[Information strategies in a polyvalent Intensive Care Unit]. / Estrategias de información en una Unidad de Cuidados Intensivos polivalente.

INTRODUCTION: Understanding the information provided to families and surrogates of the critically ill patients admitted to ICUs and its adequate communication without contradictions, is a fundamental aspect related with the possible participation of these persons in the treatment decision making and with the quality perceived regarding the care process. Our aim in this study is to assess these two aspects (information and communication of information). DESIGN: Opinion study elaborated by the medical team and nursing staff of a multidisciplinary ICU. METHOD: Observational qualitative study performed through an open answers questionnaire. Search for agreement on terminology and concepts that should be included in the information and estimation of the different contents of information provided by the main health care professional groups (physicians and nurses). Using the Delphi technique to elaborate an information communication sheet between different staff members in order to homogenize the information process. RESULTS: The analysis of the questionnaire reveals the great heterogeneity of the contents and modes of information provided. This may cause difficulties in understanding and the integration of families and relatives in the care process. The agreement achieved among the different between physicians to facilitate the information and avoid subjective interpretations by the informed people is presented.

Estrategias de información en una Unidad de Cuidados Intensivos polivalente / Information Strategies in a polyvalent intensive care unit

Introducción. La comprensión de la informaciónproporcionada a los familiares y allegados delos enfermos críticos ingresados en la Unidadde Cuidados Intensivos (UCI), y la transmisión,adecuada y sin contradicciones, de esta información,es un aspecto fundamental relacionado con la posible participación en las decisiones terapéuticasy con la calidad percibida respecto al proceso asistencial. Con el fin de establecer la adecuación de estos dos aspectos (comprensión y transmisión de la información) se ha realizado el presente estudio.Diseño. Estudio de opinión elaborado por elequipo médico, con la supervisión de enfermeríade una UCI polivalente.Método. Estudio cualitativo observacional.Encuesta de preguntas de respuesta abierta.Acuerdo de terminología y conceptos que debecontener la información y estimación de los distintoscontenidos de información proporcionada por los principales estamentos asistenciales (médicosy enfermeras). Elaboración, por técnica Delphi, de una hoja de transmisión de la información entre distintos facultativos, con el fin de homogeneizarel proceso informativo.Resultados. El análisis del cuestionario demuestrala gran heterogeneidad de los contenidosy formas de la información proporcionada, lo querepercute en defectos de comprensión y aparentescontradicciones, y a su vez dificulta la comprensiónde esa información y la integración de familiaresy allegados en el proceso asistencial.Se presenta el acuerdo logrado entre los distintosfacultativos encuestados para facilitar la informacióny evitar interpretaciones subjetivas porparte de los informados

Introduction. Understanding the informationprovided to families and surrogates of the criticallyill patients admitted to ICUs and its adequatecommunication without contradictions, is a fundamentaspect related with the possible participationof these persons in the treatment decisionmaking and with the quality perceived regardingthe care process. Our aim in this study is to assessthese two aspects (information and communicationof information).Design. Opinion study elaborated by the medicalteam and nursing staff of a multidisciplinary ICU.Method. Observational qualitative study performedthrough an open answers questionnaire.Search for agreement on terminology and conceptsthat should be included in the informationand estimation of the different contents of informationprovided by the main health care professionalgroups (physicians and nurses). Using theDelphi technique to elaborate an informationcommunication sheet between different staffmembers in order to homogenize the informationprocess.Results. The analysis of the questionnaire revealsthe great heterogeneity of the contents andmodes of information provided. This may cause difficulties in understanding and the integration offamilies and relatives in the care process.The agreement achieved among the differentbetween physicians to facilitate the informationand avoid subjective interpretations by the informedpeople is presented (AU)

[Percutaneous tracheostomy in ventilated patients]. / Traqueostomía percutánea en pacientes ventilados.

INTRODUCTION: Percutaneous tracheostomy is an alternative to conventional surgical tracheostomy. It is associated to a more feasible procedure, that is less invasive and linked to a lower degree of complications. Herein, we review our experience since the implementation of this technique in our Department. DESIGN: Retrospective observational. SETTING: Nineteen-bed intensive care department, in a general reference teaching hospital. PATIENTS AND METHOD: A total of 115 of 130 tracheostomies performed from 2001 to 2003 were retrospectively analyzed. Collected data include epidemiological information, reason for performing the procedure, maintenance time of artificial airway before the tracheostomy and type of ventilatory support or oxygen supplementation before and after the procedure. The modified PEEP (PEEP-mod = FiO2 x PEEP) was calculated, sedation level received before and 4-6 hours after the technique and also 24 hours later, were reviewed. Subsequent patient evolution was collected. INTERVENTIONS: Observational study on the results of routine procedures. VARIABLES OF INTEREST: Blood gases indicators of effectiveness in oxygen supply and the need of mechanical ventilation support. RESULTS: Median age of the 115 reviewed patients was 65 years. The most common admission reasons were: brain vascular accident in 25 cases, head and neck injury in 21, cancer in 11 and sepsis in 10 patients. Tracheostomy was indicated because prolonged mechanical ventilation in 52 patients, coma in 28 and emergency or scheduled surgery in 10 cases. Median length of stay in the ICU before tracheostomy was 14 days. Ninety-two patients were discharged from the ICU, and 52 from the Hospital. The remaining patients died during their hospital stay. Serious complications appeared in 5 patients (4%); 3 of them were the development of fistulae and all of them occurred in patients in whom the tracheostomy was performed in the ICU at bedside. Before the procedure, 72 patients were under mechanical ventilation, but only 56 received ventilatory support 24 hours after tracheostomy. When PEEP-mod values were analyzed, first monitoring of median value was 1.6 (range 0 to 2), 4-6 hours time median value was 2 (1.4-2.45), and 24 hours later median value was 1.2 (0-2) (global variation, p < 0.001). CONCLUSIONS: In our experience, percutaneous tracheostomy performed at bedside in the ICU is an adequate solution with a low complication rate and its makes it possible to reduce the level of ventilatory support.

Traqueostomía percutánea en pacientes ventilados / Percutaneous tracheostomy in ventilated patients

Introducción. La traqueostomía percutánea es una alternativa a la traqueostomía quirúrgica convencional, asociada a una realización más ágil, menos invasora y con menor tasa de complicaciones. Revisamos los resultados obtenidos mediante esta técnica desde su implantación en nuestro Servicio. Diseño. Observacional, retrospectivo. Ámbito. Servicio de Medicina Intensiva de un Hospital docente de referencia, dotado de 19 camas. Pacientes y método. Se analizan 115 registros sobre 130 traqueostomías realizadas desde 2001 hasta 2003. Se recogen datos de filiación y epidemiológicos de los pacientes, motivo de realización de la técnica, tiempo de mantenimiento de la vía aérea antes de la traqueostomía y situación de soporte ventilatorio o de oxigenoterapia antes y después del procedimiento. Se calcula la presión positiva al final de la espiración modificada (PEEP-mod) (PEEP-mod = fracción inspirada de oxígeno [FiO2] x PEEP) y se revisa la sedación que recibían los pacientes antes de la traqueostomía, a las 4-6 horas de la misma y transcurridas 24 horas. Igualmente se recoge su evolución posterior. Intervenciones. Estudio observacional de resultados de pauta de actuación rutinaria. Variables de interés. Variables de efectividad de intercambio gaseoso en relación a la FiO2 administrada y la necesidad de soporte ventilatorio mecánico. Resultados. En los 115 pacientes revisados la mediana de edad fue de 65 años. Los diagnósticos de ingreso más comunes fueron: accidente vascular cerebral en 25 pacientes, traumatismos craneoencefálicos y cervicales en 21, neoplasias en 11 y sepsis en 10. Los principales para indicar la traqueostomía fueron: ventilación mecánica prolongada en 52 pacientes, coma en 28 y cirugía en 10. La mediana de estancia en el servicio de Medicina Intensiva antes de realizarse la traqueostomía fue de 14 días. Recibieron el alta del servicio de Medicina Intensiva 92 pacientes y el alta hospitalaria 52 pacientes; el resto falleció. Se produjeron complicaciones graves en 5 pacientes (4%); 3 de ellas consistieron en el desarrollo de fístulas, que ocurren en pacientes a los que se les realiza la traqueostomía en el servicio de Medicina Intensiva. Antes de la traqueostomía 72 pacientes recibían ventilación mecánica, y tras las primeras 24 horas postraqueostomía sólo 56 pacientes recibían soporte ventilatorio. Al analizar los valores de la PEEP-mod, la mediana del primer control es de 1,6 (rango 0 a 2), a las 4-6 horas la mediana es de 2 (1,4-2,45), y a las 24 horas la mediana es de 1,2 (0-2) (variación global, p < 0,001). Conclusiones. En nuestra experiencia la traqueostomía percutánea realizada intra-Unidad de Cuidados Intensivos (UCI) constituye una solución adecuada con una tasa baja de complicaciones y que permite disminuir la intensidad del soporte ventilatorio

Introduction. Percutaneous tracheostomy is an alternative to conventional surgical tracheostomy. It is associated to a more feasible procedure, that is less invasive and linked to a lower degree of complications. Herein, we review our experience since the implementation of this technique in our Department. Design. Retrospective observational. Setting. Nineteen-bed intensive care department, in a general reference teaching hospital. Patients and method. A total of 115 of 130 tracheostomies performed from 2001 to 2003 were retrospectively analyzed. Collected data include epidemiological information, reason for performing the procedure, maintenance time of artificial airway before the tracheostomy and type of ventilatory support or oxygen supplementation before and after the procedure. The modified PEEP (PEEP-mod = FiO2 x PEEP) was calculated, sedation level received before and 4-6 hours after the technique and also 24 hours later, were reviewed. Subsequent patient evolution was collected. Interventions. Observational study on the results of routine procedures. Variables of interest. Blood gases indicators of effectiveness in oxygen supply and the need of mechanical ventilation support. Results. Median age of the 115 reviewed patients was 65 years. The most common admission reasons were: brain vascular accident in 25 cases, head and neck injury in 21, cancer in 11 and sepsis in 10 patients. Tracheostomy was indicated because prolonged mechanical ventilation in 52 patients, coma in 28 and emergency or scheduled surgery in 10 cases. Median length of stay in the ICU before tracheostomy was 14 days. Ninety-two patients were discharged from the ICU, and 52 from the Hospital. The remaining patients died during their hospital stay. Serious complications appeared in 5 patients (4%); 3 of them were the development of fistulae and all of them occurred in patients in whom the tracheostomy was performed in the ICU at bedside. Before the procedure, 72 patients were under mechanical ventilation, but only 56 received ventilatory support 24 hours after tracheostomy. When PEEP-mod values were analyzed, first monitoring of median value was 1.6 (range 0 to 2), 4-6 hours time median value was 2 (1.4-2.45), and 24 hours later median value was 1.2 (0-2) (global variation, p < 0.001). Conclusions. In our experience, percutaneous tracheostomy performed at bedside in the ICU is an adequate solution with a low complication rate and its makes it possible to reduce the level of ventilatory support