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

IntroducciónLas técnicas de depuración extracorpórea (TCDE) gestionan elevados volúmenes de intercambio de fluidos y precisa control exhaustivo de su seguridad.ObjetivoDetectar riesgos en TCDE y determinar su frecuencia por paciente.Material y métodoEstudio observacional retrospectivo. Criterios de inclusión: pacientes ingresados desde enero a diciembre de 2009 con TCDE en la Unidad de Cuidados Intensivos (UCI) Polivalente del Hospital 12 de Octubre. Identificamos previamente diez riesgos detectables en historias clínicas. Analizamos variables demográficas y del tratamiento. Las variables cuantitativas se expresan como media±desviación estándar y cualitativas, como frecuencias absolutas y relativas. Análisis: SPSS 15.0®.ResultadosSe incluyó a 54 pacientes (11,7%) con media de edad de 59,78±14,8 años; 42 (77,8%) eran varones. En el 81,4% la indicación fue fracaso renal agudo. Se trató al 80,3% con hemodiafiltración. La media de TCDE fue de 112,9±139,9 h, con una mediana [intervalo intercuartílico] de 2 [0-31] filtros por paciente. La frecuencia de riesgo/paciente fue: el 100% de los pacientes sin monitorización de Mg y P, y el 3,7% (n=2) urea; en 16 (29,6%) se produjo coagulación del circuito antes de 24 h y en 25 (46,3%) no se pudo devolver sangre; en 14 (29,3%) faltaba siempre pauta escrita en la orden de tratamiento; en gráfica del paciente no se reflejó las dosis en 2 (3,7%); en 3 pacientes (5,6%) con coagulopatía se pautó anticoagulante en el circuito; en 1 (1,9%) se evidenció sangrado y en 10 (18,5%), hipotermia leve (35-32°C).ConclusionesSe precisa monitorización protocolizada de Mg y P. Se debe pautar la terapia en el tratamiento médico. Se precisa optimizar la técnica para prolongar su duración y evitar pérdidas hemáticas (AU)

IntroductionContinuous techniques of extracorporeal depuration (CTED) manage high volumes of fluid exchange and extensive control of its safety is required.ObjectiveTo detect the risks of CTED and to determine its frequency per patient.Material and methodsAn 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®.ResultsA 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 24hours 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).ConclusionsA 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 (AU)

[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.

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)