Septic complications in patients of traumatic brain injury: An impact on clinical and functional outcome

Background: Septic complications in traumatic brain injury causes short- and long-term cerebral dysregulation by disruption of blood brain barrier, reduced brain perfusion, neuroinflammation and deposition of amyloid. Materials and methods: The present study attempted to observe patients of traumatic brain injury for the development of septic complications during the hospital stay. 89 patients were included in the study with different grades of brain injury (Injury Severity Score (ISS) range, 9-72). The patients were managed according to the trauma protocol and classified into 3 groups based on the severity of trauma (ISS 9-17 (moderate), 18-30 (severe), and >32 (most severe)). The patients were observed for the development of major septic complications during the course of their hospital stay, which impacted on the morbidity and mortality while determining the clinical and functional outcome at the end. Results: Mean age of the study population was 33.5 years. TBI was more common in younger age groups with severe grades of injury, those with multiplicity of head injuries, sepsis with a pulmonary focus, prolonged ICU and in-hospital stay together with high mortality. Septic complications were also more common in cases with higher grades of TBI and more prolonged hospital stay. Patients requiring intubation had a higher risk of developing infectious complications. 69 patients (77.5%) required intubation and mechanical ventilation. Pneumonia was the most common source of sepsis leading to the respiratory failure while the most common cause being aspiration at the time of injury Genitourinary complications were also common leading to urosepsis. Most common organisms isolated were Staphylococcus aureus, Acinetobacter, klebsiella and Pseudomonas. Conclusion: Traumatic brain injury (TBI) when complicated by sepsis and multi organ failure increases the mortality and morbidity with less favorable clinical and functional outcome together with increased duration of ICU and hospital stay.

Plan de cuidado de enfermería para el paciente al final de la vida en la Unidad de Cuidado Intensivo / Nursing care plan for the patient at the end of life in the Intensive Care Unit

Introducción: Las UCI son unidades especializadas para la atención de personas en estado crítico de salud. Sin embargo, no todos los pacientes que ingresan son susceptibles de recuperación y muchos de estos experimentan la última etapa de la vida en estas unidades. El cuidado de enfermería se da desde el origen hasta el final de la vida. Esta etapa requiere de preparación por parte de los enfermeros para brindar cuidados acordes con las necesidades del paciente y su familia. En estos momentos tan trascendentales de la vida, es necesario preservar la dignidad y el respeto ante todo, proporcionando comodidad, bienestar y alivio del sufrimiento y facilitando la presencia de los familiares. La presente propuesta, enmarcada desde la perspectiva teórica de Ruland y Moore, representa un aporte significativo a la praxis de enfermería en la Unidad de Cuidado Intensivo. Objetivo General: Diseñar un plan de cuidado de enfermería para el paciente al final de la vida en la Unidad de Cuidado Intensivo, desde la perspectiva teórica del Final tranquilo de la vida, de Ruland y Moore. Metodología: Se diseña un plan de cuidado de enfermería para el paciente que se encuentra al final de la vida en la Unidad de Cuidado Intensivo (UCI), según los conceptos de experiencia de dignidad y respeto y proximidad de los seres queridos, desde la perspectiva teórica de Ruland y Moore. El plan de cuidado se elabora de acuerdo a la revisión de la literatura científica, la estructura del Proceso de Atención de Enfermería (PAE) y las interrelaciones de las taxonomías NNN: North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) y Nursing Outcomes Classification (NOC). Resultados: Se realizó una revisión integrada de la literatura considerando los siguientes criterios de inclusión: paciente adulto al final de la vida en la UCI; artículos en español, inglés y portugués, publicados en bases de datos reconocidas en salud y revistas indexadas. Criterios de exclusión: paciente pediátrico y adolescente. Las bases de datos consultadas fueron: Academic Search Complete (EBSCO), Biblioteca Virtual en Salud (BVS), Dialnet, Embase, Medline (EBSCO), Ovid Nursing, Pubmed, Redalyc, Science Direct, SciELO y Wiley Online Library, así como libros relacionados con el tema de interés y literatura gris. Se obtuvieron 448 piezas científicas, de las cuales se seleccionaron 62 artículos. De acuerdo con los criterios de inclusión, se construyó una base de datos en el programa Microsoft Excel® , en la cual se clasificaron los artículos seleccionados. Posterior al análisis, se obtuvieron las siguientes temáticas: Cuidado de enfermería; Cuidado paliativo; Final tranquilo de la vida; Cuidado intensivo y Familia del paciente crítico. En relación con los hallazgos de la literatura científica sobre los cuidados al final de la vida en la UCI, el Proceso de Atención de Enfermería (PAE) y las interrelaciones de la taxonomía NANDA, NIC y NOC, se procedió a diseñar el Plan de cuidado de enfermería para el paciente que se encuentra al final de la vida en la UCI, a partir de los conceptos Experiencia de dignidad y respeto y proximidad de los allegados, seres queridos y/o cuidadores, desde la perspectiva teórica de Ruland y Moore. Conclusiones: Es necesario fortalecer la formación de los profesionales de la salud en relación con los cuidados al final de la vida tanto en la Academia como en las instituciones de salud. Es imprescindible incluir los cuidados paliativos intensivos, la aplicación del Proceso de Atención de Enfermería (PAE) y el uso del lenguaje estandarizado (NANDA, NIC y NOC). Se debe integrar la teoría, la investigación y la práctica de Enfermería. El plan de cuidado de enfermería para el paciente al final de la vida en la UCI constituye una herramienta de gran utilidad para el profesional de enfermería sensible y consciente del valor que tiene proporcionar cuidados dirigidos a preservar la dignidad humana. Debe ser individualizado según la condición y las necesidades de cada paciente y su familia y representar un aporte para la puesta en práctica de los conceptos de Experiencia de dignidad y respeto y proximidad de los allegados, seres queridos y/o cuidadores que contribuyen al logro del final tranquilo de la vida, como lo plantean Ruland y Moore en su teoría descriptiva de mediano rango. (AU)

Introduction: ICUs are specialized units for caring for critically ill patients. However, not all patients admitted are susceptible to recovery and many of them experience their endof-life stage in these units. Nursing care is given since the beginning to the end of life. This stage requires preparation by nursing professionals to provide caring according to patient and family needs. In those difficult times of life, it is necessary to keep dignity and respect by providing comfort, well-being and suffering relief, facilitating the presence of family members. This proposal, framed from the Ruland and Moore׳s theoretical perspective, represents a significant contribution to nursing practice in the Intensive Care Unit. Objective: To design a Nursing Care Plan for end-of-life patient who has been in Intensive Care Unit, in accordance with Ruland and Moore׳s theory of the peaceful end of life. Methodology: A nursing care plan is designed for end-of-life patient who has been Intensive Care Unit (ICU), according to the dignity, respect and closeness concepts derived from Ruland and Moore׳s theoretical perspective. The plan of care is developed based on a scientific literature review, the Nursing Care Process (NPM) structure, and the interrelationships of the NNN taxonomies: North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). Results: An integrative review was performed considering the following inclusion criteria: end-of-life adult patient who has been in ICU; Spanish, English and Portuguese articles, published indexed health databases and journals. Exclusion criteria were pediatric and adolescent patient. The databases consulted were as follows: Academic Search Complete (EBSCO), Virtual Health Library (VHL), Dialnet, Embase, MedLine (EBSCO), Ovid Nursing, Pubmed, Redalyc, Science Direct, SciELO and Wiley Online Library, as well as books related to the topic of interest and grey literature. A total of 448 scientific articles were obtained, of which 62 were selected. According to the inclusion criteria, a database was built in the Microsoft Excel® program, in which the selected articles were classified. After completing the analysis, the following topics were obtained: Nursing Care; Palliative Care; Peaceful End of Life; Intensive Care; and Critically Ill Family Patients. In relation to the findings of the scientific literature on end-of-life care in the ICU, the Nursing Care Process (NPM) and the interrelationships of the NANDA, NIC and NOC taxonomy. Nursing Care Plan for or end-of-life patient who has been Intensive Care Unit (ICU) was designed based on Experience of Dignity and Respect and Proximity of Relatives, and Loved Ones and/or Caregivers concepts, derived from Ruland and Moored and and/or Care who has. Conclusions: It is necessary to strengthen health professionals training according to end-of-life care both in the Academy and in health institutions. It is imperative to include intensive palliative care, the application of the Nursing Care Process (NPM) and the use of standardized language (NANDA, NIC and NOC). Nursing theory, research and practice must be integrated. The ICU's end-of-life nursing care plan is a very useful tool for the sensitive and value-conscious nurse practitioner in providing care aimed at preserving human dignity. It should be individualized according to the condition and needs of each patient and their family and represent a contribution to the implementation of the concepts of the experience of dignity and respect and closeness of those close to them, loved ones and/or caregivers who contribute to the achievement of the peaceful end-of-life, as proposed by descriptive theory of mid-range Ruland and Moore.(AU)

Facilidades e dificuldades do trabalho em terapia intensiva: um olhar da equipe de enfermagem / Facilidades y dificultades del trabajo en terapia intensiva: desde una perspectiva del equipo de enfermería / Difficulties and facilities in intensive care work: a nursing staff’s perspective

Objective: to recognize the facilities and difficulties met in the every day work routine of the nursing staff of an adult Intensive Care Unit (ICU). Method: exploratory-descriptive study of qualitative approach. The data were collected with 11 nursing workers of an adult ICU of a university hospital, between June and July, 2012, through a semi-structured interview. The findings were analyzed based on content analysis. Results: several factors interfere in the development of the work, among them, facilities are: the use of technology and the small and restricted environment. Obstacles faced by the subjects were: personal conflicts, lack of commitment among colleagues and lack of human resources and of materials. Conclusion: despite of the difficulties found during the development of ICU work, this activity is still seen as something rewarding by the nursing workers...

Objetivo: conhecer facilidades e dificuldades encontradas no cotidiano de trabalho da equipe de enfermagem de uma UTI Adulto. Método: estudo descritivo-exploratório de abordagem qualitativa. Os dados foram coletados com 11 trabalhadores de enfermagem, de uma UTI Adulto de um hospital universitário, entre os meses de junho e julho de 2012, por meio de entrevista semiestruturada. Os achados foram analisados por meio de análise de conteúdo. Resultados: diversos fatores interferem no desenvolvimento do trabalho, dentre eles, atribui-se como facilitadores:o uso da tecnologia, o ambiente pequeno e fechado. Já, os conflitos pessoais, a falta de comprometimento de colegas e a carência de recursos humanos e materiais surgem como alguns obstáculos enfrentados pelos sujeitos. Conclusão: conclui-se que apesar de muitas dificuldades serem encontradas para o desenvolvimento do trabalho em UTI, essa atividade ainda é vista, pelos trabalhadores de enfermagem, como algo gratificante...

Objetivo: conocer facilidades y dificultades encontradas en el trabajo diario del equipo de enfermería de una UTI Adulto. Método: estudio descriptivo exploratorio de abordaje cualitativo. Los datos fueron recolectados con 11 trabajadores de enfermería, de una UTI Adulto de un hospital universitario, entre los meses de junio y julio de 2012, por medio de entrevistas semiestructuradas. Los resultados fueron analizados por medio de análisis de contenido. Resultados: diversos factores interfieren en el desarrollo del trabajo, entre ellos, se atribuyen como facilitadores: el uso de la tecnología, el ambiente pequeño y cerrado. Ya, los conflictos personales, la falta de comprometimiento de compañeros y la carencia de recursos humanos y materiales surgen como algunos obstáculos enfrentados por los sujetos. Conclusión: se concluye que apesar de las varias dificultades encontradas para el desarrollo del trabajo en UTI, esa actividad aún es vista, por los trabajadores de enfermaría, como algo gratificante...

Dificuldades e conhecimento dos enfermeiros intensivistas acerca do pacote de 6 horas de sepse: uma proposta de capacitação / Difficulties and knowledge of critical care nurses about the package of six hours of sepsis: a training proposal

Atualmente a Sepse mata cerca 24 mil pessoas por dia no mundo; a Educação a Distância (EAD) é cada vez mais utilizada como ferramenta de ensino. O objetivo foi identificar as lacunas teórico-operacionais relativos à aplicação do protocolo de sepse por enfermeiros intensivistas. Trata-se de uma pesquisa de campo, quantitativa, descritiva e exploratória com 27 enfermeiros atuantes em Unidades de Terapia Intensiva (UTI) em Manaus-Am; foi aplicado questionário com questões fechadas. O estudo revelou que os enfermeiros apresentaram dificuldades em relação a execução do protocolo, e lacunas de conhecimento. Oe acordo com as demandas foi proposto um programa de capacitação em EaO, a respeito dos pacotes de cuidados em Protocolo de Sepse, segundo os critérios da Surviving Sepsis Campaign (SSC),lnstituto Latino Americano da Sepse (ILAS) o curso foi estruturado em dois módulos de 30horas, o primeiro denominado" Princípio de aprendizagem para entender a sepse" e o segundo "Garantindo a aprendizagem para iniciar o protocolo de sepse"...

Currently Sepsis kills about 24,000 people day in the world; Distance Learning (ODL) is increasingly used for education, technological innovation and communication; The aim of this study was to identify difficulties nurses intensive care (EI) related to sepsis in the work unit, the 6-hour sepsis bundle, specific signs and symptoms of sepsis, proposing OOL course in sepsis for nurses; it is a field research with 27 "EI" active in Intensive Care Units (ICU) in the Unified Health System (SUS), in Manaus-Am; Questionnaires were applied with closed questions; for data analysis was descriptive and inferential statistics used; The study showed good perception of nurses on the bundle; it was found difficulties in relation to the proposed objectives, the knowledge test the successes of respondents to diminished those who possessed more experience in ICU. This study allows us to elucidate that corporative education is needed; care packets will impact the efficacy of treatment of that patient...

Actualmente sepsis mata a unas 24.000 personas ai día en el mundo; La educación a distancia (LED) se utiliza cada vez más como una herramienta de enserianza. El objetivo de identificar los vacíos teóricos y operacionales sobre la aplicación dei protocolo de sepsis para las enfermeras de cuidados críticos. Este es un campo de investigación, cuantitativo, descriptivo y exploratorio con 27 enfermeras que trabajan en unidades de cuidados intensivos (UCI) en Manaus-Am; Se aplicó cuestionario con preguntas cerradas. El estudio mostró que Ias enfermeras tuvieron dificultades en relación con la implementación dei protocolo, y las lagunas de conocimiento. Oe acuerdo con las demandas propuesto un programa de formación en educación a distancia, sobre los paquetes de cuidado dei Protocolo de sepsis, de acuerdo con los criterios de la Carnpana Sobrevivi r a la Sepsis (SSC), el Instituto Latinoamericano de Ia sepsis (ILAS) el curso se estructuró en dos 30 hrs módulos, el primero llamado "Principio de aprendizaje para entender la sepsis" y el segundo "Garantizar el aprendizaje para iniciar el protocolo de sepsis"...

Guía de Práctica Clínica para el Cuidado de Enfermería a la familia del paciente pediátrico en la UCI / Clinical Practice Guideline for Nursing Care for the family of pediatric patients in the ICU

La enfermedad crítica de los niños y su ingreso a la Unidad de Cuidados Intensivos (UCI) afecta de manera negativa a las familias. Enfermería tiene un papel importante frente a las necesidades de estas familias, identificándolas y valorándolas oportunamente para ser intervenidas y satisfechas. Este estudio propone una Guía de Práctica Clínica (GPC) basada en la evidencia científica con recomendaciones fiables, esenciales para el Cuidado de Enfermería a la familia del niño hospitalizado en la UCI. Para su elaboración se identificaron 12 temas de interés, a partir del consenso de expertos, agrupados en 4 categorías con un total de 29 preguntas en formato PICO. Se realizó una búsqueda de literatura en 16 bases de datos, 1 motor de búsqueda y 1 revista indexada, utilizando palabras claves en español e inglés. Se seleccionaron 43 de 279 estudios revisados, mediante el análisis y la aplicación de una lista de chequeo que evaluaba la calidad del estudio dependiendo de la metodología utilizada. Posteriormente se calificó el nivel de evidencia teniendo como referencia el sistema de clasificación de la SIGN. Las piezas investigativas, directamente relacionadas con el tema de interés, dieron respuesta a las preguntas y permitieron establecer 47 recomendaciones. En general, la evidencia científica encontrada corresponde a los niveles 1+, 2++, 2+, 3 y 4 según la clasificación SIGN y las recomendaciones generadas son grado B, C y D.

The critical illness of children and their admission to the Intensive Care Unit (ICU) negatively affects families. Nursing plays an important role in addressing the needs of these families, identifying and assessing them in a timely manner to be intervined and satisfied. This study proposes a Clinical Practice Guideline (CPG) based on the scientific evidence with reliable and essential recommendations for Nursing Care to the family of the child hospitalized in the ICU. For its elaboration, 12 topics of interest were identified, based on the consensus of experts, grouped into 4 categories with a total of 29 questions in PICO format. The literature search was carried out on 16 databases, 1 search engine and 1 indexed journal, using key words in Spanish and English. 43 of 279 studies reviewed were selected, through analysis and application of a checklist that evaluated the quality of the study depending on the methodology used. Subsequently, the level of evidence was rated based on the classification system of the SIGN. The pieces of research, directly related to the topic of interest, answered the questions and allowed 47 recommendations. In general, the evidence corresponds to levels 1+, 2++, 2+, 3 and 4 according to the SIGN classification and the recommendations generated are grade B, C and D.

Recent Trends in Antimicrobial Resistance in Intensive Care Units in Korea / 병원감염관리

BACKGROUND: In general, higher resistance rates are observed among intensive care unit (ICU) isolates than non-ICU isolates. In this study, resistance rates of isolates from ICUs and non-ICUs were compared using the data generated from 20 hospitals in Korea. METHODS: Susceptibility data were collected from 20 hospitals participating in the Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) program. Duplicate isolates were excluded from the analysis. The resistance rates did not include intermediate susceptibility. RESULTS: The most prevalent bacteria in the ICUs were Staphylococcus aureus (21%) and Acinetobacter spp. (19%), and those in non-ICU were Escherichia coli (27%) and S. aureus (14%). The resistance rates were higher in ICUs than in non-ICUs at 84% and 58% for methicillin-resistant S. aureus, 86% and 70% for methicillin-resistant coagulase-negative Staphylcoccus (CNS), 34% and 19% for vancomycin-resistant Enterococcus faecium, 38% and 19% for cefotaxime-resistant E. coli, 45% and 25% for cefotaxime-resistant Klebsiella pneumoniae, 42% and 24% for ceftazidime-resistant Enterobacter cloacae, 29% and 11% for ceftazidime-resistant Serattia marcescens, 83% and 44% for imipenem-resistant Acinetobacter spp., and 32% and 17% for imipenem-resistant Pseudomonas aeruginosa, respectively. CONCLUSION: The most prevalent bacteria in ICUs were S. aureus, CNS, and Acinetobacter spp., and high multi-drug resistance rates were observed in the Acinetobacter isolates. Therefore, infection control should be practiced in ICUs to prevent infections caused by multi-drug resistant bacteria.