Adscripción del farmacéutico a cuidados intensivos: generando sinergias / Pharmacist Adscription To Intensive Care: Generating Synergies

OBJETIVO: Evaluar la incorporación de un farmacéutico de hospital a la actividad habitual de una unidad de cuidados intensivos (UCI). DISEÑO: Estudio observacional prospectivo para evaluar las intervenciones farmacéuticas, realizadas por un farmacéutico adscrito temporalmente a una UCI, sobre las prescripciones médicas. Ámbito: UCI médico-quirúrgica con 21 camas. PACIENTES: Se incluyeron los pacientes con al menos una estancia en UCI y se excluyeron los pacientes con ingreso y alta en periodos en los que no se contó con la presencia física del farmacéutico. INTERVENCIONES: Se realizaban tras la revisión diaria de las prescripciones y se comunicaban de forma verbal o escrita al médico responsable. Variables principales: Intervenciones realizadas, grupo terapéutico de los medicamentos implicados, forma de realización de la intervención y el grado de aceptación. RESULTADOS: Se realizaron 194 intervenciones en 62 pacientes. La mayoría estaban relacionadas con aspectos de seguridad (33%) y optimización de la terapia (32%). Las más frecuentes se dirigieron a la administración de medicamentos por sonda nasogástrica (19%) y a la monitorización farmacocinética (14,4%). Los grupos de medicamentos más implicados fueron los antiinfecciosos en un 33% de los casos y los del aparato digestivo en un 27%. El 56,2% de las intervenciones se realizaron verbalmente y el 80% fueron aceptadas. CONCLUSIONES: La adscripción de un farmacéutico a una UCI y la realización de intervenciones sobre las prescripciones han permitido mejorar la seguridad y optimizar la farmacoterapia en más de la mitad de los pacientes. La alta tasa de aceptación de las mismas apoyaría la implementación de este tipo de programas en las unidades de críticos

OBJECTIVE: To evaluate incorporation of the hospital pharmacist to the routine activity of an Intensive Care Unit (ICU). DESIGN: A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions. SETTING: A medical and surgical ICU with 21 beds. PATIENTS: Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded. INTERVENTIONS: The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician. MAIN VARIABLES: Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance. RESULTS: A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted. CONCLUSIONS: Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units

Pharmacist Adscription To Intensive Care: Generating Synergies. / Adscripción del farmacéutico a cuidados intensivos: generando sinergias.

OBJECTIVE: To evaluate incorporation of the hospital pharmacist to the routine activity of an Intensive Care Unit (ICU). DESIGN: A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions. SETTING: A medical and surgical ICU with 21 beds. PATIENTS: Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded. INTERVENTIONS: The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician. MAIN VARIABLES: Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance. RESULTS: A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted. CONCLUSIONS: Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units.

[Methodology in non-invasive ventilation]. / Metodología en ventilación no invasiva.

Objective during the application of noninvasive ventilation (NIV) in acute respiratory failure is, as occurs in conventional mechanical ventilation, to improve gas exchange. Expiratory pressure is applied to favour recruitment of collapsed alveoli, improving oxygenation. Inspiratory pressure use on airway aids respiratory muscle rest and decrease respiratory work, which has a direct repercussion in decreasing oxygen consumption. The NIV preserves defence mechanisms of the patients airway intact, which noticeably decreases appearance of mechanical ventilation associated pneumonia, with subsequent benefit in health care cost, stay and morbidity-mortality. We have reviewed the literature available regarding respiratory modes used in NIV, patient monitoring, humidification, and inhaled drug administration. However, the benefits of NIV are obtained when success of the technique is reached; this is depending on patients' collaboration, adequate indication, underlying disease, material resources available, and mainly, training and dedication of the personnel applying the respiratory support.

Metodología en ventilación no invasiva / Methodology in non-invasive ventilation

El objetivo durante la aplicación de la ventilación noinvasiva (VNI) en los pacientes con insuficienciarespiratoria aguda es, al igual que en la ventilaciónmecánica convencional, mejorar el intercambiogaseoso. Al aplicar una presión espiratoria se favoreceel reclutamiento de los alvéolos colapsadosmejorando la oxigenación. El uso de la presióninspiratoria sobre la vía aérea asiste al músculorespiratorio para ponerlo en reposo y disminuir eltrabajo respiratorio, lo que repercute directamentedisminuyendo el consumo de oxígeno. Estosbeneficios, además, se consiguen preservandointactos los mecanismos de defensa de la vía aérea delpaciente, lo que disminuye sensiblemente laaparición de neumonía asociada a ventilaciónmecánica, con el subsiguiente beneficio en el gastosanitario, los días de ingreso y la morbimortalidad.Revisamos la literatura disponible sobre los modosrespiratorios más utilizados en VNI, las característicasde los respiradores, las diferencias entre los sistemasconvencionales de cuidados intensivos y losrespiradores específicos de VNI, la monitorizacióndel paciente, la humidificación y la administración defármacos por vía inhalada. Sin embargo, losbeneficios de la VNI sólo se obtienen cuando sealcanza el éxito de la técnica, que depende de lacolaboración del paciente, una adecuada indicación,la enfermedad que origine la insuficiencia respiratoriaaguda, los recursos materiales disponibles y,fundamentalmente, la formación, dedicación ydisponibilidad del personal que aplica el soporterespiratorio

Objective during the application of noninvasiveventilation (NIV) in acute respiratory failure is, asoccurs in conventional mechanical ventilation, toimprove gas exchange. Expiratory pressure isapplied to favour recruitment of collapsed alveoli,improving oxygenation. Inspiratory pressure useon airway aids respiratory muscle rest anddecrease respiratory work, which has a directrepercussion in decreasing oxygen consumption. The NIV preserves defence mechanisms of thepatient’s airway intact, which noticeably decreasesappearance of mechanical ventilation associatedpneumonia, with subsequent benefit in health carecost, stay and morbidity-mortality. We havereviewed the literature available regardingrespiratory modes used in NIV, patient monitoring,humidification, and inhaled drug administration.However, the benefits of NIV are obtained whensuccess of the technique is reached; this isdepending on patients’ collaboration, adequateindication, underlying disease, material resourcesavailable, and mainly, training and dedication ofthe personnel applying the respiratory support

Ruptura de aneurisma micótico aórtico infrarrenal por Staphylococcus aureus originado en lesiones cutáneas / Mycotic aortic infrarrenal anaurysm rupture by staphylococcus aureus origined in skin lesions

No disponible

Sepsis grave por Nocardia asteroides en paciente con tratamiento corticoideo prolongado / Severe sepsis induced by Nocardia asteroides in a patient with prolonged corticosteroid treatment

No disponible

Encefalopatía de Wernicke como complicación de hiperemesis gravídica / Wernicke encephalopathy as a complication of hyperemesis gravidarum

No disponible