Management of analgesia, sedation and delirium in Spanish Intensive Care Units: A national two-part survey. / Prácticas de analgosedación y delirium en Unidades de Cuidados Intensivos españolas: Encuesta 2013-2014.

OBJECTIVE: To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations. DESIGN: A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC. SETTING: Spanish ICUs in public and private hospitals. RESULTS: A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent. CONCLUSIONS: This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

[Indications of dexmedetomidine in the current sedoanalgesia tendencies in critical patients]. / Indicaciones de la dexmedetomidina en las tendencias actuales de sedoanalgesia en el paciente crítico.

Recently, dexmedetomidine has been marketed in Spain and other European countries. The published experience regarding its use has placed dexmedetomidine on current trends in sedo-analgesic strategies in the adult critically ill patient. Dexmedetomidine has sedative and analgesic properties, without respiratory depressant effects, inducing a degree of depth of sedation in which the patient can open its eyes to verbal stimulation, obey simple commands and cooperate in nursing care. It is therefore a very useful drug in patients who can be maintained on mechanical ventilation with these levels of sedation avoiding the deleterious effects of over or infrasedation. Because of its effects on α2-receptors, it's very useful for the control and prevention of tolerance and withdrawal to other sedatives and psychotropic drugs. The use of dexmedetomidine has been associated with lower incidence of delirium when compared with other sedatives. Moreover, it's a potentially useful drug for sedation of patients in non-invasive ventilation.

[Donation protocol following controlled cardiac death (Maastricht type III donation). First experience]. / Protocolo de donación tras la muerte cardiaca controlada (donante tipo iii de Maastricht). Experiencia inicial.

OBJECTIVE: To present our experience with the implementation of a donation protocol following controlled cardiac death (Maastricht type III donation). DESIGN: A retrospective descriptive and observational study was made. SETTING: Intensive Care Unit of a third-level university hospital. PATIENTS: Eight patients in an irreversible state, in which withdrawal of all life support had been agreed, were evaluated as potential donors. INTERVENTIONS: Application of the adopted protocol. VARIABLES OF INTEREST: Clinical data of donors, evaluation of a donation protocol following cardiac death, warm ischemia times, and short-term outcome of the recipients. RESULTS: Eight patients were evaluated. In one case donation was not possible because no cardiac arrest developed in the 120 minutes after extubation. The 7 remaining patients were effective kidney donors. Warm ischemia times were less than 23 minutes in all cases. Although 7 of the 14 recipients suffered delayed graft function, all of them achieved good renal function. CONCLUSION: Donation after cardiac death in patients in an overwhelming and irreversible state represents a potential source of donors not previously considered in this country. The prior development of a consensus-based protocol can help increase the number of organs in combination with those obtained after brain death. In our experience, the results of kidney transplants obtained from donors after cardiac death are good, and the success of these types of protocols could be extended to other organs such as the liver and lungs.

Tigecycline therapy for infections due to carbapenemase-producing Klebsiella pneumoniae in critically ill patients.

BACKGROUND: The aim of this study was to assess the efficacy of tigecycline in the treatment of infections due to carbapenemase-producing Klebsiella pneumoniae (CPKP) in critically ill patients. METHODS: A retrospective observational study was conducted in critically ill patients receiving different tigecycline doses for severe CPKP infections. We evaluated demographic data, localization and severity of infection, response to therapy, and mortality. RESULTS: Fifteen patients received tigecycline for 16 episodes of CPKP infection. The main infections were pneumonia (31%), urinary tract infection (31%), peritonitis (20%), catheter-related bacteraemia (12%), and meningitis (6%). Most infections were complicated with severe sepsis (44%), septic shock (12%), and/or bacteraemia (19%). The daily maintenance dose of tigecycline was 200 mg in 10 episodes and 100 mg in 6 episodes. The overall 30-day mortality rate was 25%. Univariate analysis showed that mortality was significantly associated (p < 0.01) with mean APACHE II and SOFA scores and the presence of immunosuppression, but not with the tigecycline dose. CONCLUSIONS: Tigecycline appears to be an effective therapy for severe infections due to CPKP in critically ill patients. Mortality is related to the severity of the underlying disease. We observed no benefit from a higher maintenance dose of tigecycline, although the number of patients included in the study was too small to draw any general conclusions in this regard.

[Monitoring of deep sedation. The BIS(R) monitor]. / Monitorización de la sedación profunda. El monitor BIS(R).

Adequate monitoring of analgesia and sedation should be one of the main goals in the Intensive Care Units. Once the analgesia is assured, the correct dosage of the sedatives will depend on the correct monitoring of the sedation level. For years, clinical scales have been used to evaluate the sedation level. These scales are appropriate for the evaluation of mild sedation but they cannot correctly evaluate deeply sedated patients or those patients who require continuous intravenous administration of neuromuscular blockade agents. In this chapter, we review the most used monitor to control the adequate level of sedation in the Intensive Care Units as well as the BIS(R) Monitor, which is the one recommended by the Analgesia and Sedation Work Group of the Spanish Society of Critical Care Medicine (SEMICYUC).

Monitorización de la sedación profunda. El monitor BIS® / Monitoring of deep sedation. The BIS® monitor

La correcta monitorización de la analgesia y la sedación debe ser uno de los objetivosprincipales en las Unidades de Cuidados Intensivos. Una vez asegurada la analgesia, lacorrecta dosificación de los sedantes va a depender de la monitorización correcta delnivel de sedación. Desde hace años se han utilizado sistemas de monitorización basadosen escalas. Estas escalas son adecuadas para la monitorización de la sedación superficial,pero no son capaces de evaluar el grado de sedación en pacientes profundamente sedadoso con bloqueantes neuromusculares en perfusión continua. Actualmente disponemosde diferentes sistemas de monitorización que nos facilitan llegar donde las escalas noalcanzan. En este capítulo revisaremos el monitor más empleado en la actualidad en lasUnidades de Cuidados Intensivos, y el recomendado por el grupo de trabajo de Sedacióny Analgesia de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias(SEMICYUC) para la monitorización de la sedación profunda, el Monitor BIS® (AU)

Adequate monitoring of analgesia and sedation should be one of the main goals in the IntensiveCare Units. Once the analgesia is assured, the correct dosage of the sedatives will dependon the correct monitoring of the sedation level. For years, clinical scales have beenused to evaluate the sedation level. These scales are appropriate for the evaluation of mildsedation but they cannot correctly evaluate deeply sedated patients or those patients whorequire continuous intravenous administration of neuromuscular blockade agents. In thischapter, we review the most used monitor to control the adequate level of sedation in theIntensive Care Units as well as the BIS® Monitor, which is the one recommended by the Analgesiaand Sedation Work Group of the Spanish Society of Critical Care Medicine (SEMICYUC) (AU)

Analgesia con remifentanilo / Remifentanil analgesia

No disponible