NEMS: ¿nuevo predictor de mortalidad en el paciente crítico? / Nems: a new predictor of mortality in the critical patient?

En las unidades de cuidados intensivos se utilizan habitualmente escalas que predicen el riesgo de mortalidad hospitalaria y objetivan las necesidades terapéuticas y asistenciales que requieren los pacientes críticos. El objetivo de este trabajo fue estudiar si el NEMS podía ser utilizado como predictor de mortalidad, comparándolo con el APACHE II. Se realizó un estudio prospectivo en una unidad de cuidados intensivos polivalente de 24 camas. El APACHE II y NEMS se estratificaron en 3 niveles. Se recogieron datos demográficos y el valor en las primeras 24 horas del APACHE II y NEMS. Se incluyeron 1.257 pacientes; fallecieron el 16,4%. Fueron quirúrgicos el 69,6%; la mediana para estancia y edad fue de 2 días (1-4) y 66 años (50-77); el 59,3% fueron hombres. La mediana para vivos y muertos de APACHE II fue 10 (6-20) y 22,5 (17,25-29) respectivamente, (p<0,001) y para NEMS, 24 (18-29) y 34 (25-39,7), (p<0,001). La correlación entre ambas escalas fue rho=0,457, (p<0,01). La regresión logística controlada por edad, sexo y APACHE mostró solo para NEMS elevados un OR=3,1 (IC95%: 1,5-6,6), respecto al nivel mas inferior. Según los resultados no se debe utilizar el NEMS como predictor de mortalidad, aunque el riesgo de muerte aumenta tres veces con NEMS altos (AU)

Abstract Numerical scales are commonly used in intensive care units to predict hospital mortality and to assess the therapeutic effort and care that critically ill patients require. The aim of this work was to study whether the NEMS value can be used as a predictor of mortality, comparing it with the APACHE II. A prospective study in a 24 intensive care unit beds was conducted. The APACHE II and NEMS values were stratified into three levels. Demographic data and the first 24 hours values of APACHE II and NEMS scales were collected. A total of 1257 patients were included, 16.4% of whom died. 69.6% were surgical; median stay was 2 days (1-4). Medianage was 66 years (50-77), 59.3% were men. The median APACHE II and NEMS for the living and the dead in the subsequent course was 10 (6-20) versus 22.5 (17.25 to 29) (p <0.001) and 24(18-29) versus 34 (25 to 39.7) (p < 0.001) respectively. The correlation between both scales was rho = 0.457 (p < 0.01). Logistic regression controlled for age, sex and APACHE II showed an OR of3.1 (95% CI: 1.5-6.6) only for high NEMS, compared to the lowest level. According to the results NEMS should not be used as a predictor of mortality, although the risk of death increases by three times with high NEMS (AU)

[NEMS: a new predictor of mortality in the critical patient?]. / NEMS: ¿nuevo predictor de mortalidad en el paciente crítico?

Numerical scales are commonly used in intensive care units to predict hospital mortality and to assess the therapeutic effort and care that critically ill patients require. The aim of this work was to study whether the NEMS value can be used as a predictor of mortality, comparing it with the APACHE II. A prospective study in a 24 intensive care unit beds was conducted. The APACHE II and NEMS values were stratified into three levels. Demographic data and the first 24 hours values of APACHE II and NEMS scales were collected. A total of 1257 patients were included, 16.4% of whom died. 69.6% were surgical; median stay was 2 days (1-4). Median age was 66 years (50-77), 59.3% were men. The median APACHE II and NEMS for the living and the dead in the subsequent course was 10 (6-20) versus 22.5 (17.25 to 29) (p <0.001) and 24 (18-29) versus 34 (25 to 39.7) (p<0.001) respectively. The correlation between both scales was rho=0.457 (p<0.01). Logistic regression controlled for age, sex and APACHE II showed an OR of 3.1 (95% CI: 1.5-6.6) only for high NEMS, compared to the lowest level. According to the results NEMS should not be used as a predictor of mortality, although the risk of death increases by three times with high NEMS.

[Evaluation of the effect of a cleaning/disinfection intervention on the rate of multiresistant microorganism infections in the Intensive Care Unit]. / Evaluación del efecto de una intervención de limpieza/desinfección sobre la incidencia de infecciones por microorganismos multirresistentes en una Unidad de Cuidados Intensivos.

AIM: Evaluate the effect of an intervention on the rate of nosocomial infections (NI) produced by multiresistant microorganisms in the Intensive Care Units. MATERIAL AND METHODS: A study was conducted before and after an intervention in two ICUs to control an outbreak of multiresistant Acinetobacter baumanii (MRAB). During the outbreak (from 22-12-06 to 12-2-07) the wards were closed and both the wards and the equipment of both ICUs were cleaned and disinfected. A microbiological sampling was also made. The nosocomial infection rate density of the multiresistant microorganisms was compared between hospitalized patients: preintervention (1-3-2006 to 15-12-2006) and postintervention (1-3-2007 to 15-12-2007). To certify if there were any statistically significant differences between them, a rate ratio (RT) was calculated with a 95% confidence interval. The level of statistical significance was established at p < 0.05. We stratified per unit, per type of microorganism and location of the infection. RESULTS: The global NI incidence rate for multiresistant microorganisms significantly declined after the interventions in both units (RT: 1.83, 95% CI: 1.34-2.50), p < 0.005. A significant decrease was also observed on the NI incidence rate for the following microorganisms: P. aeruginosa (RT: 2.36, 95% CI: 1.41-3.96), Enterobacter BLEE (RT: 2.31, 95% CI: 1.11-4.82) and S. maltophilia (RT: 2.77, 95% CI: 1.10-6.99). In regards to the infection location, a significant decrease in respiratory infection rates was observed (RT: 1.96, 95% CI: 1.29-2.99). CONCLUSION: The intervention conducted to control the MRAB outbreak was effective in reducing the NI incidence of multiresistant microorganisms.

Evaluación del efecto de una intervención de limpieza/ desinfección sobre la incidencia de infecciones por microorganismos multirresistentes en una Unidad de Cuidados Intensivos / Evaluation of the effect of a cleaning/disinfection intervention on the rate of multiresistant microorganism infections in the Intensive Care Unit

Objetivo. Evaluar el efecto de una intervención sobre la incidencia de infecciones nosocomiales(IN) por microorganismos multirresistentes en las Unidades de Cuidados Intensivos (UCI).Material y métodos. Se realizó un estudio antes-después de una intervención para el controlde un brote de Acinetobacter baumannii multirresistente (ABMR) en dos UCI. Durante el brote(del 22-12-06 al 12-2-07) se procedió al cierre y limpieza/desinfección de las salas y equipamientode las dos UCI, con muestreo microbiológico antes y después. Se comparó la densidadde incidencia de IN por microorganismos multirresistentes entre los pacientes ingresados: preintervención(del 1-3-2006 al 15-12-2006) y posintervención (del 1-3-2007 al 15-12-2007). Paracomprobar si existían diferencias estadísticamente signifi cativas se calculó la razón de tasas(RT) y su intervalo de confi anza (IC) al 95%. El nivel de signifi cación estadística se estableció enp < 0,05. Se estratifi có por unidad, tipo de microorganismo y localización de la infección.Resultados. La tasa de incidencia global de IN por microorganismos multirresistentes disminuyósignifi cativamente tras la intervención en ambas unidades (RT: 1,83, IC 95% 1,34-2,50), p < 0,005.También existió disminución signifi cativa en la tasa de incidencia de IN para los microorganismos:P. aeruginosa (RT: 2,36, IC 95% 1,41-3,96), enterobacterias BLEE (RT: 2,31, IC 95% 1,11-4,82) y S.maltophilia (RT: 2,77, IC 95% 1,10-6,99). Con respecto a la localización de la infección resultósignifi cativa la disminución en la tasa de infecciones respiratorias (RT: 1,96, IC 95% 1,29-2,99).Conclusión. La intervención realizada para el control del brote de ABMR fue efectiva paradisminuir la incidencia de IN por otros microorganismos multirresistentes(AU)

Aim. Evaluate the effect of an intervention on the rate of nosocomial infections (NI)produced by multiresistant microorganisms in the Intensive Care Units.Material and methods. A study was conducted before and after an intervention in two ICUsto control an outbreak of multiresistant Acinetobacter baumanii (MRAB). During theoutbreak (from 22-12-06 to 12-2-07) the wards were closed and both the wards and theequipment of both ICUs were cleaned and disinfected. A microbiological sampling was alsomade. The nosocomial infection rate density of the multiresistant microorganisms wascompared between hospitalized patients: preintervention (1-3-2006 to 15-12-2006) andpostintervention (1-3-2007 to 15-12-2007). To certify if there were any statisticallysignifi cant differences between them, a rate ratio (RT) was calculated with a 95% confi denceinterval. The level of statistical signifi cance was established at p < 0.05. We stratifi ed perunit, per type of microorganism and location of the infection.Results. The global NI incidence rate for multiresistant microorganisms signifi cantlydeclined after the interventions in both units (RT: 1.83, 95% CI: 1.34-2.50), p < 0.005. Asignifi cant decrease was also observed on the NI incidence rate for the followingmicroorganisms: P. aeruginosa (RT: 2.36, 95% CI: 1.41-3.96), Enterobacter BLEE (RT: 2.31,95% CI: 1.11-4.82) and S. maltophilia (RT: 2.77, 95% CI: 1.10-6.99). In regards to theinfection location, a signifi cant decrease in respiratory infection rates was observed (RT:1.96, 95% CI: 1.29-2.99).Conclusion. The intervention conducted to control the MRAB outbreak was effective inreducing the NI incidence of multiresistant microorganisms(AU)

Effect of adverse drug reactions on length of stay in intensive care units.

The objective of the present study was to determine the frequency of adverse drug reactions (ADRs) in intensive care units (ICUs) and to evaluate their effect on the length of stay. We performed a prospective study to detect ADRs in 420 patients hospitalised in 10 predetermined beds in the ICU of our hospital between the months of March and December 1996. While the patients were staying in the ICU, data was gathered regarding suspected ADRs and on different variables related to the length of stay. 96 different ADRs were detected in 85 of the 420 patients seen [20.2%, 95% confidence intervals (95% CI) 16.5 to 24.4]. The ADRs were most frequently caused by the following drugs: nitrates (n = 25), opiates (n = 21) and ultrashort-acting benzodiazepines (n = 10). Eight ADRs were severe, the suspected medication had to be discontinued in 51 cases and new drugs were necessary to manage the ADRs in 73 cases. The crude estimation of the effect of the number of ADRs performed with a bivariant regression model indicated that each ADR was related to a 2.38-day increase (95% CI 1.31 to 3.45) in the length of stay. Although this estimation was reduced to 1.76 days (95% CI 0.72 to 2.79), when other confounding variables associated with the length of stay were considered, it was still important.In conclusion, the ADRs were a significant clinical problem in the ICUs and were responsible for a significant increase in the length of stay.