[OPTIMIZATION OF GLUCOSE METABOLISM IN PATIENTS UNDERGOING THERAPEUTIC HYPOTHERMIA AFTER SUDDEN CARDIAC ARREST]. / Optimización del metabolismo glucémico: DE LOS PACIENTES SOMETIDOS A HIPOTERMIA TERAPÉUTICA TRAS UNA PARADA CARDIORRESPIRATORIA.

OBJECTIVE: Therapeutic hypothermia (TH) is recommended to improve survival and neurologic prognosis in sudden cardiac arrest (SCA) survivors. There are few data aboutglycemic levels in these patients. The aim of this study is to evaluate the glycemic control using a specific protocol in this group ofpeople. METHOD: A retrospective analysis of the patients receiving TH in our institution, between January 2010 and March 2013,. was performed. Baseline characteristics, in-hospital prognosis and glycemic levels during different stages of the TH were analyzed. RESULTS: From a total of 55 patients suffering a SCA, 49 patients underwent TH and received a specific insulin protocol. The mean age was 57.5 ± 12.8 years, the main cause of SCA was ischemic (76%) and ventricular fibrillation was the most frequent first rhythm detected (55%). Regarding glycemic alterations as each stage of TH, a high rate of glycemic alteration was observed in the induction stage, decreasing after starting the insulin protocol (induction stage: 95.9%; maintenance stage: 89.8%; rewarming stage: 69.4%; p = 0.001). With respectto clinicresults, there were low rates of severe hypoglycemia (12%), in-hospital mortality (20%) and anoxic encephalopathy (27%), with a high rate of infections (75%). CONCLUSIONS: The implementation of a specific insulin protocol in patients receiving TH contributes to improve the blood glucose levels. Further studies are needed to evaluate the clinical impact of these protocols in this group ofpatients.

Optimización del metabolismo glucémico de los pacientes sometidos a hipotermia terapéutica tras una parada cardiorrespiratoria / Optimization of glucose metabolism in patients undergoing therapeutic hypothermia after sudden cardiac arrest

Objectivo. La hipotermia terapéutica (HT) se recomienda para mejorar el pronóstico vital y neurológico en pacientes que sobreviven a una parada cardiorrespiratoria (PCR). Existen pocos datos acerca de los niveles glucémicos en estos pacientes. El objetivo del estudio es evaluar el control glucémico mediante un protocolo específico para estas personas. Método. Se realizó un análisis retrospectivo de los pacientes que recibieron HT en nuestra institución entre enero de 2010 y marzo de 2013. Se analizaron las características basales, el pronóstico intrahospitalario y la glucemia en las distintas fases de la HT. Resultados. De un total de 55 pacientes que presentaron PCR, 49 se sometieron a HT y recibieron un protocolo específico de control glucémico. La edad media fue 57.5 ± 12.8 años, la principal causa de la PCR fue isquémica (76 %) y la fibrilación ventricular fue el primer ritmo monitorizado más frecuente (55 %). Respecto a las alteraciones glucémicas según cada fase de la HT, se objetivó un elevado porcentaje inicial de alteraciones glucídicas que pudo disminuirse tras la instauración de nuestro protocolo (fase de inducción: 95.9 %; fase de mantenimiento: 89.8 %; fase de recalentamiento: 69.4 %; p = 0.001). En los resultados clínicos destaca un bajo porcentaje de hipoglucemias severas (12 %), mortalidad intrahospitalaria (20 %) y encefalopatía anóxica (27 %), pero un elevado porcentaje de infecciones (75 %). Conclusiones. La instauración de un protocolo de control glucémico específico en los pacientes que reciben HT por una PCR parece mejorar el control glucémico. Se requieren más estudios para evaluar el impacto clínico de esta terapia en estos pacientes (AU)

Objective. Therapeutic hypothermia (TH) is recommended to improve survival and neurologic prognosis in sudden cardiac arrest (SCA) survivors. There are few data about glycemic levels in these patients. The aim of this study is to evaluate the glycemic control using a specific protocol in this group of people. Methods. A retrospective analysis of the patients receiving TH in our institution, between January 2010 and March 2013, was performed. Baseline characteristics, in-hospital prognosis and glycemic levels during different stages of the TH were analyzed. Results. From a total of 55 patients suffering a SCA, 49 patients underwent TH and received a specific insulin protocol. The mean age was 57.5 ± 12.8 years, the main cause of SCA was ischemic (76 %) and ventricular fibrillation was the most frequent first rhythm detected (55 %). Regarding glycemic alterations as each stage of TH, a high rate of glycemic alteration was observed in the induction stage, decreasing after starting the insulin protocol (induction stage: 95.9 %; maintenance stage: 89.8 %; rewarming stage: 69.4 %; p = 0.001). With respect to clinic results, there were low rates of severe hypoglycemia (12 %), in-hospital mortality (20 %) and anoxic encephalopathy (27 %), with a high rate of infections (75 %). Conclusions. The implementation of a specific insulin protocol in patients receiving TH contributes to improve the blood glucose levels. Further studies are needed to evaluate the clinical impact of these protocols in this group of patients (AU)

Optimización del metabolismo glucémico de los pacientes sometidos a hipotermia terapética tras una parada cardiorrespiratoria / Optimization of glucose metabolism in patients undergoing therapeutic hypothermia after sudden cardiac arrest

Objetivo. La hipotermia terapéutica (HT) se recomienda para mejorar el pronóstico vital y neurológico en pacientes que sobreviven a una parada cardiorrespiratoria (PCR). Existen pocos datos acerca de los niveles glucémicos en estos pacientes. El objetivo del estudio es evaluar el control glucémico mediante un protocolo específico para estas personas. Método. Se realizó un análisis retrospectivo de los pacientes que recibieron HT en nuestra institución entre enero de 2010 y marzo de 2013. Se analizaron las características basales, el pronóstico intrahospitalario y la glucemia en las distintas fases de la HT. Resultados. De un total de 55 pacientes que presentaron PCR, 49 se sometieron a HT y recibieron un protocolo específico de control glucémico. La edad media fue 57.5 ± 12.8 años, la principal causa de la PCR fue isquémica (76 %) y la fibrilación ventricular fue el primer ritmo monitorizado más frecuente (55 %). Respecto a las alteraciones glucémicas según cada fase de la HT, se objetivó un elevado porcentaje inicial de alteraciones glucídicas que pudo disminuirse tras la instauración de nuestro protocolo (fase de inducción: 95.9 %; fase de mantenimiento: 89.8 %; fase de recalentamiento: 69.4 %; p = 0.001). En los resultados clínicos destaca un bajo porcentaje de hipoglucemias severas (12 %), mortalidad intrahospitalaria (20 %) y encefalopatía anóxica (27 %), pero un elevado porcentaje de infecciones (75 %). Conclusiones. La instauración de un protocolo de control glucémico específico en los pacientes que reciben HT por una PCR parece mejorar el control glucémico. Se requieren más estudios para evaluar el impacto clínico de esta terapia en estos pacientes (AU)

Objective. Therapeutic hypothermia (TH) is recommended to improve survival and neurologic prognosis in sudden cardiac arrest (SCA) survivors. There are few data about glycemic levels in these patients. The aim of this study is to evaluate the glycemic control using a specific protocol in this group of people. Method. A retrospective analysis of the patients receiving TH in our institution, between January 2010 and March 2013, was performed. Baseline characteristics, in-hospital prognosis and glycemic levels during different stages of the TH were analyzed. Results. From a total of 55 patients suffering a SCA, 49 patients underwent TH and received a specific insulin protocol. The mean age was 57.5 ± 12.8 years, the main cause of SCA was ischemic (76 %) and ventricular fibrillation was the most frequent first rhythm detected (55 %). Regarding glycemic alterations as each stage of TH, a high rate of glycemic alteration was observed in the induction stage, decreasing after starting the insulin protocol (induction stage: 95.9 %; maintenance stage: 89.8 %; rewarming stage: 69.4 %; p = 0.001). With respect to clinic results, there were low rates of severe hypoglycemia (12 %), in-hospital mortality (20 %) and anoxic encephalopathy (27 %), with a high rate of infections (75 %). Conclusions. The implementation of a specific insulin protocol in patients receiving TH contributes to improve the blood glucose levels. Further studies are needed to evaluate the clinical impact of these protocols in this group of patients (AU)

Valoración de la carga de trabajo de Enfermería en pacientes sometidos a hipotermia terapéutica / Evaluation of nurse workload in patients undergoing therapeutic hypothermia

OBJETIVO: La hipotermia terapéutica (HT) se recomienda para minimizar el daño neurológico de pacientes que sobreviven a una parada cardiorrespiratoria (PCR). Existen pocos datos que evalúen la carga de trabajo de Enfermería en estos pacientes. El objetivo del estudio es evaluar la carga de trabajo del personal de Enfermería en pacientes sometidos a HT tras una PCR. MÉTODO: Se diseñó un estudio prospectivo-retrospectivo comparativo de cohortes durante 43 meses donde se incluyeron todos los pacientes ingresados en unidades de cuidados intensivos con PCR recuperada. Se compararon características basales, manejo médico, mortalidad intrahospitalaria, y carga de trabajo de Enfermería en las primeras 96 horas mediante las escalas validadas Therapeutic Intervention Scoring System-28 (TISS-28); Nursing Activities Score (NAS); y Nine Equivalents of Nursing Manpower Use Score (NEMS) entre aquellos pacientes tratados y no tratados mediante HT. RESULTADOS: Se incluyeron 46 pacientes: 26 en el grupo HT y 20 en el grupo no HT. El grupo HT presentó mayor prevalencia de tabaquismo (69 vs. 25%, p = 0,012), PCR extrahospitalaria (96 vs. 55%, p < 0,001) y realización de coronariografías (96 vs. 65%, p = 0,014). No hubo diferencias en la carga de trabajo evaluada por las escalas TISS 28, NAS o NEMS ni tampoco en el pronóstico intrahospitalario. CONCLUSIONES: En este estudio la realización de HT en pacientes que sobreviven a una PCR no se asocia con un aumento de la carga de trabajo de Enfermería. La instauración de programas de HT no requeriría la implementación de más recursos en Enfermería en términos de carga de trabajo

OBJECTIVE: Therapeutic hypothermia (TH) is recommended to minimize neurological damage in patients surviving sudden cardiac arrest (SCA). There is scarcity of data evaluating the nursing workload in these patients. The objective of the study is to assess the workload of nurses whilst treating patients undergoing TH after SCA. METHOD: A 43-month prospective-retrospective comparative cohort study was designed. Patients admitted to intensive care unit, for recovered SCA and persistent coma, were included. A comparison was made using the baseline characteristics, medical management, in-hospital mortality, and nursing workload during the first 96 hours using the Therapeutic Intervention Scoring System-28 (TISS-28); Nursing Activities Score (NAS); and Nine Equivalents of Nursing Manpower Use Score (NEMS) scales among patients who received TH and those who did not. RESULTS: A total 46 patients were included: 26 in the TH group and 20 in the Non-TH group. Regarding baseline characteristics and management, the TH group presented higher prevalence of smoking habit (69 vs. 25%, p = 0 .012), out-of-hospital SCA (96 vs. 55%, p < 0 .001), and the performance of coronary angiography (96 vs. 65%, p = 0 .014) compared with the non-TH group. No differences were observed in the nursing workload, assessed by TISS 28, NAS or NEMS scales, or in-hospital mortality. CONCLUSIONS: In this study performance of TH in SCA survivors is not associated with an increase in nursing workload. The installation of a TH program does not require the use of more nursing resources in terms of workload

[Evaluation of nurse workload in patients undergoing therapeutic hypothermia]. / Valoración de la carga de trabajo de Enfermería en pacientes sometidos a hipotermia terapéutica.

OBJECTIVE: Therapeutic hypothermia (TH) is recommended to minimize neurological damage in patients surviving sudden cardiac arrest (SCA). There is scarcity of data evaluating the nursing workload in these patients. The objective of the study is to assess the workload of nurses whilst treating patients undergoing TH after SCA. METHOD: A 43-month prospective-retrospective comparative cohort study was designed. Patients admitted to intensive care unit, for recovered SCA and persistent coma, were included. A comparison was made using the baseline characteristics, medical management, in-hospital mortality, and nursing workload during the first 96hours using the Therapeutic Intervention Scoring System-28 (TISS-28); Nursing Activities Score (NAS); and Nine Equivalents of Nursing Manpower Use Score (NEMS) scales among patients who received TH and those who did not. RESULTS: A total 46 patients were included: 26 in the TH group and 20 in the Non-TH group. Regarding baseline characteristics and management, the TH group presented higher prevalence of smoking habit (69 vs. 25%, p=0.012), out-of-hospital SCA (96 vs. 55%, p<0.001), and the performance of coronary angiography (96 vs. 65%, p=0.014) compared with the non-TH group. No differences were observed in the nursing workload, assessed by TISS 28, NAS or NEMS scales, or in-hospital mortality. CONCLUSIONS: In this study performance of TH in SCA survivors is not associated with an increase in nursing workload. The installation of a TH program does not require the use of more nursing resources in terms of workload.