ABSTRACT
El descenso en la potencialidad de donación en muerte encefálica ha determinado la necesidad de valorar fuentes alternativas y la donación en asistolia representa una buena opción. Los objetivos del presente artículo han sido describir las características de la donación de órganos controlada tipo iii de Maastricht y determinar los cuidados al final de la vida y el papel de las enfermeras en el proceso de donación. En este tipo de donación, la parada cardiocirculatoria es previsible tras la limitación de tratamientos de soporte vital. Se trata de pacientes para los que no existen opciones de terapia efectivas y, en el contexto de una práctica organizada y planificada en la que participan cada uno de los profesionales implicados en el cuidado del paciente, se toma la decisión, de acuerdo con la familia, de retirar medidas de soporte vital. Esta limitación de tratamientos de soporte vital nunca se lleva a cabo con el objetivo de realizar una donación Maastricht iii, sino con el de evitar la prolongación del proceso de morir mediante intervenciones inútiles y posiblemente degradantes. La obligación del equipo de salud es proporcionar una muerte digna y ello no solo incluye la ausencia de dolor, sino que se debe garantizar al paciente y su entorno familiar una sensación de placidez y serenidad. Una vez tomada la decisión de no instauración o retirada de medidas, la enfermera tiene un papel importante en la implementación de un plan de cuidados paliativos en el que deben participar médicos, enfermeros y paciente/familiares, y cuyo foco debe ser la dignidad y el bienestar del paciente, considerando sus necesidades físicas, psicológicas y espirituales
The decrease in potential donation after brain death has resulted in a need to evaluate alternative sources. Donation after cardiac death is a good option. The objectives of this article are to describe the Maastricht type iii controlled organ donation characteristics and to determine end-of-life care and the role of nurses in the donation process. In this type of donation, cardiocirculatory arrest is predictable after the limitation of life sustaining treatments. These are patients for whom there are no effective therapy options and, in the context of an organised and planned practice involving all the professionals involved in the care of the patient, the decision is made, in consultation with the family, to withdraw life support measures. This limitation of life sustaining treatments is never carried out with the aim of making a Maastricht iii donation, but to avoid prolonging the dying process through useless and possibly degrading interventions. The obligation of the health team is to provide a dignified death and this not only includes the absence of pain, but the patient and their family must be guaranteed a feeling of calmness and serenity. Once the decision has been taken to withhold or withdraw measures, the nurse has an important role in the implementation of a palliative care plan in where physicians, nurses and patients/families should be involved and whose focus should be on patients' dignity and comfort, considering their physical, psychological and spiritual needs
Subject(s)
Humans , Young Adult , Adult , Death , Terminal Care/ethics , Tissue and Organ Procurement/classification , Tissue and Organ Procurement/ethics , Heart Arrest/classification , Critical Care Nursing , Intensive Care UnitsABSTRACT
The decrease in potential donation after brain death has resulted in a need to evaluate alternative sources. Donation after cardiac death is a good option. The objectives of this article are to describe the Maastricht type iii controlled organ donation characteristics and to determine end-of-life care and the role of nurses in the donation process. In this type of donation, cardiocirculatory arrest is predictable after the limitation of life sustaining treatments. These are patients for whom there are no effective therapy options and, in the context of an organised and planned practice involving all the professionals involved in the care of the patient, the decision is made, in consultation with the family, to withdraw life support measures. This limitation of life sustaining treatments is never carried out with the aim of making a Maastricht iii donation, but to avoid prolonging the dying process through useless and possibly degrading interventions. The obligation of the health team is to provide a dignified death and this not only includes the absence of pain, but the patient and their family must be guaranteed a feeling of calmness and serenity. Once the decision has been taken to withhold or withdraw measures, the nurse has an important role in the implementation of a palliative care plan in where physicians, nurses and patients/families should be involved and whose focus should be on patients' dignity and comfort, considering their physical, psychological and spiritual needs.
Subject(s)
Death , Heart Arrest/classification , Terminal Care/ethics , Tissue and Organ Procurement/classification , Tissue and Organ Procurement/ethics , Adult , Humans , Middle Aged , Nurse's Role , Young AdultABSTRACT
OBJECTIVE: Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity. DESIGN: An analytical, observational, longitudinal prospective study was carried out. SETTING: Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain). PATIENTS: Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each. INTERVENTIONS: None. VARIABLES OF INTEREST: The presence of gradei-iv pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables. RESULTS: The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradei andii pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10. CONCLUSIONS: The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios.
Subject(s)
Critical Care , Pressure Ulcer/epidemiology , Severity of Illness Index , Adult , Aged , Area Under Curve , Female , Humans , Incidence , Intensive Care Units , Length of Stay , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , ROC CurveABSTRACT
INTRODUCTION: Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. METHODOLOGY: The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered. RESULTS: From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning. CONCLUSIONS: There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development.
Subject(s)
Pressure Ulcer/etiology , Critical Illness , Humans , Intensive Care Units , Pressure Ulcer/epidemiology , Risk FactorsABSTRACT
Introducción Las úlceras porpresión representan un significativo problema para pacientes, profesionales y sistemas sanitarios. Presentan una incidencia y una prevalencia importantes a nivel mundial. Su carácter iatrogénico plantea que su aparición es evitable y su incidencia es un indicador de calidad científico-técnica tanto en el ámbito de la atención primaria como en el de la especializada. El objetivo de esta revisión ha sido identificar los factores de riesgo relacionados con la aparición de úlceras por presión en pacientes críticos. Metodología Se siguieron las recomendaciones de la declaración PRISMA adaptadas a la identificación de estudios sobre factores de riesgo. Se ha realizado una revisión sistemática cualitativa de estudios primarios a través de una búsqueda en Pubmed, The Cochrane Library, Scopus y Web of Science. Se consideraron las limitaciones metodológicas en estudios observacionales. Resultados De 200 referencias bibliográficas, 17 cumplieron nuestros criterios de selección. Estos estudios incluyeron 19.363 pacientes ingresados en unidades de cuidados intensivos. Seis se clasificaron como de calidad fuerte y 11 de calidad moderada. Los factores de riesgo que aparecieron más frecuentemente asociados al desarrollo de úlceras por presión incluyeron: edad, tiempo de estancia en UCI, diabetes, tiempo de PAM <60-70mmHg, ventilación mecánica, duración de la ventilación mecánica, terapia de hemofiltración venovenosa continua o diálisis intermitente, tratamiento con drogas vasoactivas, con sedantes y cambios posturales. Conclusiones No aparecen factores de riesgo que por sí mismos puedan predecir la aparición de la úlcera por presión. Más bien se trata de una interrelación de factores que incrementan la probabilidad de su desarrollo.
Subject(s)
Ulcer , Critical Care , AgedSubject(s)
Humans , Male , Adult , Testicular Neoplasms/pathology , Seminoma/pathology , Cryptorchidism/complicationsABSTRACT
Eight-seven patients with severe tinnitus were studied. All patients underwent a complete audiological examination and tinnitus evaluation (pitch-matching, loudness, post-masking effect, masking curves, etc.). Most of the patients with a positive residual inhibition test had Feldman type I and III masking curves.
Subject(s)
Hearing Disorders/diagnosis , Tinnitus/diagnosis , Audiometry, Pure-Tone , Female , Humans , Male , Severity of Illness IndexABSTRACT
A study was made of a noninvasive functional test of mucociliary clearance using micronized indigo blue colorant, which is insoluble in airway secretions. Transport time to the nasopharynx was measured optically with an endoscope. This method was more objective and less irritating than others tested by other authors. Measurements were made in each subject using different endoscopes. The results were highly suggestive of a difference in nasal mucociliary clearance time between healthy and unhealthy subjects. This may mean that chronic inflammation, atrophic rhitis, dyskinesia, and other diseases lead to malfunction of the nasal mucociliary system.
Subject(s)
Mucociliary Clearance , Nasal Mucosa/physiopathology , Adolescent , Adult , Endoscopy , Female , Humans , Male , Middle AgedABSTRACT
The purpose of this paper is to study 33 cholesteatomatous patients with surgical treatment. We report individual and predisposal factors concerning these patients, as well as their clinical and radiological data. Histologic study these cholesteatoma was carried after surgical removal, using conventional staining (H-E, A-B, fluorescence, etc.) and a new technique to observation the namely EPU (Epithelial Proliferative Unit).
