Propuesta de un índice que resume las medidas preventivas no farmacológicas adoptadas frente al SARS-CoV-2 en las empresas: el caso del Parc de Salut Mar (Barcelona) / A proposal for a summary index of nonpharmacological preventive measures adopted against SARS-CoV-2 in companies: the case of Parc de Salut Mar (Barcelona)

Introducción: Proponer la construcción de un índice numérico con las medidas preventivas no farmacológicas frente a SARS-CoV-2 a partir de la experiencia de una institución sanita-ria en Barcelona, el Parc de Salut Mar (PSMar).Método: La construcción del índice se ha realizado en tres fases. La identificación y selec-ción de las variables a incluir a partir de entrevistas semiestructuradas a informantes clave y la revisión documental. La definición de las dimensiones (constituidas a partir de una o más variables) y, finalmente la operatividad del índice a partir de dichas dimensiones. Se ha estimado el índice en el PSMar, y en sus dos principales centros, el Hospital del Mar y el Hospital de la Esperanza.Resultados: Se identificaron y categorizaron 21 variables, clasificadas en 5 dimensiones: equipos de protección individual, medidas organizativas individuales, medidas organizati-vas colectivas, medidas de vigilancia epidemiológica y actividades formativas. Además, De forma complementaria se añadió si existía un protocolo de actuación. Durante la primera ola, el índice en el Hospital del Mar se mantuvo por encima del valor obtenido en el Hos-pital de la Esperanza, mientras que en la segunda ola ambos índices presentaron valores similares hasta la semana 36, cuando el del hospital del Mar comenzó a presentar valores superiores. Estas oscilaciones se debieron principalmente a las dimensiones equipos de protección individual y actividades formativas.Conclusiones: El índice propuesto pone de manifiesto las dificultades para aplicar las diver-sas medidas preventivas no farmacológicas en las primeras semanas de la pandemia. Esta herramienta puede ser útil para evaluar las actividades desarrolladas frente a la pandemia por parte de los Servicios de Prevención de Riesgos Laborales, con las oportunas adapta-ciones a la realidad de cada empresa (AU)

Introduction: We propose the construction of a numerical index of nonpharmacological preventive measures against SARS-CoV-2 based on the experience of Parc de Salut Mar (PSMar), a healthcare institution in Barcelona.Method: The construction of the index was carried out in three phases. First, we identified and selected the variables to be included based on semi-structured interviews with key in-formants and a review of relevant documents. Second, we defined the dimensions (consist-ing of one or more variables) and, as a final step, operationalised the index based on these dimensions. The index was then applied to generate estimates for the PSMar, and in its two main centres, the Hospital del Mar and the Hospital de la Esperanza.Results: Twenty-one variables were identified and categorised into five dimensions: person-al protective equipment, individual organisational measures, collective organisational mea-sures, epidemiological surveillance measures, and training activities. We also developed an action protocol. During the first SARS-CoV-2 wave, the index at the Hospital del Mar re-mained above that estimated for the Hospital de la Esperanza, whereas in the second wave both indices showed similar values until week 36, when the Hospital del Mar index began o show higher values. These oscillations were mainly due to the dimensions of personal protective equipment and training activities.Conclusions: The proposed index identified the difficulties in implementing the various non-pharmacological preventive measures during the first weeks of the pandemic. This tool can be useful for evaluating the activities carried out by the occupational risk prevention services during the pandemic, followed by appropriate adaptations to the realities of each individual company (AU)

Respuesta a la carta: Contestación a la carta «Actuación ante un caso de extubación accidental con paciente en posición de decúbito prono» / Reply to letter: Response to the letter «Anaesthesia management of accidental extubation in the prone position»

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Actuación ante un caso de extubación accidental con paciente en posición de decúbito prono / Anesthesia management of accidental extubation in the prone position

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Preoperative estimated glomerular filtration rate and the risk of major adverse cardiovascular and cerebrovascular events in non-cardiac surgery.

BACKGROUND: Chronic kidney disease is an independent predictor of perioperative cardiovascular morbidity and mortality. We analysed the preoperative estimated glomerular filtration rate (eGFR) as a risk factor for perioperative major adverse cardiovascular and cerebrovascular events (MACCE) in non-cardiac surgery. METHODS: In a post hoc analysis of the ANESCARDIOCAT database, patients were classified into six stages of eGFR calculated with the abbreviated Modification of Diet in Renal Disease Study and the Chronic Kidney Disease Epidemiology Collaboration equations: >90 (1), 60-89.9 (2), 45-59.9 (3a), 30-44.9 (3b), 15-29.9 (4), and <15 (5) ml min(-1) 1.73 m(-2). We analysed differences in MACCE, length of hospital stay, and all-cause mortality between eGFR stages. RESULTS: The eGFR was available in 2323 patients. Perioperative MACCE occurred in 4.5% of patients and cardiac-related mortality was 0.5%. Five hundred and forty-three (23.4%) patients had an eGFR of <60 ml min(-1) 1.73 m(-2) and 127 (5.4%) had an eGFR below 45 ml min(-1) 1.73 m(-2). Logistic regression analysis showed that MACCE increased with eGFR impairment (P<0.001), with a marked increase from stage 3b onwards (odds ratio 1.8 vs 3.9 in 3a and 3b, respectively, P=0.047). All-cause mortality was not related to eGFR (P=0.071), but increased substantially between stages 3b and 4. The length of stay correlated with eGFR (P<0.001). CONCLUSIONS: Perioperative MACCE increase with declining eGFR, primarily when <45 ml min(-1) 1.73 m(-2). We recommend the use of preoperative eGFR for cardiovascular risk assessment.

Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design.

BACKGROUND: The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double-blind, double-dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery. METHODS: Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 µg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded. RESULTS: Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47-2.61)] and 2.5 [1.08 (1.07-4.85)] µg/kg/h, respectively (P < 0.001). The epidural group had a shorter time to awakening, with a median of 8 min [4.5 (3-18)] compared with 20 min [12.5 (7-34)] for the intravenous group (P < 0.001). There were no significant differences in propofol requirements. The time to analgesia request was also delayed in the epidural group, with a median of 5 h [5.5 (1-16)] vs. 2 h [1 (1-5)] when fentanyl was administered intravenously (P < 0.001). The incidence of adverse effects was similar in both groups. CONCLUSION: During major abdominal surgery, epidural administration requires lower doses of intraoperative fentanyl when compared with the intravenous route. Epidural fentanyl also facilitates early awakening and residual analgesia without increasing adverse events.

[Ultrasound-guided posterior approach to block the sciatic nerve at the popliteal fossa]. / Bloqueo poplíteo posterior guiado por ecografía.

The recent introduction of ultrasound guidance for locating peripheral nerves and nerve plexi has allowed injection of anesthetic agents to block the sciatic nerve at the popliteal fossa proximal to division, thus preventing damage to adjacent structures, repeated punctures, and multiple nerve stimulations to verify anesthetic diffusion around the nerve. We report the case of a 23-year-old man, ASA I, who underwent reduction and osteosynthesis of a fractured right fibula. Ultrasound was used to guide the needle after identification of the sciatic nerve 10 cm from the knee fold and 3.5 cm deep. When the point of the needle was near the nerve, the nerve stimulator was switched on to 0.5 mA, and when no response was obtained the current was increased to 1.5 mA. The needle was moved slightly (1-2 mm) to produce a plantar flexion (tibial component) that persisted until stimulation had been reduced to 0.4 mA, at which time 30 mL of 1.5% mepivacaine was injected. The sonographic image during injection showed that the anesthetic had surrounded the nerve (donut sign). The motor and sensory block of the sciatic nerve was complete and no adverse events occurred during or after surgery. We conclude that the combination of ultrasound guidance and nerve stimulation allows the sciatic nerve to be located easily. The approach to the point before division of the sciatic nerve can be guaranteed so that puncture of neighboring vessels can be avoided and optimal anesthesia provided.

[Assessment of the nutritional status of elderly patients treated at a home-hospital unit]. / Evaluación del estado nutricional de los pacientes mayores atendidos en una unidad de hospitalización a domicilio.

GOALS: To establish the nutritional status of our elderly patients, assess the usefulness of the various anthropometric and biochemical parameters as markers of malnutrition and to determine which of the variables studied have the greatest correlation with malnutrition. SCOPE: Home Hospital Unit of the Arnau de Vilanova Teaching Hospital in Lerida. PATIENTS: 57 patients > or = 60 years. Mean admission to our unit: 12.1 days. VARIABLES: Age, sex, groups by treatment complexity, associated pathology, diagnosis, reason for admission, duration of stay in hospital, surgery performed, complications during the stay at the Home Hospital Unit, weight, height, PCT, AC, BMI, albumin, haemoglobin and RTL. RESULTS: Patients of great age present lower levels of serum albumin (p < 0.005), total proteins (p < 0.001), transferrin (p < 0.03), haemoglobin (p < 0.02) and RTL (p < 0.04) than "younger" elderly patients. Serum albumin and haemoglobin are lower in patients in a complicated post-surgical condition (p < 0.04 and p < 0.02, respectively) and this group is the one with the longest stays (p < 0.001). Those patients with hypoalbuminaemia (74.1%) present lower PCT and RTL (p < 0.02) and a longer stay in hospital (p < 0.01) than those with normal levels of albumin in blood. Patients with anaemia (63.3%) present a lower RTL (p < 0.01) and a greater hospitalization time than those without anaemia. Total proteins (p < 0.0001), albumin (p < 0.004), transferrin (p < 0.003) and RTL (p < 0.005) correlate negatively with age. Albumin (p < 0.001), haemoglobin (p < 0.006) and RTL (p < 0.0001) present a negative correlation with length of hospital stay. CONCLUSION: The prevalence of global malnutrition is high (51% moderate-severe). The nutritional status worsens with age. The length of hospitalization increases gradually with age, with deteriation in the nutritional status and with complexity of the treatment provided.

Evaluación del estado nutricional de los pacientes mayores atendidos en una unidad de hospitalización a domicilio / Assessment of the nutritional status of elderly patients treated at a home-hospital unit

Objetivos: Establecer el estado nutricional de nuestros pacientes mayores, valorar la utilidad de los distintos parámetros antropométricos y bioquímicos como marcadores de desnutrición y determinar qué variables estudiadas tienen mayor correlación con la malnutrición. Ámbito: Unidad de Hospitalización a Domicilio del Hospital Universitario Arnau de Vilanova de Lleida. Pacientes: 57 pacientes 60 años. Media de estancia en nuestra unidad: 12,1 días. Variables: Edad, sexo, grupos según la complejidad de las curas, patología asociada, diagnóstico, motivo de ingreso, tiempo de estancia hospitalaria, intervención quirúrgica practicada, complicaciones durante la estancia en la UHD, peso, talla, PCT, CB, IMC, CMB, albúmina, hemoglobina y RTL. Resultados: Los pacientes de "más edad" presentan una tasa de seroalbúmina (p < 0,005 ) de proteínas totales (p < 0,001), de transferrina (p < 0,03), de hemoglobina (p < 0,02) y de RTL (p < 0,04) menor, que los ancianos "más jóvenes". La hemoglobina y la albúmina sérica están más descendidas en los pacientes con un postoperatorio complicado (p < 0,02 y p < 0,04 respectivamente); siendo este grupo los que están más tiempo hospitalizados (p < 0,001). Los pacientes con hipoalbuminemia (74,1 per cent) presentan un PCT y RTL menor (p < 0,02) y una estancia hospitalaria mayor (p < 0,01) que los que presentan normoalbuminemia. Los pacientes con anemia (63,3 per cent) presentan un RTL menor (p < 0,01) y una estancia hospitalaria mayor que los pacientes sin anemia. Las proteínas totales (p<0,0001), la albúmina (p<0,004), la transferrina (p<0,003), y el RTL (<0,005) presentan una correlación negativa con la edad. La albúmina (p<0,001), la hemoglobina (p<0,006), y el RTL (p<0,0001 ) presentan una correlación negativa con la estancia hospitalaria. Conclusión: La prevalencia de malnutrición global es elevada (51 per cent moderada-severa). El estado nutricional empeora con la edad. La estancia hospitalaria se incrementa progresivamente con la edad, con el deterioro del estado nutricional y con la complejidad de las curas (AU)

Goals. To establish the nutritional status of our elderly patients, assess the usefulness of the various anthropometric and biochemical parameters as markers of malnutrition and to determine which of the variables studied have the greatest correlation with malnutrition. Scope: Home Hospital Unit of the Arnau de Vilanova Teaching Hospital in Lerida. Patients: 57 patients ≥ 60 years. Mean admission to our unit: 12.1 days. Variables: Age, sex, groups by treatment complexity, associated pathology, diagnosis, reason for admission, duration of stay in hospital, surgery performed, complications during the stay at the Home Hospital Unit, weight, height, PCT, AC, BMI, albumin, haemoglobin and RTL. Results: Patients of great age present lower levels of serum albumin (p < 0.005), total proteins (p < 0.001), transferrin (p < 0.03), haemoglobin (p < 0.02) and RTL (p < 0.04) than "younger" elderly patients. Serum albumin and haemoglobin are lower in patients in a complicated post-surgical condition (p < 0.04 and p < 0.02, respectively) and this group is the one with the longest stays (p < 0.001). Those patients with hypoalbuminaemia (74.1%) present lower PCT and RTL (p < 0.02) and a longer stay in hospital (p < 0.01) than those with normal levels of albumin in blood. Patients with anaemia (63.3%) present a lower RTL (p < 0.01) and a greater hospitalization time than those without anaemia. Total proteins (p < 0.0001), albumin (p < 0.004), transferrin (p < 0.003) and RTL (p < 0.005) correlate negatively with age. Albumin (p < 0.001), haemoglobin (p < 0.006) and RTL (p < 0.0001) present a negative correlation with length of hospital stay. Conclusion: The prevalence of global malnutrition is high (51% moderate-severe). The nutritional status worsens with age. The length of hospitalization increases gradually with age, with deterioration in the nutritional status and with complexity of the treatment provided (AU)