[Burnout syndrome in different intensive care units]. / Síndrome de burnout en distintas Unidades de Cuidados Intensivos.

OBJECTIVES: To determine the prevalence of the professional burnout syndrome in health care personnel of different Intensive Care Units (ICUs). To know the association between burnout, its dimensions and sociodemographic-laboral variables. To compare the dimensions of burnout, characteristics of the personnel and of the patients of the different ICUs. MATERIAL AND METHODS: Analytic, comparative, cross-sectional study performed in the ICU of a tertiary hospital in November 2006 performed in a sample of 289 professionals. The Maslach Burnout Inventory questionnaire and sociodemographic-laboral variables were provided. The following were evaluated in the ICUs: Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay, isolations and travel of third parties. The chi2 test, Fischer test, Kruskall-Wallis test and multivariate logistic regression analysis were used. RESULTS: A total of 73% of the workers answered. Ages ranged from 37 +/- 9 and 81% were women. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% of residents, 13% physicians and 10% auxiliary workers. Burnout was associated to low professional satisfactions, relationship with regular colleagues, low work recognition and time worked and experience in the ICU to high emotional tiredness, with a p < 0.05. In a polyvalent ICU, higher values of the following were obtained: TISS 42 +/- 11, NEMS 35 +/- 10, mortality 18%, stay 5 +/- 9, isolation 21%, burnout syndrome 17%, elevated emotional tiredness 49%, elevated depersonalization 63% and low professional performance 44%. CONCLUSIONS: The prevalence of the burnout syndrome in our sample was 14%, those being affected most being the nursing professionals. We detected elevated levels of depersonalization and middle levels of emotional tiredness and professional performance. The variables related with professional burnout syndrome were low professional satisfaction, relationship with regular colleagues, low work recognition, and elevated emotional tiredness in the more expert personnel. The ICU with the greatest prevalence of burnout during the month studied attended patients with greater TISS, NEMS, mortality, stay and isolations.

Síndrome de burnout en distintas Unidades de Cuidados Intensivos / Burnout syndrome in different Intensive Care Units

Objetivos. Determinar la prevalencia del síndrome de desgaste profesional (burnout) enel personal sanitario de distintas Unidades de Cuidados Intensivos (UCI).Conocer la asociaciónentre el burnout, sus dimensiones y variables sociodemográficas-laborales. Comparardimensiones del burnout, características del personal y de los pacientes de distintas UCI.Material y métodos. Estudio analítico comparativo transversal, realizado en UCI de un hospitalterciario, en noviembre de 2006. La muestra fue 289 profesionales. Se entregó el cuestionarioMaslach Burnout Inventory y variables sociodemográficas-laborales. Se valoró en UCI:Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower UseScore (NEMS), mortalidad, estancia, aislamientos y desplazamientos terciarios. Se empleó laprueba de la χ2, Fischer, Kruskall-Wallis y análisis multivariable de regresión logística.Resultados. Contestaron el 73% de los trabajadores, edad 37 ± 9 y un 81% eran mujeres.Prevalencia de burnout 14%, afectados el 16% de enfermeros, 14% de residentes, 13% demédicos y 10% de auxiliares. El burnout se asoció a satisfacción profesional baja, relacióncon compañeros regular, reconocimiento laboral bajo, y tiempo trabajado y experienciaen UCI a un cansancio emocional elevado, con una p < 0,05. En la UCI Polivalente se obtuvieronvalores más elevados de: TISS 42 ± 11, NEMS 35 ± 10, mortalidad 18%, estancia5 ± 9, aislamientos 21%, síndrome burnout 17%, cansancio emocional elevado 49%, despersonalizaciónelevada 63% y realización profesional baja 44%.Conclusiones. La prevalencia del síndrome de burnout en nuestra muestra fue del 14%,siendo los profesionales de enfermería los más afectados. Detectamos niveles elevadosde despersonalización y niveles medios de cansancio emocional y de realización profesional.Las variables relacionadas con el (..) (AU)

Objectives. To determine the prevalence of the professional burnout syndrome inhealth care personnel of different Intensive Care Units (ICUs). To know the associationbetween burnout, its dimensions and sociodemographic-laboral variables. To comparethe dimensions of burnout, characteristics of the personnel and of the patients of thedifferent ICUs.Material and methods. Analytic, comparative, cross-sectional study performed in the ICUof a tertiary hospital in November 2006 performed in a sample of 289 professionals. TheMaslach Burnout Inventory questionnaire and sociodemographic-laboral variables wereprovided. The following were evaluated in the ICUs: Therapeutic Intervention ScoringSystem (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay,isolations and travel of third parties. The χ2 test, Fischer test, Kruskall-Wallis test andmultivariate logistic regression analysis were used.Results. A total of 73% of the workers answered. Ages ranged from 37 ± 9 and 81% werewomen. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% ofresidents, 13% physicians and 10% auxiliary workers. Burnout was associated to lowprofessional satisfactions, relationship with regular colleagues, low work recognition andtime worked and experience in the ICU to high emotional tiredness, with a p < 0.05. In apolyvalent ICU, higher values of the following were obtained: TISS 42 ± 11, NEMS 35 ± 10,mortality 18%, stay 5 ± 9, isolation 21%, burnout syndrome 17%, elevated emotionaltiredness 49%, elevated depersonalization 63% and low professional performance 44%.Conclusions. The prevalence of the burnout syndrome in our sample was 14%, those beingaffected most being the nursing professionals. We detected elevated levels ofdepersonalization and middle levels of emotional tiredness and professional performance. (..) (AU)

[Analysis of 4 sedation rating scales in the critical patient]. / Análisis de 4 escalas de valoración de la sedación en el paciente crítico.

BACKGROUND: This study aimed to verify the relationship between different Sedation Rating Scales (SRSs) for critical patients on mechanical ventilation and to know the relationship between the SRSs, clinical information and the dose of sedative and analgesia drugs (SAD). MATERIAL AND METHODS: A longitudinal, prospective analytic pilot study conducted in a Medical-Surgical Intensive Care Unit of a tertiary hospital from October-December 2006. The sample included patients who required administration of SAP and mechanical ventilation. The following biological parameters and scales were evaluated: patient's demographics, RAMSAY, Sedation Agitation Scale (SAS), Richmond Agitation Sedation Scale (RASS), Motor Activity Assessment Scale (MASS), SAD dose, mean blood pressure, cardiac rate, pupil diameter and respiratory frequency. Spearman coefficient of interrelation was used to compare the relationship between the different scales. RESULTS: A total of 2.412 measurements were made for each variable: SRS, clinical information and SAD dose in 30 patients with different diseases, 63 % males, age 52 +/- 19 years, APACHEII 24 +/- 8, SAPSII 44 +/- 16, with an ICU mortality UCI 34 %. Median and IQ range of stay in ICU 15.5 and 20 days, of mechanical ventilation 9 and 14 days, of SAD 6 and 5.5 days and of paralyzing drugs (PD) 2 and 5 days, respectively. Interrelation was detected between all the SRSs, with p < 0.0001. The relationship between SAS, RASS and MASS was direct, whereas these were related inversely to RAMSAY. No evidence of interrelation was found between the SRSs, the clinical information and the SAD doses. CONCLUSION: The RAMSAY scale that has not been validated in ICU patients has a strong interrelation with the other already validated SRSs. SRSs are subjective and do not correlate with the clinical information and the SAD doses, probably due to the sample's small size and heterogeneity.

Análisis de 4 escalas de valoración de la sedación en el paciente crítico / Analysis of 4 sedation rating scales in the critical patient

Introducción. Los objetivos del estudio fueron comprobar la correlación entre distintasescalas de valoración de la sedación (EVS) del paciente crítico con ventilación mecánica,así como conocer la asociación entre las EVS, datos clínicos y dosis de sedoanalgesia enperfusión (SAP).Material y métodos. Estudio analítico longitudinal prospectivo, realizado en una Unidadde Cuidados Intensivos Polivalente de un hospital terciario, desde octubre a diciembre de2006. La muestra incluyó a pacientes que precisaron administración de SAP y ventilaciónmecánica. Se valoraron: características de los pacientes, escala de Ramsay, escala desedación-agitación (SAS), escala de agitación-sedación de Richmond (RASS), escala deevaluación de la actividad motora (MAAS), dosis de SAP, tensión arterial media, frecuenciacardiaca, tamaño pupilar y frecuencia respiratoria. Se empleó el coeficiente de correlaciónde Spearman para valorar la relación entre las diferentes escalas.Resultados. Se realizaron 2.412 mediciones de cada variable: EVS, datos clínicos y dosisde SAP, en 30 pacientes con distintas patologías, 63% varones, edad 53 ± 19 años, APACHEII 23,8 ± 8,54, SAPS II 44,93 ± 16,52, mortalidad al alta en Unidad de Cuidados Intensivos(UCI) 34%. Mediana y rango intercuartílico de estancia en UCI 15,5 y 20 días, de ventilaciónmecánica 9 y 14 días, de SAP 6 y 5,5 días y de relajación en perfusión (RP) 2 y 5 días,respectivamente. Se detectó correlación entre todas las EVS, con una p < 0,0001. La relaciónentre SAS, RASS y MASS fue directa, mientras que estas se relacionaron inversamentecon el Ramsay. No se observó correlación entre las EVS, los datos clínicos y lasdosis de SAP.Conclusión. La escala de Ramsay, no validada, tiene una fuerte correlación con el restode las EVS estudiadas, ya validadas. Las EVS son subjetivas y no se correlacionan con losdatos clínicos y las dosis de SAP, probablemente por el reducido tamaño y heterogeneidadmuestral(AU)

Background. This study aimed to verify the relationship between different SedationRating Scales (SRSs) for critical patients on mechanical ventilation and to know therelationship between the SRSs, clinical information and the dose of sedative and analgesiadrugs (SAD).Material and methods. A longitudinal, prospective analytic pilot study conducted in aMedical-Surgical Intensive Care Unit of a tertiary hospital from October-December 2006.The sample included patients who required administration of SAP and mechanicalventilation. The following biological parameters and scales were evaluated: patient’sdemographics, RAMSAY, Sedation Agitation Scale (SAS), Richmond Agitation SedationScale (RASS), Motor Activity Assessment Scale (MASS), SAD dose, mean blood pressure,cardiac rate, pupil diameter and respiratory frequency. Spearman coefficient ofinterrelation was used to compare the relationship between the different scales.Results. A total of 2.412 measurements were made for each variable: SRS, clinicalinformation and SAD dose in 30 patients with different diseases, 63 % males, age 52 ± 19years, APACHEII 24 ± 8, SAPSII 44 ± 16, with an ICU mortality UCI 34 %. Median and IQrange of stay in ICU 15.5 and 20 days, of mechanical ventilation 9 and 14 days, of SAD 6and 5.5 days and of paralyzing drugs (PD) 2 and 5 days, respectively. Interrelation wasdetected between all the SRSs, with p < 0.0001. The relationship between SAS, RASS andMASS was direct, whereas these were related inversely to RAMSAY. No evidence ofinterrelation was found between the SRSs, the clinical information and the SAD doses.Conclusion. The RAMSAY scale that has not been validated in ICU patients has a stronginterrelation with the other already validated SRSs. SRSs are subjective and do notcorrelate with the clinical information and the SAD doses, probably due to the sample’ssmall size and heterogeneity(AU)