circuits withdrawn due to finished treatment (72 h), and by coagulation or changes in pressures.

[Analysis of 4 sedation rating scales in the critical patient]. / Análisis de 4 escalas de valoración de la sedación en el paciente crítico.

BACKGROUND: This study aimed to verify the relationship between different Sedation Rating Scales (SRSs) for critical patients on mechanical ventilation and to know the relationship between the SRSs, clinical information and the dose of sedative and analgesia drugs (SAD). MATERIAL AND METHODS: A longitudinal, prospective analytic pilot study conducted in a Medical-Surgical Intensive Care Unit of a tertiary hospital from October-December 2006. The sample included patients who required administration of SAP and mechanical ventilation. The following biological parameters and scales were evaluated: patient's demographics, RAMSAY, Sedation Agitation Scale (SAS), Richmond Agitation Sedation Scale (RASS), Motor Activity Assessment Scale (MASS), SAD dose, mean blood pressure, cardiac rate, pupil diameter and respiratory frequency. Spearman coefficient of interrelation was used to compare the relationship between the different scales. RESULTS: A total of 2.412 measurements were made for each variable: SRS, clinical information and SAD dose in 30 patients with different diseases, 63 % males, age 52 +/- 19 years, APACHEII 24 +/- 8, SAPSII 44 +/- 16, with an ICU mortality UCI 34 %. Median and IQ range of stay in ICU 15.5 and 20 days, of mechanical ventilation 9 and 14 days, of SAD 6 and 5.5 days and of paralyzing drugs (PD) 2 and 5 days, respectively. Interrelation was detected between all the SRSs, with p < 0.0001. The relationship between SAS, RASS and MASS was direct, whereas these were related inversely to RAMSAY. No evidence of interrelation was found between the SRSs, the clinical information and the SAD doses. CONCLUSION: The RAMSAY scale that has not been validated in ICU patients has a strong interrelation with the other already validated SRSs. SRSs are subjective and do not correlate with the clinical information and the SAD doses, probably due to the sample's small size and heterogeneity.