Ejercicio físico como tratamiento efectivo y seguro en el paciente crítico: una revisión sistemática / Physical exercise as a safe and effective treatment in critically-ill patients: a systematic review

Con el objetivo de establecer la efectividad y seguridad de los programas basados en el ejercicio en pacientes ingresados en cuidados intensivos, se realizó una búsqueda en las bases de datos Medline, Registro Cochrane de Ensayos, CINAHL, LILACS, Embase y PEDro. Los factores limitantes aplicados fueron: edad, tiempo, idioma y tipo de estudio. La calidad metodológica de los estudios se evaluó mediante la plantilla CASPe. Se obtuvieron 10 ensayos clínicos controlados aleatorizados con un total de 679 pacientes. La heterogeneidad de los estudios no permitió realizar un metaanálisis. Las mejoras significativas se relacionaron con el aumento de fuerza de los músculos respiratorios y la capacidad para caminar y realizar actividades de la vida diaria, no así en la duración de la ventilación mecánica ni en la reducción de estancias, y no se encontraron efectos adversos graves. En conclusión, la terapia basada en ejercicio puede considerarse efectiva y segura en el paciente crítico (AU)

To establish the safety and effectiveness of exercise-based programmes in patients admitted to intensive care units, a search was conducted in the following databases: Medline, Cochrane Register of Trials, CINAHL, LILACS, Embase, and PEDro. The limiting factors applied were age, time, language and type of study. The methodological quality of the studies was evaluated using the CASPe template. Ten randomised controlled trials were obtained, with a total of 679 patients. The heterogeneity of the studies did not allow meta-analysis. Significant improvements were related to increased respiratory muscle strength and to the ability to walk and perform activities of daily living. No significant improvements were found in the duration of mechanical ventilation or in reduced length of stay. No serious adverse effects were found. In conclusion, exercise-based therapy can be considered safe and effective in critically-ill patients (AU)

Ensayo clínico aleatorizado para la comparación de dos métodos de cura de traqueotomía en una Unidad de Cuidados Intensivos / Randomised clinical trial to compare two tracheotomy care methods in an Intensive Care Unit

Introducción: La traqueotomía es una técnica habitual en las Unidades de Cuidados Intensivos (UCI). Es sabido que los cuidados enfermeros durante y posteriores al procedimiento están directamente relacionados con el éxito del mismo, minimizando el riesgo de aparición de complicaciones como la infección del estoma y favoreciendo la adecuada evolución del paciente crítico. Objetivos: Comparar la incidencia de infección en las traqueotomías realizadas en UCI según el antiséptico empleado: cura con polihexanida (PLX) y cura con suero fisiológico + povidona yodada (PY). Material y método: Ensayo experimental, aleatorizado y abierto, realizado en una UCI polivalente de 32 camas durante 2 años. El estudio fue aprobado por el Comité Ético de Investigación del Principado de Asturias. Resultados: La tasa observada de infecciones por 100 pacientes-día de traqueotomía fue de 1,34 (IC del 95%, 0,81-2,01): 1,46 en PLX y 1,21 PY (p valor 0,685). Conclusiones: A pesar de que el tratamiento experimental (PLX) ha mostrado su eficacia en otro tipo de heridas, en nuestro estudio no se encontraron diferencias significativas entre esta técnica y la estándar. Dado que no existe un registro nacional de incidencia de infección asociada a traqueotomías, no se puede saber si la observada está dentro de los parámetros habituales

Introduction: Tracheotomy is a common technique in Intensive Care Units (ICU). It is known that nursing care during and after that procedure is directly related to its success, by reducing the possible complications to a minimum, such as the stoma infection, and contributing to a favourable outcome in critical patients. Objectives: To compare the use of polyhexanide (PLX) versus saline + povidone iodine (PY) as antiseptics and infection incidence in tracheostomies performed in Intensive Care Units. Material and method: A 2-year, experimental, randomised, open-label trial carried out in a multidiscipline ICU with 32 beds. The study was approved by the Research Ethics Committee of Principality of Asturias. Results: The overall infection rate observed for every hundred patients was 1.34 (95% CI; 0.81-2.01), with 1.46 when using PLX and 1.21 for PY (P=.685). Conclusions: In spite of the experimental treatment (PLX) was shown to be effective in other types of wounds in our study. No significant differences were found between this technique and the standard one. Since there is no national registry of tracheotomy- associated infections, it is not possible to know whether the rate observed is within the usual parameters

[Randomised clinical trial to compare two tracheotomy care methods in an Intensive Care Unit]. / Ensayo clínico aleatorizado para la comparación de dos métodos de cura de traqueotomía en una Unidad de Cuidados Intensivos.

INTRODUCTION: Tracheotomy is a common technique in Intensive Care Units (ICU). It is known that nursing care during and after that procedure is directly related to its success, by reducing the possible complications to a minimum, such as the stoma infection, and contributing to a favourable outcome in critical patients. OBJECTIVES: To compare the use of polyhexanide (PLX) versus saline+povidone iodine (PY) as antiseptics and infection incidence in tracheostomies performed in Intensive Care Units. MATERIAL AND METHOD: A 2-year, experimental, randomised, open-label trial carried out in a multidiscipline ICU with 32 beds. The study was approved by the Research Ethics Committee of Principality of Asturias. RESULTS: The overall infection rate observed for every hundred patients was 1.34 (95% CI; 0.81-2.01), with 1.46 when using PLX and 1.21 for PY (P=.685). CONCLUSIONS: In spite of the experimental treatment (PLX) was shown to be effective in other types of wounds in our study. No significant differences were found between this technique and the standard one. Since there is no national registry of tracheotomy- associated infections, it is not possible to know whether the rate observed is within the usual parameters.