The roles and responsibilities of advanced practice nurses in intensive care units: A scoping review.

INTRODUCTION: Since the intensive care units are one of the most sensitive hospital settings and critically ill patients undergo various stressful factors that put their lives in danger, a more advanced level of nursing practice is imperative to accommodate these issues and provide optimal care of patients. OBJECTIVES: To review the literature describing the roles and activities performed by advanced practice nurses in intensive care units. REVIEW METHODS: We conducted a scoping review to search published articles using Scopus, PubMed, CINAHL (EBSCOhost), Science Direct, MEDLINE (EBSCOhost) and Cochrane Library during a 10-year period from 2013 to 2023. RESULTS: We identified 729 records, from which eleven articles were included in the review. We included six reviews and five original articles or research papers. With regard to the target area of our review, we used the information provided by these studies and categorized the contents related to the roles of advanced practice nurses in intensive care units into five sections, including direct practice, education and counseling, research, collaboration, and leadership. CONCLUSION: Advanced practice nurses are essential members of critical care team by playing various roles in practice, education, research, collaboration, and leadership, and therefore, they can increase patients' access to critical care and improve healthcare outcomes. The advancement of technology and complexity of care in intensive care units have led to the role expansion of these nurses which results in task-shifting between doctors and nurses. Therefore, it is considered essential for nursing and medical professionals to reach an agreement to establish standardized roles for advanced practice nurses.

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.

Perception of novice nurses in an emergency box: A qualitative approach to their experiences and needs.

BACKGROUND: Nurses play an essential role in the care of emergency hospital patients, being the ones who have the most contact with the patient and the first to be able to detect their imminent deterioration. However, the literature shows the impact that this can have in terms of stress and insecurity among new nurses, with the consequent risk of resignation in the institution and in their learning process. AIMS: To explore the process of incorporation of new nurses in the emergency room, as well as to identify and understand their emotions, difficulties, needs and proposals for improvement. METHODS: Qualitative research aimed at emergency room nurses in a tertiary level university hospital in Catalonia, between April 2022 and March 2023. Twelve semi-structured interviews were conducted with content analysis. RESULTS: Four categories emerged: identification of deficiencies, emotional dimension, competencies of the expert nursing professional, and needs and proposals for improvement, as main themes. CONCLUSIONS: Insufficient training and deficit of interdisciplinary communication skills appear as main stressors. The analysis of the results suggests the need to create an intervention program that protects the mental and emotional health of new nurses and ensures the integrity of their patients. Innovative and multimodal training adapted to generational change is called for, with virtual, immersive, and contextualized simulation scenarios, together with the implementation of tools such as debriefing and nursing clinical sessions.

Estrategias de destete y desmonte de cánula nasal de alto flujo en adultos / Adult High-Flow Nasal Cannula Weaning and Disassembly Strategies

Introducción: La cánula nasal de alto flujo es un sistema que utiliza una mezcla de aire-oxígeno humidificado y calentado con un caudal de hasta 70 litros por minuto. Es utilizada mayoritariamente en la insuficiencia respiratoria aguda de origen hipoxémico, donde ha demostrado brindar mayor comodidad y poder resolutivo de la hipoxemia, en comparación con la oxigenoterapia convencional. Aunque se conocen sus indicaciones y estrategia de seguimiento, en la práctica clínica no es claro su proceso de destete/desmonte. Objetivo: Identificar en la bibliografía la literatura existente acerca de estrategias de destete/desmonte de la cánula nasal de alto flujo en adultos. Métodos: Se realizó una revisión bibliográfica en las bases de datos del portal regional de la BVS, PubMed, Web Of Science, Scopus y Google scholar, sin límite de tiempo y es- tructurando una ecuación PIO con palabras clave y operadores booleanos. Se asumieron artículos publicados en inglés y español, texto completo. Resultados: En la bibliografía, aún se reporta discrepancia en el proceso de destete y desmonte de la cánula nasal de alto flujo, pero en la mayoría de los estudios encontrados en esta revisión se propone disminuir la FiO2 primero de forma gradual (5-10%) hasta valores de 30-50% y, posteriormente, el flujo. Para desmontarla, se podría considerar tener una FiO2 entre 30-50%, flujo entre 20-30 litros por minuto, SaO2 >92%, con adecuada mecánica respiratoria y estado de conciencia. Conclusión: Aún no existe unanimidad en el proceso de destete/desmonte en la cánula nasal de alto flujo en el paciente adulto.

Introduction: The high-flow nasal cannula is a system that uses a humidified and heated air-oxygen mixture with a flow rate of up to 70 liters per minute. It is mostly used in acute respiratory failure of hypoxemic origin, where it has been shown to provide greater comfort and resolving power of hypoxemia, compared to conventional oxygen therapy. Although its indications and follow-up strategy are known, in clinical practice the weaning/weaning process is not clear. Objective: To identify in the bibliography the existing literature on weaning/ weaning strategies of high-flow nasal cannula in adults. Methods: A bibliographic review was carried out in the databases of the regional portal of the BVS, PubMed, Web Of Science, Scopus and Google scholar, without time limit and structuring a PIO equation with keywords and boléan connectors. Articles published in English and Spanish, full text, were assumed. Results: The literature still reports discrepancy in the process of weaning and disassembling the high-flow nasal cannula, but most of the studies found in this review propose to decrease the FiO2 first gradually (5-10%) to values of 30-50% and then the flow. To dismantle it, one could consider having a FiO2 between 30-50%, flow between 20-30 liters per minute, SaO2 >92%, with adequate respiratory mechanics and state of consciousness. Conclusion: There is still no unanimity on the weaning/weaning process in the high- flow nasal cannula in the adult patient.

Asociación entre Glucemia inestable, tiempo de estancia y mortalidad de pacientes en estado críticos: Estudio de cohorte / Associação Entre Glicemia Instável, Tempo de Permanência e Mortalidade de Pacientes Críticos: Estudo de Coorte / Relationships between unstable Glycemia, Hospital Length Of Stay, and mortality In Critically Ill patients: A cohort study

Resumen Introducción: El control y la evaluación de los niveles glucémicos de pacientes en estado críticos es un desafío y una competencia del equipo de enfermería. Por lo que, determinar las consecuencias de esta durante la hospitalización es clave para evidenciar la importancia del oportuno manejo. Objetivo: Determinar la asociación entre la glucemia inestable (hiperglucemia e hipoglucemia), el resultado de la hospitalización y la duración de la estancia de los pacientes en una unidad de cuidados intensivos. Metodología: Estudio de cohorte prospectivo realizado con 62 pacientes a conveniencia en estado crítico entre marzo y julio de 2017. Se recogieron muestras diarias de sangre para medir la glucemia. Se evaluó la asociación de la glucemia inestable con la duración de la estancia y el resultado de la hospitalización mediante ji al cuadrado de Pearson. El valor de p<0.05 fue considerado significativo. Resultados: De las 62 personas participantes, 50 % eran hombres y 50 % mujeres. La edad media fue de 63.3 años (±21.4 años). La incidencia de glucemia inestable fue del 45.2 % y se asoció con una mayor duración de la estancia en la UCI (p<0.001) y una progresión a la muerte como resultado de la hospitalización (p=0.03). Conclusión: Entre quienes participaron, la glucemia inestable se asoció con una mayor duración de la estancia más prolongada y con progresión hacia la muerte, lo que refuerza la importancia de la actuación de enfermería para prevenir su aparición.

Resumo Introdução: O controle e avaliação dos níveis glicêmicos em pacientes críticos é um desafio e uma competência da equipe de enfermagem. Portanto, determinar as consequências da glicemia instável durante a hospitalização é chave para evidenciar a importância da gestão oportuna. Objetivo: Determinar a associação entre glicemia instável (hiperglicemia e hipoglicemia), os desfechos hospitalares e o tempo de permanência dos pacientes em uma unidade de terapia intensiva. Métodos: Um estudo de coorte prospectivo realizado com 62 pacientes a conveniência em estado crítico entre março e julho de 2017. Foram coletadas amostras diariamente de sangue para medir a glicemia. A associação entre a glicemia instável com o tempo de permanência e o desfecho da hospitalização foi avaliada pelo teste qui-quadrado de Pearson. O valor de p <0,05 foi considerado significativo. Resultados: Das 62 pessoas participantes, 50% eram homens e 50% mulheres. A idade média foi de 63,3 anos (±21,4 anos). A incidência de glicemia instável foi de 45,2% e se associou a um tempo de permanência mais prolongado na UTI (p <0,001) e uma progressão para óbito como desfecho da hospitalização (p = 0,03). Conclusão: Entre os participantes, a glicemia instável se associou a um tempo mais longo de permanência e com progressão para óbito, enfatizando a importância da actuação da equipe de enfermagem para prevenir sua ocorrência.

Abstract Introduction: The control and evaluation of glycemic levels in critically ill patients is a challenge and a responsibility of the nursing team; therefore, determining the consequences of this during hospitalization is key to demonstrate the importance of timely management. Objective: To determine the relationship between unstable glycemia (hyperglycemia and hypoglycemia), hospital length of stay, and the hospitalization outcome of patients in an Intensive Care Unit (ICU). Methods: A prospective cohort study conducted with 62 critically ill patients by convenience sampling between March and July 2017. Daily blood samples were collected to measure glycemia. The correlation of unstable glycemia with the hospital length of stay and the hospitalization outcome was assessed using Pearson's chi-square. A p-value <0.05 was considered significant. Results: Among the 62 patients, 50% were male and 50% were female. The mean age was 63.3 years (±21.4 years). The incidence of unstable glycemia was 45.2% and was associated with a longer ICU stay (p<0.001) and a progression to death as a hospitalization outcome (p=0.03). Conclusion: Among critically ill patients, unstable glycemia was associated with an extended hospital length of stay and a progression to death, emphasizing the importance of nursing intervention to prevent its occurrence.

Cultura de segurança em unidades de terapia intensiva na perspectiva da equipe multiprofissional: Estudo multicêntrico / Cultura de seguridad en unidades de terapia intensiva en la perspectiva del equipo multiprofesional: Estudio multicéntrico / Safety Culture in intensive care units from multiprofessional team perspective: A multicenter study

Resumo Introdução: A Cultura de Segurança do Paciente é considerada um importante componente estrutural dos serviços, que favorece a implantação de práticas seguras e a diminuição da ocorrência de eventos adversos. Objetivo: Identificar os fatores associados à cultura de segurança do paciente nas unidades de terapia intensiva adulto em hospitais de grande porte da região Sudeste do Brasil. Método: Estudo transversal do tipo survey e multicêntrico. Participaram 168 profissionais de saúde de quatro unidades (A, B, C e D) de terapia intensiva adulto. Foi utilizado o questionário "Hospital Survey on Patient Safety Culture". Considerou-se como variável dependente o nível de cultura de segurança do paciente e variáveis independentes aspectos sociodemográficos e laborais. Foram usadas estatísticas descritivas e para a análise dos fatores associados foi elaborado um modelo de regressão logística múltipla. Resultados: Identificou-se associação entre tipo de hospital com onze dimensões da cultura de segurança, quanto à função a categoria profissional médico, técnico de enfermagem e enfermeiro foram relacionadas com três dimensões; o gênero com duas dimensões e tempo de atuação no setor com uma dimensão. Conclusão: Evidenciou-se que o tipo de hospital, categoria profissional, tempo de atuação no setor e gênero foram associados às dimensões de cultura de segurança do paciente.

Resumen Introducción: La cultura de seguridad del paciente se considera un componente estructural importante de los servicios, que favorece la aplicación de prácticas seguras y la reducción de la aparición de acontecimientos adversos. Objetivo: Identificar los factores asociados a la cultura de seguridad del paciente en unidades de terapia intensiva adulto en hospitales de la región Sudeste del Brasil. Metodología: Estudio transversal de tipo encuesta y multicéntrico. Participaron 168 profesionales de salud de cuatro unidades (A, B, C y D) de terapia intensiva adulto. Se utilizó el cuestionario "Hospital Survey on Patient Safety Culture". Se consideró como variable dependiente el nivel de cultura de seguridad del paciente y variables independientes los aspectos sociodemográficos y laborales. Fueron usadas estadísticas descriptivas y, para analizar los factores asociados, fue elaborado un modelo de regresión logística múltiple. Resultados: Se identificó asociación entre tipo de hospital con once dimensiones de cultura de seguridad del paciente. En relación a la función, personal médico, técnicos de enfermería y personal de enfermería fueron asociados con tres dimensiones, el género con dos dimensiones y tiempo de actuación con una dimensión en el modelo de regresión. Conclusión: Se evidenció que el tipo de hospital, función, tiempo de actuación en el sector y género fueron asociados a las dimensiones de la cultura de seguridad del paciente.

Abstract Introduction: Patient safety culture is considered an important structural component of the services, which promotes the implementation of safe practices and the reduction of adverse events. Objective: To identify the factors associated with patient safety culture in adult intensive care units in large hospitals in Belo Horizonte. Method: Cross-sectional survey and multicenter study. A total of 168 health professionals from four units (A, B, C and D) of adult intensive care participated. The questionnaire "Hospital Survey on Patient Safety Culture" was used. The patient's level of safety culture was considered as a dependent variable, and sociodemographic and labor aspects were the independent variables. Descriptive statistics were used and a multiple logistic regression model was developed to analyze the associated factors. Results: An association was identified between the type of hospital and eleven dimensions of the safety culture. In terms of function, the doctors, nursing technicians, and nurse were related to three dimensions; gender with two dimensions, and time working in the sector with one dimension. Conclusion: It was evidenced that the type of hospital, function, time working in the sector, and gender were associated with the dimensions of patient safety culture.

A Nationwide Online Tracking System of pediatric ICU demand and capacity during a respiratory epidemic in Uruguay / Desarrollo de un Sistema Nacional de Monitoreo En Línea de Capacidad y Demanda de las Unidades de Cuidados Intensivos Pediátricas Durante Una Epidemia Respiratoria

Monitoring national capacity of pediatric intensive care (PICU) beds is important for resource allocation. We describe the development and application of an online tool for bed occupancy monitoring during the respiratory epidemic of 2023 in Uruguay. A 5-minute survey was sent out daily to each PICU designated staff utilizing an instant messaging application, throughout the 12-week of 2023 winter season. The survey gathered information on staffed bed capacity, occupancy rates, invasive mechanical ventilation (IMV) demand and number of children admitted for lower respiratory tract infections (LRTIs). Data was manually entered using the REDcap Software platform. A comparison between PICUs from the capital city Montevideo (MVD) and the inland region (INN) was performed. Participating PICUs had access to a daily dashboard with nationwide data. We collected data from 100% (n=20) of Uruguayan PICUs, 68% in MVD (2.72 PICU beds per-10,000 <18 years) and 32% in the INN (0.86 PICU beds per-10,000 <18 years). National average bed occupancy rate was 55.5%, without differences between MVD and INN. However, LRTI admissions and IMV incidence were notably higher among INN PICUs compared with MVD PICUs, 83.0% vs. 71% (P<0.01) and 19.9% vs. 14.7% (P<0.01) respectively. During one week occupancy exceeded 80% without differences between MVD and INN. The implementation of a nationwide PICU bed monitoring tool was possible. Although occupancy rates did not reach critical levels at a national grade, regional differences were found that merit further study to improve vital PICUs resource allocation.

Monitorear la capacidad nacional de camas de cuidados intensivos pediátricos (UCIP) es importante para la asignación de recursos. Describimos el desarrollo y aplicación de una herramienta online para el seguimiento de la ocupación de camas durante la epidemia respiratoria de 2023 en Uruguay. Se envió diariamente una encuesta de 5 minutos a cada personal designado de la UCIP mediante una aplicación de mensajería instantánea, durante las 12 semanas de la temporada de invierno de 2023. La encuesta recopiló información sobre la capacidad de camas con personal, las tasas de ocupación, la demanda de ventilación mecánica invasiva (IMV) y el número de niños admitidos por infecciones del tracto respiratorio inferior (LRTI). Los datos se ingresaron manualmente utilizando la plataforma del software REDcap. Se realizó una comparación entre UCIP de la capital Montevideo (MVD) y del interior (INN). Las UCIP participantes tuvieron acceso a un panel diario con datos a nivel nacional. Se recolectaron datos del 100% (n=20) de las UCIP uruguayas, el 68% en MVD (2,72 camas UCIP por 10.000 <18 años) y el 32% en el INN (0,86 camas UCIP por 10.000 <18 años). La tasa de ocupación de camas promedio nacional fue del 55,5%, sin diferencias entre MVD e INN. Sin embargo, los ingresos por LRTI y la incidencia de IMV fueron notablemente mayores entre las UCIP INN en comparación con las UCIP MVD, 83,0% frente a 71% (P<0,01) y 19,9% frente a 14,7% (P<0,01), respectivamente. Durante una semana la ocupación superó el 80% sin diferencias entre MVD y INN. Fue posible implementar una herramienta de monitoreo de camas UCIP a nivel nacional. Aunque las tasas de ocupación no alcanzaron niveles críticos a nivel nacional, se encontraron diferencias regionales que merecen más estudios para mejorar la asignación de recursos vitales de las UCIP.

Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review.

INTRODUCTION: The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE: Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY: Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS: It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION: There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.

National record and analysis of pharmaceutical interventions in critical care units: PHARMACRITIC study. / Registro nacional y análisis de intervenciones farmacéuticas en unidades de cuidados críticos: estudio FARMACRITIC.

OBJECTIVE: To design a homogeneous methodology for the registration and analysis of pharmaceutical interventions performed in Spanish critical adults' care units. METHOD: Observational, prospective and multicenter study. In the first stage, a national registry of pharmaceutical interventions will be agreed upon and subsequently all the pharmaceutical interventions performed on adult patients admitted to Spanish CCUs during eight weeks will be recorded. Variables related to the type of CCU, the drug involved in the intervention, type of intervention (indication, effectiveness, safety), recommendation made by the pharmacist and the degree of acceptance will be evaluated. Risk and incidence will be calculated for each of the medication errors detected. The χ2-squared test or Fisher exact test will be used for categorical variables and Mann-Whitney U or Kruskal-Wallis test for continuous variables. All tests will be performed with a significance level α = 0.05 and confidence intervals with confidence 1- α. DISCUSSION: The results obtained from this project will make it possible to obtain a homogeneous classification of the pharmaceutical interventions performed in CCU, a national record and an evaluation of the weak points with the aim of developing strategies for improvement in the pharmaceutical care of the critically ill patient.

Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness.

Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.

Clinically significant depressive and post-traumatic stress disorder symptoms in survivors of COVID-19 critical illness, especially in patients who had undergone invasive mechanical ventilation, were highly frequent, occurred soon after discharge, and persisted over the long term.

Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study.

OBJECTIVE: Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM). DESIGN: Retrospective cohort study (2014-2022). SETTING: Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center. PATIENTS: Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU. RESULTS: We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76-0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary. CONCLUSIONS: In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%. CLINICAL TRIAL REGISTRATION: NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).

Intensity of Interprofessional Collaboration and related factors in Intensive Care Units. A descriptive cross-sectional study with an analytical approach.

OBJECTIVE: To determine the Intensity of Collaboration between the intensive care professionals of a third level hospital. METHOD: Descriptive cross-sectional study with an analytical approach. SETTING: 6 intensive care units of a third level hospital. SAMPLE: nurses and doctors. Consecutive type non-probabilistic sampling. DATA COLLECTION: sociodemographic, economic, motivation and professional satisfaction variables, and the intensity of collaboration using the "Scale of Intensity of Interprofessional Collaboration in Health." RESULTS: A total of 102 health professionals (91 nurses and 11 doctors) were included. The mean overall Intensity of Collaboration (IoC) was moderate. Men showed higher scores in all factors (p<.05). The IoC global score was higher in the group of professionals with ≤10 years of experience (p=.043) and those who were highly satisfied with the profession (p=.037). Physicians presented higher scores in the global IdC (p=.037) and in the Collaboration mean (p=.020) independently in the multivariate models. A negative linear relationship (rho: -0,202, p=.042) was observed between age and the overall IoC score. Professionals aged ≤30years reported a higher perception of Shared Activities (p=.031). Negative linear relationships were observed between years of experience and total IoC score (rho: -0,202, p=.042) and patients' Perception score (rho: -0.241, p=0.015). The research activity also showed to be a variable related to a greater degree of Collaboration at a global level and in some of the factors (p<.05). The scale of IoC obtained a Cronbach's α of 0,9. CONCLUSIONS: The intensity of interprofessional collaboration in ICUs is moderate. Professionals with experience of ≤10 years, a higher level of satisfaction and participation in research activities show a greater intensity of collaboration. Doctors perceive collaboration more intensely than nurses. All factors contribute equally to the internal consistency of the questionnaire.

Clinical utility of rapid shallow breathing index in predicting successful weaning: secondary analysis of the COBRE-US trial.

OBJECTIVE: To assess the predictive capacity of the Rapid Shallow Breathing Index (RSBI) for success in spontaneous breathing trials (SBT) and extubation in critically ill patients. We evaluated the association between RSBI, duration of mechanical ventilation, and ventilator-free time at 28 days. DESIGN: Prospective multicenter observational study. Secondary analysis of the COBRE-US study. SETTING: Intensive care unit (ICU). PATIENTS OR PARTICIPANTS: 367 patients in the ICU receiving invasive mechanical ventilation. INTERVENTIONS: Assessment of RSBI at the end of SBT. MAIN VARIABLES OF INTEREST: RSBI, SBT, duration of mechanical ventilation, and ventilator-free time at 28 days were evaluated. RESULTS: 367 patients in the ICU under invasive mechanical ventilation were evaluated, of whom 59.7% were male with a median age of 61 years (IQR: 49-72). A total of 456 SBT were conducted with a success rate of 76.5%. RSBI had a ROC-curve of 0.53 for SBT success and a ROC-curve of 0.48 for extubation. The Spearman correlation coefficient between RSBI and duration of ventilation was 0.117 (p = 0.026), while for ventilator-free time at 28 days, it was -0.116 (p = 0.028). CONCLUSIONS: RSBI was not associated with success in SBT or extubation, regardless of the cutoff point used. Correlation analyses showed weak associations between RSBI and both the duration of ventilation and ventilator-free time at 28 days.

Absenteísmo por covid-19 em profissionais de enfermagem de unidade de terapia intensiva / Absenteeism due to covid-19 in nursing professionals in the intensive care unit / Ausentismo debido al covid-19 em profesionales de enfermería en la unidad de cuidados intensivos

Objetivo: Identificar as variáveis associadas ao absenteísmo por covid-19 avaliando a Qualidade de Vida no Trabalho dos profissionais de enfermagem da Unidade de Terapia Intensiva de um hospital público. Métodos: Estudo de abordagem quantitativa, observacional e retrospectivo, realizada na Unidade de Terapia Intensiva de um hospital público estadual em Manaus, aplicado dois questionários para a coleta de dados. Resultados: O absenteísmo teve influência das seguintes variáveis: técnicos de enfermagem (100%); dois vínculos empregatícios (64%); especialização nível médio ou pós-técnico (50%); renda até dois salários-mínimos (73,9%). Conclusão: Este estudo visa contribuir para o avanço do conhecimento científico por meio das relações entre o absenteísmo e a Covid-19 e, através do índice de Qualidade de Vida busca ajudar na criação de melhorias para a classe da enfermagem e de aspectos organizacionais. (AU)

Objective: To identify the variables associated with absenteeism by covid-19 evaluating the Quality of Life at Work of nursing professionals in the Intensive Care Unit of a public hospital. Methods: A quantitative, observational and retrospective study. The research was carried out in the Intensive Care Unit of a public hospital in Manaus, where two questionnaires were applied for data collection. Results: The absenteeism was influenced by the following variables: nursing technicians (100%); two jobs (64%); medium or post-technical specialization (50%); income up to two minimum wages (73.9%). Conclusion: This study aims to contribute to the advancement of scientific knowledge through the relationship between absenteeism and Covid-19 and, through the Quality of Life index, seeks to help create improvements for the nursing class and organizational aspects. (AU)

Objetivo: Identificar las variables asociadas al absentismo por covid-19 evaluando la Calidad de Vida Laboral de los profesionales de enfermería de la Unidad de Cuidados Intensivos de un hospital público. Métodos: Estudio cuantitativo, observacional y retrospectivo. La investigación se realizó en la Unidad de Cuidados Intensivos de un hospital público de Manaus, donde se aplicaron dos cuestionarios para la recogida de datos. Resultados: En el absentismo influyeron las siguientes variables: técnicos de enfermería (100%); dos empleos (64%); especialización media o postécnica (50%); ingresos de hasta dos salarios mínimos (73,9%). Conclusión: Este estudio pretende contribuir al avance del conocimiento científico a través de la relación entre el absentismo y el Covid-19 y, a través del índice de Calidad de Vida, busca ayudar en la creación de mejoras para la clase de enfermería y los aspectos organizativos. (AU)

Postintensive care syndrome in patients and family members. Analysis of COVID-19 and non-COVID-19 cohorts, with face-to-face follow-up at three months and one year.

OBJECTIVE: Compare prevalence and profile of post-intensive care patient (P-PICS) and family/caregiver (F-PICS) syndrome in two cohorts (COVID and non-COVID) and analyse risk factors for P-PICS. DESIGN: Prospective, observational cohort (March 2018-2023), follow-up at three months and one year. SETTING: 14-bed polyvalent Intensive Care Unit (ICU), Level II Hospital. PATIENTS OR PARTICIPANTS: 265 patients and 209 relatives. Inclusion criteria patients: age > 18 years, mechanical ventilation > 48 h, ICU stay > 5 days, delirium, septic shock, acute respiratory distress syndrome, cardiac arrest. Inclusion criteria family: those who attended. INTERVENTIONS: Follow-up 3 months and 1 year after hospital discharge. MAIN VARIABLES OF INTEREST: Patients: sociodemographic, clinical, evolutive, physical, psychological and cognitive alterations, dependency degree and quality of life. Main caregivers: mental state and physical overload. RESULTS: 64.9% PICS-P, no differences between groups. COVID patients more physical alterations than non-COVID (P = .028). These more functional deterioration (P = .005), poorer quality of life (P = .003), higher nutritional alterations (P = .004) and cognitive deterioration (P < .001). 19.1% PICS-F, more frequent in relatives of non-COVID patients (17.6% vs. 5.5%; P = .013). Independent predictors of PICS-P: first years of the study (OR: 0.484), higher comorbidity (OR: 1.158), delirium (OR: 2.935), several reasons for being included (OR: 3.171) and midazolam (OR: 4.265). CONCLUSIONS: Prevalence PICS-P and PICS-F between both cohorts was similar. Main factors associated with the development of SPCI-P were: higher comorbidity, delirium, midazolan, inclusion for more than one reason and during the first years.

Severity and complications in infants with respiratory syncytial virus infection after the SARS-CoV-2 pandemic.

BACKGROUND: After the SARS-CoV-2 pandemic, there has been an increase in hospitalization for lower respiratory infection secondary to respiratory syncytial virus (RSV), with greater complications. Associated extrapulmonary alterations, biventricular dysfunction, acute kidney injury, among others, have been found. The objective of this study was to analize the evolution and complications in hospitalized children with lower respiratory infection secondary to RSV after COVID-19 pandemic. METHODS: All pediatric patients under 2 years of age admitted to the emergency department with RSV infection were included. Clinical characteristics, need for supplemental oxygen, use of amines, renal angina index, and requirement for renal replacement therapy were analyzed. Lung ultrasound was performed upon admission. Statistical analysis was carried out for the quantitative variables by means of mean and standard deviation, and qualitative variables by frequency and percentage. Differences in the distribution were evaluated with Fisher's exact distribution. RESULTS: 45 patients with RSV infection were identified, 26.7% required invasive mechanical ventilation and 11.1% requiered peritoneal dialysis. Fatality was observed in four cases, three of these younger than 12 months with a LUS score > 7; contrasts with 90.2% of survivors with a score < 7 (p = 0.0004). CONCLUSIONS: An increase in the incidence of bronchiolitis after pandemic was observed, with more than half having moderate to severe symptoms and requiring supplemental oxygen support in all patients upon admission. Acute kidney injury is the most common extrapulmonary manifestation.

INTRODUCCIÓN: Posterior a la pandemia por SARS-CoV-2 se ha observado un incremento en la hospitalización por virus respiratorio sincitial (VRS), con mayores complicaciones. Se han encontrado alteraciones extrapulmonares asociadas, disfunción biventricular y lesión renal aguda, entre otras. El objetivo de este estudio fue analizar la evolución y las complicaciones en niños hospitalizados con enfermedad respiratoria de vías bajas secundaria a infección por VRS tras la pandemia de COVID-19. MÉTODOS: Se incluyeron todos los menores de 2 años que ingresaron al servicio de urgencias con infección por VRS. Se analizaron las características clínicas, la necesidad de oxígeno suplementario, el uso de aminas, el índice de angina renal y el requerimiento de terapia de sustitución renal. Se realizó ecografía pulmonar al ingreso. En el análisis estadístico, para las variables cuantitativas se determinaron la media y la desviación estándar, y para las variables cualitativas la frecuencia y el porcentaje. Se evaluaron las diferencias de la distribución con la prueba exacta de Fisher. RESULTADOS: Hubo 45 pacientes con infección por VRS. El 26.7% requirieron ventilación mecánica invasiva y el 11.1% diálisis peritoneal. La letalidad fue de cuatro casos, tres de ellos menores de 12 meses con puntuación de LUS > 7; esto contrasta con el 90.2% de los sobrevivientes con puntaje < 7 (p = 0.0004). CONCLUSIONES: Se observó un aumento en la incidencia de bronquiolitis tras la pandemia, en más de la mitad de los casos con cuadros de moderados a graves, y todos requirieron oxígeno suplementario al ingreso. La lesión renal aguda fue la manifestación extrapulmonar más frecuente.

Bronchodilator administration by pressurized inhaler during invasive mechanical ventilation in adults: A scoping review.

OBJECTIVE: To identify the administration characteristics and connection methods of bronchodilators by pressurized inhalers to the ventilatory circuit of patients under invasive mechanical ventilation. METHODS: A scope review was conducted following the PRISMA for Scoping Review, using the PubMed, Embase Elsevier, Cochrane Library, and Lilacs databases without language restrictions, up to July 2023. Eligible sources included reviews and consensuses (based on clinical studies), experimental and observational studies involving adult patients admitted to the intensive care unit and undergoing invasive mechanical ventilation, regardless of the underlying condition, who used bronchodilator drugs contained in pressurized inhalers. Information regarding inhalation technique, pressurized inhalers connection mode to the circuit, and patient care were collected by 2 researchers independently, with discrepancies resolved by a third reviewer. Studies involving bronchodilators combined with other pharmacological classes in the same device, as well as reviews containing preclinical studies, were excluded. RESULTS: In total, 23 publications were included, comprising 19 clinical trials and 4 non-randomized experimental studies. Salbutamol (albuterol) was the bronchodilator of study in the majority of the articles (n=18), and the spacer device was the most commonly used to connect the pressurized inhaler to the circuit (n=15), followed by an in-line adapter (n=3), and a direct-acting device without chamber (n=3). Concerning the pressurized inhaler placement in the circuit, 18 studies positioned it in the inspiratory limb, and 19 studies synchronized the jet actuation with the start of the inspiratory phase. Agitation of the pressurized inhaler before each actuation, waiting time between actuations, airway suction before administration, and semi-recumbent patient positioning were the most commonly described measures across the studies. CONCLUSIONS: This review provided insights into the aspects related to inhalation technique in mechanically ventilated patients, as well as the most prevalent findings and the existing gaps in knowledge regarding bronchodilator administration in this context. The evidence indicates the need for further research on this subject.

Restrictive calcium replacement in septic shock: a multicenter before-after intervention study. / Reposición restrictiva de calcio en pacientes con shock séptico: estudio de intervención antes-después.

OBJECTIVES: To study the impact of a restrictive calcium replacement protocol in comparison with a liberal one in patients with septic shock. MATERIAL AND METHODS: Multicenter retrospective before-after study that estimated the impact of implementing a restrictive calcium replacement protocol in patients with septic shock. Patients admitted to an intensive care unit between May 2019 and April 2021 were assigned to liberal calcium replacement, and those admitted between May 2021 and April 2022 were assigned to a restrictive protocol. The primary outcome measure was 28-day mortality. Patients were matched with propensity scores. RESULTS: A total of 644 patients were included; liberal replacement was used in 453 patients and the restrictive replacement in 191. We paired 553 patients according to propensity scores, 386 in the liberal group and 167 in the restrictive group. Mortality did not differ significantly between the groups at 28 days (35.3% vs 32.3%, respectively; hazard ratio, 0.97; 95% CI, 0.72-1.29) or after resolution of septic shock (81.5% vs 83.8%; hazard ratio, 0.89; 95% CI, 0.73-1.09). Nor did scores on the Sepsis-related Organ Failure Assessment scale differ (2.1 vs 2.6; P = 0.20). CONCLUSION: The implementation of a restrictive calcium replacement protocol in patients with septic shock was not associated with a decrease in 28-day mortality in comparison with use of a liberal protocol. However, we were able to reduce calcium replacement without adverse effects.

OBJETIVO: Investigar el efecto de un protocolo de reposición restrictiva de calcio frente a una estrategia liberal en pacientes con shock séptico. METODO: Estudio multicéntrico, antes-después y retrospectivo que evaluó el efecto de la implementación de un protocolo de reposición restrictiva de calcio en pacientes con shock séptico. Los pacientes que ingresaron en unidades de cuidados intensivos (UCI) entre mayo de 2019 y abril de 2021 se asignaron al grupo con administración liberal, y los que se presentaron entre mayo de 2021 y abril de 2022 ­tras la implementación del protocolo­ al grupo con administración restrictiva. La variable de resultado principal fue la mortalidad a 28 días. Se realizó un emparejamiento por puntuación de propensión. RESULTADOS: Se incluyeron 644 pacientes, 453 en el grupo liberal y 191 en el grupo restrictivo. De los que 553 se emparejaron (386 en el grupo liberal, y 167 en el grupo restrictivo). No hubo diferencias entre los dos grupos en la mortalidad a los 28 días (35,3% vs 32,3%; HR: 0,97; IC 95%: 0,72-1,29), en la finalización del shock (81,5% vs a 83,8%; HR: 0,89; IC 95%: 0,73-1,09) ni en la puntuación de la escala SOFA (2,1 vs 2,6; p = 0,20). CONCLUSIONES: La implementación de un protocolo de administración restrictiva de calcio, en pacientes con shock séptico, no se asoció a una disminución de la mortalidad a los 28 días en comparación con una administración liberal. No obstante, la reposición de calcio podría reducirse sin efectos adversos.

Mortalidad, Secuelas Clínicas y Calidad de Vida Luego del Alta de Unidades de Cuidados Intensivos en Pacientes con COVID-19: Estudio Multicéntrico Descriptivo en Argentina.

OBJECTIVE: Patients with COVID-19 who require hospitalization in an intensive care unit, in addition to being at risk of presenting premature death, have higher rates of complications. This study aimed to describe mortality, rehospitalizations, quality of life, and symptoms related to postintensive care syndrome (PICS) and prolonged COVID-19 in patients with COVID-19 discharged from the intensive care unit in hospitals in Argentina. METHODS: A cross-sectional study was conducted in 4 centers in the Autonomous City and province of Buenos Aires as of December 2022. The variables of interest were mortality after discharge, rehospitalization, health-related quality of life, post-COVID-19-related symptoms, cognitive status, and PICS. Data collection was by telephone interview between 6 and 18 months after discharge. RESULTS: A total of 124 patients/families were contacted. Mortality was 7.3% (95% CI: 3.87-13.22) at 14.46 months of follow-up after discharge. Patients reported a reduction of the EQ-5D-3L visual analog scale of 13.8 points, reaching a mean of 78.05 (95% CI: 73.7-82.4) at the time of the interview. Notably, 54.4% of patients (95% CI: 41.5-66.6) reported cognitive impairment and 66.7% (95% CI: 53.7-77.5) developed PICS, whereas 37.5% (95% CI: 26-50.9) had no symptoms of prolonged COVID-19. CONCLUSION: The results showed a significant impact on the outcomes studied, consistent with international evidence.

Características clínicas y evolución del paciente anciano mayor de 80 años en una Unidad de Cuidados Intensivos / Clinical features and disease progression of elderlypatients at the ICU setting

Objetivo Describir y caracterizar una cohorte de pacientes octogenarios ingresados en la UCI del Hospital Universitario Central de Asturias (HUCA). Diseño Estudio retrospectivo, observacional y descriptivo de 14 meses de duración. Ámbito Unidad de Cuidados Intensivos (UCI) Cardiaca y UCI Polivalente del Servicio de Medicina Intensiva del HUCA (Oviedo). Participantes Pacientes mayores de 80 años que ingresaron en la UCI durante más de 24 horas.Intervenciones Ninguna. Variables de interés principales Edad, sexo, comorbilidad, capacidad funcional, tratamiento, complicaciones, evolución, mortalidad. Resultados Los motivos de ingreso más frecuentes fueron la cirugía cardiaca y la neumonía. La estancia media de ingreso fue significativamente mayor en pacientes menores de 85 años (p=0,037). El 84,3% de estos últimos se benefició de ventilación mecánica invasiva (VMI) vs. 46,2% de los pacientes más mayores (p=<0,001). Los pacientes mayores de 85 años presentaron mayor fragilidad. El ingreso por intervención quirúrgica cardiaca se asoció con menor riesgo de mortalidad (hazard ratio [HR]=0,18; intervalo de confianza [IC] 95%, 0,062-0,527; p=0,002). Conclusiones Los resultados muestran una asociación entre el motivo de ingreso en UCI y el riesgo de mortalidad en pacientes octogenarios. La cirugía cardiaca se asoció con mejor pronóstico frente a la patología médica, donde la neumonía se asoció con mayor riesgo de mortalidad. Además, se observó una relación positiva significativa entre edad y fragilidad. (AU)

ObjectiveTo describe and characterize a cohort of octogenarian patients admitted to the ICU of the University Central Hospital of Asturias (HUCA). Design Retrospective, observational and descriptive study of 14 months’ duration. Setting Cardiac and Medical Intensive Care Units (ICU) of the HUCA (Oviedo). Participants Patients over 80 years old who were admitted to the ICU for more than 24hours. Interventions None. Main variables of interest Age, sex, comorbidity, functional dependence, treatment, complications, evolution, mortality. Results The most frequent reasons for admission were cardiac surgery and pneumonia. The average admission stay was significantly longer in patients under 85 years of age (p=0,037). 84,3% of the latter benefited from invasive mechanical ventilation compared to 46,2% of older patients (p=<0,001). Patients over 85 years of age presented greater fragility. Admission for cardiac surgery was associated with a lower risk of mortality (HR=0,18; 95% CI (0,062-0,527; p=0,002). Conclusions The results have shown an association between the reason for admission to the ICU and the risk of mortality in octogenarian patients. Cardiac surgery was associated with a better prognosis compared to medical pathology, where pneumonia was associated with a higher risk of mortality. Furthermore, a significant positive association was observed between age and frailty. (AU)