National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study).

INTRODUCTION: The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies. of communication between family members, patients and professionals. METHODS: Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. RESULTS: 29% of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. CONCLUSIONS: The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context.

Mejorar el sueño nocturno de los pacientes críticos / Improve night sleep in critical patients

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Encuesta nacional sobre el manejo de la vía aérea y la vía aérea difícil en las unidades de cuidados intensivos / National survey on airway and difficult airway management in intensive care units

OBJETIVO: Conocer la organización, el manejo y la formación en vía aérea (VA) en las unidades de cuidados intensivos (UCI) españolas, con especial interés en la vía aérea difícil (VAD). DISEÑO: Estudio transversal descriptivo y subanálisis con χ2, elaborado mediante una encuesta nacional realizada del 1 de noviembre al 15 de diciembre de 2016. Con el aval de la SEMICYUC, se envió a 179 UCI un cuestionario online con 27 apartados. Ámbito: UCI de hospitales públicos, privados y consorcios. RESULTADOS: Responden 101 UCI (56,4%), que suponen 1.827 camas y casi 95.000 ingresos/año. El 85,1% son hospitales públicos, y el 83,2%, con residentes. El 22,8% no utilizan rutinariamente escalas de valoración de VA, siendo la más frecuente la asociación Cormack-Mallampati (35,6%). El 77,2% no tienen protocolo de intubación (IOT), ni el 75,2% protocolo de VAD. El 82,2% tienen carro de VAD. El 48,5% refieren formación en IOT, y el 53,5%, en VAD. Identificar a un experto en VAD se asocia significativamente con mayor formación en IOT (60% vs. 39,3%; p = 0,03), VAD (64,4% vs. 44,6%; p = 0,04) y más protocolos de VA (73,4% vs. 37,5%; p = 0,000). El 99% estima necesario disponer de una guía específica de manejo de VAD en UCI. CONCLUSIONES: Existe un amplio margen de mejora para el manejo de la VA. Es necesario identificar un experto en VAD en cada unidad y elaborar una guía específica de manejo de VAD en el paciente crítico

OBJECTIVE: To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW). DESIGN: Descriptive cross-sectional study and χ2 subanalysis, conducted through a national survey from november 1th to december 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs. SETTING: ICUs of public, private centers, and consortia. RESULTS: In total, 101 units responded (56.4%), corresponding to 1,827 beds and almost 95,000 incomes/year. The 85.1% are public hospitals, and 83.2% had residents. Of the responders, 22.8% don't use routinely AW assessment scales, being the most frequently used the Cormack-Mallampati association (35.6%). There's not intubation (IOT) protocol in 77.2%, nor DAW protocol in 75.2%. An 82.2% have a DAW cart. The 48.5% have training in IOT, and in VAD 53.5%. Having a DAW expert is significantly associated with greater training in IOT (60% vs. 39.3%; P=.03), DAW (64.4% vs. 44.6%; P=.04), and more AW protocols (73.4% vs. 37.5%; P=.000). Having an specific guideline for DAW management in UCI is considered necessary in 99%. CONCLUSIONS: There is room for improvement in AW management. It's necessary to identify an expert in DAW in each Unit, and the development of an specific guideline for DAW management in critical care