Medicina predictiva potencialmente maleficente / Potential maleficence of predictive medicine

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Percepción de las actitudes éticas de la enfermería de cuidados intensivos ante la limitación del tratamiento / Perception of ethical attitudes of intensive care nurses on treatment limitation

Objetivo Analizar la percepción de la enfermería de cuidados intensivos acerca de la limitación del esfuerzo terapéutico (LET). Método Estudio transversal, descriptivo durante 2 meses, llevado a cabo entre el personal de enfermería de cuidados intensivos de nuestro Hospital. Se utilizó una encuesta anónima, para valorar las actitudes de la enfermería de cuidados intensivos acerca de la LET. Resultados Cincuenta y dos enfermeros/as (86,6%), 57,7% mujeres, con un tiempo trabajado de 8,8±4,8 años y el 17,7% poseía alguna formación suplementaria en ética. La decisión de no ingresar a un paciente con una calidad de vida muy mala a corto plazo cambia cuando se tiene en cuenta la opinión del paciente (36,5% vs 61,5%; p=0,008), diferencia que la marcan los varones sin formación previa en ética. El 23,1% desconoce que existen en el servicio unas guías consensuadas sobre LET. Un 17,3% piensa que limitar un tratamiento, bien no suministrándoselo o retirándolo, es una forma de eutanasia pasiva, que sería una práctica aceptable a diferencia de la eutanasia. 84,6% piensa que no es lo mismo administrar un tratamiento que retirarlo. El 36,5% opina que la enfermería no debería participar en la decisión de limitar un tratamiento, así como tampoco los pacientes (34,6%) ni los familiares (23,1%).Conclusiones La enfermería no es consciente de la importancia que puede tener, junto a familiares y pacientes, en la toma de decisiones en relación a la limitación del tratamiento del paciente crítico, aportando su visión humanizadora y ética de los cuidados (AU)

Objective Analyze the perception of intensive care nurses regarding the limitation of therapeutic efforts (LET).Method A 2-month cross-sectional, descriptive study carried out among Intensive Care nursing staff of our Hospital. An anonymous survey was used to assess the attitudes of intensive care nurses on LET.Results Fifty-two nurses (86.6%), 57.7% women, with a working experience of 8.8±4.8 years and 17.7%, had some additional training in ethics. The decision not to hospitalize a patient whose short term quality of life is very poor changes when the patient's opinion is considered (36.5% vs 61.5%, p=0.008), a difference that is greater in male nurses without prior training in ethics. A total of 23.1% were not aware of the existence of agreed on guidelines on LET in the Service. A total of 17.3% consider that limiting treatment, either by not providing it or by withdrawing it, is a form of passive euthanasia, which would be an acceptable practice as opposed to euthanasia and 84.6% consider that administering a treatment is not the same as withdrawing it. Of those surveyed, 36.5% felt that the neither the nursing staff should not participate in the decision to limit treatment nor the patients (34.6%) nor family (23.1%).ConclusionsNursing is not aware of the importance it can have, along with the family and patient, in decision making in relationship to the limitation of the treatment of the critical patient, providing a humanizing and ethical view of the care (AU)

[Perception of ethical attitudes of intensive care nurses on treatment limitation]. / Percepción de las actitudes éticas de la enfermería de cuidados intensivos ante la limitación del tratamiento.

OBJECTIVE: Analyze the perception of intensive care nurses regarding the limitation of therapeutic efforts (LET). METHOD: A 2-month cross-sectional, descriptive study carried out among Intensive Care nursing staff of our Hospital. An anonymous survey was used to assess the attitudes of intensive care nurses on LET. RESULTS: Fifty-two nurses (86.6%), 57.7% women, with a working experience of 8.8±4.8 years and 17.7%, had some additional training in ethics. The decision not to hospitalize a patient whose short term quality of life is very poor changes when the patient's opinion is considered (36.5% vs 61.5%, p=0.008), a difference that is greater in male nurses without prior training in ethics. A total of 23.1% were not aware of the existence of agreed on guidelines on LET in the Service. A total of 17.3% consider that limiting treatment, either by not providing it or by withdrawing it, is a form of passive euthanasia, which would be an acceptable practice as opposed to euthanasia and 84.6% consider that administering a treatment is not the same as withdrawing it. Of those surveyed, 36.5% felt that the neither the nursing staff should not participate in the decision to limit treatment nor the patients (34.6%) nor family (23.1%). CONCLUSIONS: Nursing is not aware of the importance it can have, along with the family and patient, in decision making in relationship to the limitation of the treatment of the critical patient, providing a humanizing and ethical view of the care.

[Satisfaction survey administered to the relatives of critical patients]. / Encuesta de satisfacción a los familiares de pacientes críticos.

OBJECTIVE: To know the family needs of patients admitted to our Intensive Care Unit (ICU). DESIGN: Prospective, descriptive study performed over a 6-month period. SETTING: ICU of the Insular University Hospital in Gran Canary Islands. PARTICIPANTS: Adult patients admitted to the ICU for more than 48 hours who were discharged to the hospitalization ward. INTERVENTION: A modified Society of Critical Care Medicine Family Needs Assessment instrument was administered to the first-degree relatives of patients after discharge by face-to-face interviews by not-informing personnel. MAIN VARIABLES: Data were gathered on demographic information on the patients and their interviewed relatives, reason for admission, and evaluation on information, care, empathy with the personnel and comfort. RESULTS: Family members of 99 patients were interviewed. A total of 80% of those interviewed considered the information had been in terms that they could understand, that they understood what was happening to the patient and why things were being done. However, 74% answered that the personnel had never explained the equipment being used. About 90% thought that they had received sincere information and that adequate care was being given. Considering empathy with the personnel, almost all considered they were nice but that 73% of them had never been asked if they needed anything. A total of 85% of them were sure that someone would phone them if there was any significant change in their relative's condition, and they felt comfortable during the time of visit; 74% did not feel alone or isolation. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their relatives in the intensive care unit, but the need to improve some aspects of the communication with families was identified.

Encuesta de satisfacción a los familiares de pacientes críticos / Satisfaction survey administered to the relatives of critical patients

Objetivo. Conocer la satisfacción de los familiares de pacientes ingresados en nuestra Unidad de Cuidados Intensivos (UCI). Diseño. Estudio prospectivo descriptivo durante un período de 6 meses. Ámbito. UCI polivalente del Hospital Universitario Insular de Gran Canaria. Sujetos. Familiares de pacientes adultos ingresados en la UCI durante más de 48 horas y que fueron dados de alta a planta de hospitalización. Intervención. Se realizó una encuesta personal a los familiares directos de los pacientes, en el momento del alta de la unidad, llevada a cabo por personal médico no informador. Variables de interés principales. Se recogieron datos demográficos de los pacientes y de los familiares entrevistados, diagnóstico de ingreso, y la valoración acerca de la información, cuidados, empatía con el personal y la comodidad. Resultados. Se entrevistó a familiares de 99 pacientes. El 80% recibieron la información con terminología comprensible, entendían lo que le ocurría a su familiar y los medios que se estaban poniendo para su curación, a pesar de que al 74% nunca se les había explicado la tecnología utilizada. El 90% creían recibir una información sincera y que los cuidados eran los adecuados. A nivel de empatía con el personal médico, para casi todos eran amables; sin embargo, al 73% ninguno le preguntó si necesitaba algo. El 85% estaban seguros de que alguien les llamaría a casa si ocurría algún cambio en el estado de su familiar y se sentían cómodos durante el tiempo de visita; el 74% no tuvo sentimiento de soledad ni aislamiento. Conclusiones. La mayoría de los familiares estaban muy satisfechos con los cuidados recibidos por ellos y por sus familiares enfermos en la UCI, aunque detectamos la necesidad de mejorar en determinados aspectos de la comunicación con los familiares

Objective. To know the family needs of patients admitted to our Intensive Care Unit (ICU). Design. Prospective, descriptive study performed over a 6-month period. Setting. ICU of the Insular University Hospital in Gran Canary Islands. Participants. Adult patients admitted to the ICU for more than 48 hours who were discharged to the hospitalization ward. Intervention. A modified Society of Critical Care Medicine Family Needs Assessment instrument was administered to the first-degree relatives of patients after discharge by face-to-face interviews by not-informing personnel. Main variables. Data were gathered on demographic information on the patients and their interviewed relatives, reason for admission, and evaluation on information, care, empathy with the personnel and comfort. Results. Family members of 99 patients were interviewed. A total of 80% of those interviewed considered the information had been in terms that they could understand, that they understood what was happening to the patient and why things were being done. However, 74% answered that the personnel had never explained the equipment being used. About 90% thought that they had received sincere information and that adequate care was being given. Considering empathy with the personnel, almost all considered they were nice but that 73% of them had never been asked if they needed anything. A total of 85% of them were sure that someone would phone them if there was any significant change in their relative's condition, and they felt comfortable during the time of visit; 74% did not feel alone or isolation. Conclusions. Most family members were highly satisfied with the care provided to them and their relatives in the intensive care unit, but the need to improve some aspects of the communication with families was identified

Usefulness of microscopic examination of intracellular organisms in lavage fluid in ventilator-associated pneumonia.

STUDY OBJECTIVE: To assess the usefulness of quantification of bronchoalveolar lavage (BAL) cells containing intracellular organisms (ICO) in the diagnosis of ventilator-associated pneumonia. DESIGN: The reliability of cytologic analysis in comparison with the protected specimen brush (PSB) and BAL quantitative cultures has been assessed in a prospective study. SETTING: An intensive care unit of a tertiary-referral teaching hospital. PATIENTS: A total of 33 ventilated patients with suspected pneumonia based on clinical grounds and radiographic findings. INTERVENTIONS: All patients underwent fiberoptic bronchoscopy within the first 24 h after clinical suspicion of pneumonia. Specimens were obtained by PSB and BAL and were processed for quantitative cultures using standard methods. Two 0.5-ml samples of resuspended original BAL fluid were centrifuged and stained with Gram and modified May-Grünwald-Giemsa for differential cell counts and percentage of cells with ICO. RESULTS: Pneumonia was the final diagnosis in 16 (49 percent) of the 33 patients. In 14 (42 percent) patients, pneumonia was excluded and in the remaining 3 the diagnosis was uncertain. Twelve of the 16 patients with pneumonia had their conditions diagnosed by PSB, 14 by BAL, and 10 by quantification of ICO. Only one patient's condition was diagnosed exclusively by cytologic examination. There were no false-positive results with any of the diagnostic techniques. CONCLUSIONS: Microscopic identification of ICO in cells recovered by BAL allows early and accurate diagnosis of pneumonia in mechanically ventilated patients. However, the sensitivity of this technique is lower than with either PSB or BAL.

[The usefulness of elastin fibers as a diagnostic marker in ventilator-related pneumonia]. / Utilidad de las fibras de elastina como marcador diagnóstico de la neumonía asociada al ventilador.

The diagnosis of nosocomial pneumonia is especially difficult in intubated patients due to the low specificity of their clinico-radiological signs. The objective of this study was to evaluate the usefulness of basing diagnosis on elastin fibers (EF) in bronchoaspirate (BAS) as an indication of pneumonia in mechanically-ventilated (MV) patients. Forty-seven MV patients suspected of having nosocomial pneumonia were studied prospectively. Fiber bronchoscopy was carried out on all patients and samples were obtained using a protected catheter brush (PCB) and bronchoalveolar lavage (BAL). A purulent sample of BAS was also examined, after addition of 40% KOH, to determine the presence of EF. EF was found in 15 patients, 11 of whom had pneumonia while 3 more had necrotizing pneumonia (sensitivity 52%, specificity 85%). Ten of the 17 microorganisms isolated in the cases of EF positive pneumonia were gram negative, although the germ found most often was S. aureus. There were no differences in the prognosis for pneumonia patients who were EF positive and those who were EF negative. In conclusion, once necrotizing pneumopathology has been ruled out, the presence of EF in BAS may offer reasonable support for firm diagnosis in some MV patients with pneumonia.