Dysphagia management by nurses in Spanish intensive care units.

INTRODUCTION/PURPOSE: Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses. METHOD: Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis. OUTCOMES: 43 nurses were recruited. Dysphagia is considered an important problem (90,7%) but in 50,3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32,6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = ,029). The most common treatment is modification of food consistency (86,0%). CONCLUSION: The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.

Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge.

INTRODUCTION: The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge. OBJECTIVES: To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge. METHODOLOGY: Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. VARIABLES: pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. STATISTICS: descriptive and multivariate analysis. RESULTS: 254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge. CONCLUSIONS: CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.

La disfagia en cuidados intensivos, un problema real: análisis de factores de riesgo / Dysphagia in intensive care, a real problem: analysis of risk factors

Objetivos: Determinar los factores de riesgo presentes en los pacientes con disfagia en relación con una población de pacientes críticos. Método: Serie de casos de una cohorte de pacientes reclutados en la unidad de cuidados intensivos (UCI) hasta el alta hospitalaria. Se reclutaron a aquellos pacientes que dieron su consentimiento y cumplían los criterios de inclusión. El método de exploración clínica Volumen-Viscosidad fue utilizado para la detección de la disfagia. Se realizó un análisis estadístico uni- y bivariante, a través del odds ratio (OR) para detectar los factores de riesgo en la disfagia. Resultados: 103 pacientes fueron reclutados de 401 posibles. La media de edad fue de 59,33±13,23; los hombres representaban el 76,7%. La gravedad media fue: APACHE II (12,74±6,17) y Charlson (2,98±3,31). Un 45,6% de los pacientes desarrollaron disfagia, obteniendo valores significativos de OR (p<0,050) para el desarrollo de disfagia: la mayor edad, los antecedentes neurológicos, COVID19, la alta estancia en UCI y hospitalización y la presencia de traqueotomía. Los pacientes COVID19 representaban el 46,6%, por lo que se realizó un análisis de este subgrupo observando resultados similares, con un riesgo de Charlson (OR:4,65; IC95%: 1,31-16,47; p=0,014) y una estancia hospitalaria (OR: 8,50; IC95%: 2,20-32,83; p<0,001). Al alta de UCI, el 37,9% de la población presentaba todavía disfagia, y mantenía este problema al alta hospitalaria el 12,6%. Conclusiones: Casi la mitad de nuestros pacientes presentaron disfagia. Fueron factores de riesgo la gravedad clínica y la presencia de traqueotomía. Se observó en estos pacientes una mayor estancia tanto en UCI como en hospitalización.(AU)

Aims: To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes: 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p=0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. Conclusions: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.(AU)

Dysphagia in intensive care, a real problem: analysis of risk factors.

AIMS: To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES: 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.

[Perceptions of intensive care professionals about hand hygiene compared with observational studies]. / Percepciones de los profesionales de cuidados intensivos sobre la higiene de manos en comparación con estudios observacionales.

OBJETIVE: To identify perceptions and knowledge about the adherence to hand hygiene of the healthcare staff of an intensive care unit, correlating them with compliance data on adherence to hand hygiene through observational studies MATERIAL AND METHOD: A quantitative methodology has been combined, based on the completion of a personal survey, and a qualitative methodology based on direct observation. Units of Intensive Care of Adults (A-ICU) and Pediatrics (P-ICU) of a tertiary hospital. There were 187 health professionals. Personal and work data of the professionals were collected, as well as questions related to their knowledge and perceptions about the hand hygiene. RESULTS: Those 187 professionals, 75,9% from A-ICU, represented more than 80% of the study population, and 91.4% had received previous training on hand hygiene. Regarding knowledge, 35% of the A-ICU professionals and almost 50% from the P-ICU consider that hand washing is more effective than hand friction with alcohol-based solutions for the elimination of microorganisms. They have a better perception that they correctly perform the hand washing (89.32% ICU-P and 82.93% ICU-A), than when we compare them to the adherence rates obtained by direct observation (ICU-P 73.8% and ICU-A 51.4%, P=0.0001). CONCLUSIONS: Despite having previous training on hand hygiene, they have incomplete knowledge and, although they overestimate the problem of the healthcare-associated infections, they have a perception that does not fit with reality.

[Perception of the quality of nursing research in a public hospital]. / Percepción de la calidad de la investigación enfermera en un hospital público.

BACKGROUND AND OBJECTIVES: Nurses, as health professionals, play an important role in research, as progress in care and treatment could not be made without it. The aim of this study is to analyse the perception by nurses of the current research system in the whole of their hospital and, second, study how this perception varies according to their research profile, as well as their level of satisfaction and commitment to the organisation in which work. MATERIAL AND METHOD: A cross-sectional descriptive study was conducted in a third level hospital with a convenience sample of nurses with more than 6 months experience. The Group of Experts of the III Forum of Science of the Lilly Foundation questionnaire was used, adapting it to the characteristics of the population. The purpose of the questionnaire was to collect the perception and assessment, real and ideal, that nurses have on research. Univariate and bivariate analyses were performed using the Student t-test. RESULTS: In the sample of 295 nurses, the perception and assessment of the current situation of nursing research, its impact, its recognition, and its integration with nursing work were well below the ideal scores, obtaining statistically differences (P<.001). There was a significance in the values that recognise that more research is needed by nursing staff, the impact and recognition by management, and synergy with the pharmaceutical industry (P<.001). The level of satisfaction did not affect the assessment, the commitment of the nurses if it influenced their assessment of the research. No differences were found between the ICU staff and the other departments as regards the perception and assessment of nursing research. CONCLUSIONS: Nurses take the research as part of their functions and mention that the state of the research is very much improved. A support infrastructure is needed to strengthen research in care, as well as real recognition by institutions.