Humanizar los cuidados reduce la mortalidad en el enfermo crítico / Humanizing care reduces mortality in critically ill patients

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Revisión narrativa sobre humanización en cuidados intensivos pediátricos: ¿dónde estamos? / Narrative review of pediatric critical care humanization: Where we are?

La corriente humanizadora surge como respuesta a un hecho que parece indiscutible: el desarrollo científico y tecnológico de las Unidades de Cuidados Intensivos. Este ha mejorado el cuidado del paciente crítico en términos cuantitativos y ha relegado, quizá, las necesidades humanas y emocionales de pacientes, familias y profesionales a un segundo plano. La humanización debe ser objeto de debate, sin que esto se confunda con poner en duda la humanidad desplegada por los profesionales. Se analizan y describen en este trabajo las líneas estratégicas sobre las que pivota el cuidado humanizado del paciente crítico, adaptándolas al ámbito pediátrico

The humanization of care emerges as a response to something that seems indisputable: the scientific and technological developments in Intensive Care Units. Such development has improved the care of the critically ill patient in quantitative terms, but has perhaps caused the emotional needs of patients, families and professionals to be regarded as secondary concerns. The humanization of healthcare should be discussed without confusing or discussing the humanity displayed by professionals. In this paper we review and describe the different strategic lines proposed in order to secure humanized care, and adopt a critical approach to their adaptation and current status in the field of pediatric critical care

Dígame qué necesita. Le escucho / Tell me what you need. I hear you

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Narrative review of pediatric critical care humanization: Where we are? / Revisión narrativa sobre humanización en cuidados intensivos pediátricos: ¿dónde estamos?

The humanization of care emerges as a response to something that seems indisputable: the scientific and technological developments in Intensive Care Units. Such development has improved the care of the critically ill patient in quantitative terms, but has perhaps caused the emotional needs of patients, families and professionals to be regarded as secondary concerns. The humanization of healthcare should be discussed without confusing or discussing the humanity displayed by professionals. In this paper we review and describe the different strategic lines proposed in order to secure humanized care, and adopt a critical approach to their adaptation and current status in the field of pediatric critical care.

Principales demandas informativas de los familiares de pacientes ingresados en Unidades de Cuidados Intensivos / Main information requests of family members of patients in Intensive Care Units

OBJETIVO: Elaborar un catálogo de demandas informativas priorizadas por los familiares, conocer qué profesionales consideran estos que pueden responder a estas demandas y explorar las diferencias de criterio entre familiares y profesionales. DISEÑO: Análisis cualitativo de validación de contenido; estudio descriptivo transversal. Ámbito: Cuarenta y una UCI españolas. PARTICIPANTES: Familiares, médicos y enfermeras/os de pacientes críticos. Intervención: De un listado inicial de preguntas extraído de revisión de la literatura, médicos, enfermeras/os y familiares de pacientes críticos incorporaron cuestiones que consideraron no incluidas. Tras análisis de validación de contenido, se obtuvo un nuevo listado que fue valorado nuevamente por los participantes para determinar el nivel de importancia que asignaban a cada pregunta y qué profesional consideraban adecuado para responderla. RESULTADOS: Cuestiones más importantes para los familiares: preocupación por la situación clínica, medidas a tomar, pronóstico e información. Existió coincidencia entre familiares y profesionales en las cuestiones prioritarias para las familias. Existieron diferencias significativas en la importancia dada a cada pregunta: entre médicos y familiares (72/82 preguntas) y entre enfermeras/os y familiares (66/82 cuestiones) (p < 0,05). Para los familiares, el 63% de las preguntas podrían ser contestadas por médicos o enfermeras/os indistintamente, el 27% preferentemente por los médicos y 10% por las enfermeras/os. CONCLUSIONES: Las cuestiones más relevantes para las familias fueron pronóstico y gravedad, pero también la necesidad de información. Los profesionales sanitarios tendemos a subestimar la importancia de muchas de las cuestiones que preocupan a las familias. Los familiares consideran que la mayoría de sus inquietudes pueden ser resueltas indistintamente por médicos o enfermeras/os

OBJECTIVE: To compile an inventory of information requests prioritized by the family members, to find out which professionals them consider able to respond these requests, and to explore the differences in perception between family members and professionals. DESIGN: Qualitative analysis of content validation and descriptive cross-sectional study. Scope: 41 Spanish ICU. PARTICIPANTS: Relatives, physicians and nurses of critical patients. Intervention: From an initial list of questions extracted from literature review, physicians, nurses, and relatives of critical patients incorporated issues that they considered not included. After analyzing content validity, a new list was obtained, which was again submitted to the participants' assessment to evaluate the level of importance that they assigned to each question and which professional they considered appropriate to answer it. RESULTS: most important questions for the relatives: concern about the clinical situation, measures to be taken, prognosis and information. There was a coincidence between relatives and professionals in the priority issues for families. There were significant differences in the importance given to each question: between doctors and relatives (72/82 questions), and between nurses and relatives (66/82 questions) (P<.05). For the relatives, 63% of the questions could be answered by doctors or nurses, 27% preferably by doctors and 10% by nurses. CONCLUSIONS: The most relevant issues for families were prognosis and severity, but also the need for information. Healthcare professionals tend to underestimate the importance of many of the questions that concern families. Relatives feel that most of their concerns can be resolved either by doctors or nurses

Main information requests of family members of patients in Intensive Care Units. / Principales demandas informativas de los familiares de pacientes ingresados en Unidades de Cuidados Intensivos.

OBJECTIVE: To compile an inventory of information requests prioritized by the family members, to find out which professionals them consider able to respond these requests, and to explore the differences in perception between family members and professionals. DESIGN: Qualitative analysis of content validation and descriptive cross-sectional study. SCOPE: 41 Spanish ICU. PARTICIPANTS: Relatives, physicians and nurses of critical patients. INTERVENTION: From an initial list of questions extracted from literature review, physicians, nurses, and relatives of critical patients incorporated issues that they considered not included. After analyzing content validity, a new list was obtained, which was again submitted to the participants' assessment to evaluate the level of importance that they assigned to each question and which professional they considered appropriate to answer it. RESULTS: most important questions for the relatives: concern about the clinical situation, measures to be taken, prognosis and information. There was a coincidence between relatives and professionals in the priority issues for families. There were significant differences in the importance given to each question: between doctors and relatives (72/82 questions), and between nurses and relatives (66/82 questions) (P<.05). For the relatives, 63% of the questions could be answered by doctors or nurses, 27% preferably by doctors and 10% by nurses. CONCLUSIONS: The most relevant issues for families were prognosis and severity, but also the need for information. Healthcare professionals tend to underestimate the importance of many of the questions that concern families. Relatives feel that most of their concerns can be resolved either by doctors or nurses.

Effects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease or obesity-hypoventilation syndrome with metabolic alkalosis. A randomized trial.

BACKGROUND: Metabolic alkalosis (MA) inhibits respiratory drive and may delay weaning from mechanical ventilation (MV). MA is common in CO2-retainer patients that need MV. Acetazolamide (ACTZ) decreases serum bicarbonate concentration and stimulates respiratory drive. This study evaluated the effects of ACTZ on the duration of MV in patients with MA and COPD or obesity hypoventilation syndrome (OHS) intubated with acute respiratory failure. METHODS: Multicenter, randomized, controlled, double-blind study, with COPD or OHS patients with MV < 72 h and initial bicarbonate >28 mmol/L and pH > 7.35. Test-treatment, ACTZ 500 mg or placebo, was daily administered if pH > 7.35 and bicarbonate >26 mmol/L. Clinical, respiratory and laboratory parameters were recorded. RESULTS: 47 patients (36 men) were randomized. There were no significant differences between groups in comorbidities, baseline characteristics or arterial blood gases at inclusion. The mean difference in the duration of MV between placebo and ACTZ group was 1.3 days (95%CI, -2.1-4.8; p = 0.44). Kaplan-Meier curves showed no differences in the duration of MV (Log-Rank p = 0.41). Between-group comparison of estimated marginal means (CI 95%) during MV were, respectively: PaCO2 55 (51-59) vs 48 (47-50) mm Hg, p = 0.002; bicarbonate concentration 34 (32-35) vs 29 (28-30) mmol/L, p < 0.0001; and minute volume 9.7 (8.9-10.4) vs 10.6 (9.2-12.0) L/min, p = 0.26. There were no severe adverse effects with ACTZ administration. CONCLUSIONS: Among patients with MA and COPD or OHS, early treatment with ACTZ did not shorten significantly the duration of MV compared with placebo. TRIAL REGISTRY: clinical.trials.gov; NCT01499485; URL:.www.clinicaltrials.gov.

HUCI se escribe con H de HUMANO / HUCI is written with H as in HUMAN

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Aplicación de las Técnicas de Información y Comunicación para la detección de pacientes de alto riesgo: alarmas de rápida asistencia. Estudio piloto del Proyecto ARA-Son Llàtzer / Application of Medical Information Systems for the detection of high risk patients: Rapid care alerts. Pilot study of the ARA-Son Llàtzer Project

Objetivo Describir la implementación de Técnicas de Información y Comunicación (TIC) sobre el Servicio de Medicina Intensiva (SMI).Diseño Estudio de cohortes prospectivo observacional. Ámbito Hospitalización de Áreas Médicas y Quirúrgicas del Hospital Son Llàtzer. Pacientes Pacientes con criterios de alarma de rápida asistencia (ARA) no tratados, paradas cardiacas (PC) y muertes inesperadas en planta (MI) durante el año 2010.Variables de interés principa lEdad, sexo, turno de enfermería, alerta de enfermería, criterios ARA, ingreso en SMI, PC, fallecimiento y MI. Resultados El sistema informático (SI) detectó 9.647 episodios con criterios ARA en 4.020 pacientes (26,4 episodios/día). Se realizaron 8.547 revisiones por el intensivista. Sesenta y cinco pacientes precisaron actuación temprana del SMI. De ellos, el 61,5% fueron detectados en el segundo turno (de 15:00 a 22:00) y el 61,5% ingresó en el SMI. La disminución del nivel de conciencia (DNC) y la insuficiencia respiratoria fueron los más frecuentes. La etiología más frecuente fue la sepsis (23%). Se incluyeron 45 PC y 35 MI. Del total de PC, 33 pacientes fallecieron (73,3%) y el 66,7% presentaron criterios ARA no tratados. La monitorización (p<0,05) y los ritmos desfibrilables (p<0,002) se asociaron a supervivencia. En las MI, el 75% presentaron criterios ARA no tratados y el 40,6% presentaron DNC. En el segundo semestre se observó una reducción significativa de las MI (p=0,01). Conclusiones Las TIC pueden ser una herramienta complementaria a la actividad asistencial del SMI para mejorar el pronóstico de los pacientes hospitalizados en planta (AU)

Objective To describe the implementation of a Medical Information System (MIS) in the Critical Care Departament (CCD).Design A prospective observational cohort study was carried out. Setting Clinical and Surgical wards in Son Llàtzer Hospital. Patients Patients with criteria of rapid care alert (RCA) without treatment, cardiac arrest (CA), and unexpected ward deaths (UWD), during 2010.Main variables Age, sex, nursing shift, nursing alert, vital signs, unplanned admission to intensive care, CA, UWD and death. Results The MIS detected 9647 episodes with RCA signs in 4020 patients (26.4 episodes/day). A total of 8547 episodes were reviewed. Sixty-five patients required rapid response by the intensive care staff; 61.5% were detected in the afternoon shift (15:00 a 22:00), and 61.5% were admitted to the CCD. Diminished consciousness (DC) and respiratory failure were the most frequent problems. The sepsis rate was 23%. We reviewed 45 CA and 35 UWD. Of the total cases of CA, 33 patients died (73.3%) and 66.7% had criteria of untreated RCA. Monitoring (P<.05) and rhythms amenable to defibrillation (P<.002) were associated to survival. As regards the UWD, 75% had criteria of untreated RCA, and 40.6% presented diminished consciousness. In the last 6 months there was a significant reduction in UWD (P=.01) Conclusions The MIS could be a complimentary tool in the activity of the CCD to improve the prognosis of hospitalized patients (AU)

Application of Medical Information Systems for the detection of high risk patients: rapid care alerts. Pilot study of the ARA-Son Llàtzer Project.

OBJECTIVE: To describe the implementation of a Medical Information System (MIS) in the Critical Care Departament (CCD). DESIGN: A prospective observational cohort study was carried out. SETTING: Clinical and Surgical wards in Son Llàtzer Hospital. PATIENTS: Patients with criteria of rapid care alert (RCA) without treatment, cardiac arrest (CA), and unexpected ward deaths (UWD), during 2010. MAIN VARIABLES: Age, sex, nursing shift, nursing alert, vital signs, unplanned admission to intensive care, CA, UWD and death. RESULTS: The MIS detected 9647 episodes with RCA signs in 4020 patients (26.4 episodes/day). A total of 8547 episodes were reviewed. Sixty-five patients required rapid response by the intensive care staff; 61.5% were detected in the afternoon shift (15:00 a 22:00), and 61.5% were admitted to the CCD. Diminished consciousness (DC) and respiratory failure were the most frequent problems. The sepsis rate was 23%. We reviewed 45 CA and 35 UWD. Of the total cases of CA, 33 patients died (73.3%) and 66.7% had criteria of untreated RCA. Monitoring (P<.05) and rhythms amenable to defibrillation (P<.002) were associated to survival. As regards the UWD, 75% had criteria of untreated RCA, and 40.6% presented diminished consciousness. In the last 6 months there was a significant reduction in UWD (P=.01) CONCLUSIONS: The MIS could be a complimentary tool in the activity of the CCD to improve the prognosis of hospitalized patients.