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

IntroducciónLas técnicas de depuración extrarrenal han obtenido grandes avances que han conseguido una ampliación de las indicaciones y una mejora en la tecnología de la monitorización continua de las presiones.ObjetivoEl objetivo del estudio es conocer si existe asociación entre el aumento de las presiones de los circuitos y la duración de éstos.Material y métodosEstudio analítico longitudinal prospectivo, realizado en una unidad de cuidados intensivos polivalente de un hospital terciario, desde octubre de 2008 hasta abril de 2009. Se recogieron datos de filiación de pacientes con técnicas de depuración extrarrenal y valores horarios de: presión de entrada (PE), presión de retorno (PR), presión transmembrana (PTM) y presión prefiltro (PPF). Se utilizó la correlación de Spearman y T de Student.ResultadosSe analizaron 44 sets correspondientes a 11 pacientes (el 45,5% eran hombres y el 54,5% eran mujeres) con un media de edad de 62 años. Se utilizó el mismo catéter de doble luz: GamCath (11 Fr) y la misma terapia: hemodiafiltración venovenosa continua. La media de duración de los circuitos fue de 39h. Los valores de media, mediana, máximo y mínimo de las presiones de la muestra fueron: (-52,17; -52,57; 160 y -256 [milímetros de mercurio] mmHg), PR (98,6; 95,3; 323 y -2mmHg), PTM (58,57; 58,52; 245 y -20mmHg) y PPF (161,76; 159,42; 375 y -13mmHg), respectivamente. Conclusiones: Se demuestra correlación negativa entre la duración de los sets y la media de PR y de PPF. Conclusiones: La muestra obtenida incluía tanto circuitos retirados por tratamiento completo (72h) como por coagulación o cambio en presiones

IntroductionContinuous 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.AimThis study has aimed to discover if there are any associations between the increase of the circuit pressures and their duration.Materials and methodsA 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.ResultsThe 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 39h. 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; −2mmHg); TMP: (58.57; 58.52; 245; −20mmHg) and PFP: (161.76; 159.42; 375; −13mmHg), respectively.ConclusionsA 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 (72h), and by coagulation or changes in pressures(AU)

[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.

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

Introducción. Los objetivos del estudio fueron comprobar la correlación entre distintasescalas de valoración de la sedación (EVS) del paciente crítico con ventilación mecánica,así como conocer la asociación entre las EVS, datos clínicos y dosis de sedoanalgesia enperfusión (SAP).Material y métodos. Estudio analítico longitudinal prospectivo, realizado en una Unidadde Cuidados Intensivos Polivalente de un hospital terciario, desde octubre a diciembre de2006. La muestra incluyó a pacientes que precisaron administración de SAP y ventilaciónmecánica. Se valoraron: características de los pacientes, escala de Ramsay, escala desedación-agitación (SAS), escala de agitación-sedación de Richmond (RASS), escala deevaluación de la actividad motora (MAAS), dosis de SAP, tensión arterial media, frecuenciacardiaca, tamaño pupilar y frecuencia respiratoria. Se empleó el coeficiente de correlaciónde Spearman para valorar la relación entre las diferentes escalas.Resultados. Se realizaron 2.412 mediciones de cada variable: EVS, datos clínicos y dosisde SAP, en 30 pacientes con distintas patologías, 63% varones, edad 53 ± 19 años, APACHEII 23,8 ± 8,54, SAPS II 44,93 ± 16,52, mortalidad al alta en Unidad de Cuidados Intensivos(UCI) 34%. Mediana y rango intercuartílico de estancia en UCI 15,5 y 20 días, de ventilaciónmecánica 9 y 14 días, de SAP 6 y 5,5 días y de relajación en perfusión (RP) 2 y 5 días,respectivamente. Se detectó correlación entre todas las EVS, con una p < 0,0001. La relaciónentre SAS, RASS y MASS fue directa, mientras que estas se relacionaron inversamentecon el Ramsay. No se observó correlación entre las EVS, los datos clínicos y lasdosis de SAP.Conclusión. La escala de Ramsay, no validada, tiene una fuerte correlación con el restode las EVS estudiadas, ya validadas. Las EVS son subjetivas y no se correlacionan con losdatos clínicos y las dosis de SAP, probablemente por el reducido tamaño y heterogeneidadmuestral(AU)

Background. This study aimed to verify the relationship between different SedationRating Scales (SRSs) for critical patients on mechanical ventilation and to know therelationship between the SRSs, clinical information and the dose of sedative and analgesiadrugs (SAD).Material and methods. A longitudinal, prospective analytic pilot study conducted in aMedical-Surgical Intensive Care Unit of a tertiary hospital from October-December 2006.The sample included patients who required administration of SAP and mechanicalventilation. The following biological parameters and scales were evaluated: patient’sdemographics, RAMSAY, Sedation Agitation Scale (SAS), Richmond Agitation SedationScale (RASS), Motor Activity Assessment Scale (MASS), SAD dose, mean blood pressure,cardiac rate, pupil diameter and respiratory frequency. Spearman coefficient ofinterrelation was used to compare the relationship between the different scales.Results. A total of 2.412 measurements were made for each variable: SRS, clinicalinformation and SAD dose in 30 patients with different diseases, 63 % males, age 52 ± 19years, APACHEII 24 ± 8, SAPSII 44 ± 16, with an ICU mortality UCI 34 %. Median and IQrange of stay in ICU 15.5 and 20 days, of mechanical ventilation 9 and 14 days, of SAD 6and 5.5 days and of paralyzing drugs (PD) 2 and 5 days, respectively. Interrelation wasdetected between all the SRSs, with p < 0.0001. The relationship between SAS, RASS andMASS was direct, whereas these were related inversely to RAMSAY. No evidence ofinterrelation 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 stronginterrelation with the other already validated SRSs. SRSs are subjective and do notcorrelate with the clinical information and the SAD doses, probably due to the sample’ssmall size and heterogeneity(AU)