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Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2). An Pediatr (Barc) 2021; 95:397-405. [PMID: 34824043 DOI: 10.1016/j.anpede.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24 h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneously assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR = 0.35-6.55) were included. An overall discomfort score of 10.79 ± 3.7 was observed during morning compared to 10.31 ± 3.3 during the night. When comparing analgosedation and non-analgosedation groups, statistical differences were found in both shifts (χ2: 45.48; P = .001). At the same time, an association was observed (P < .001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.
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Bosch-Alcaraz A, Luna-Castaño P, Garcia-Soler P, Tamame-San Antonio M, Falcó-Pegueroles A, Alcolea-Monge S, Fernández Lorenzo R, Piqueras-Rodríguez P, Molina-Gallego I, Potes-Rojas C, Gesti-Senar S, Orozco-Gamez R, Tercero-Cano MC, Saz-Roy MÁ, Jordan I, Belda-Hofheinz S. [Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2)]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30475-6. [PMID: 33317976 DOI: 10.1016/j.anpedi.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/11/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.
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Affiliation(s)
- Alejandro Bosch-Alcaraz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España; Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil. Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.
| | - Patricia Luna-Castaño
- Unidad de Apoyo a la Investigación Enfermera, Hospital Universitario La Paz, Madrid, España
| | - Patricia Garcia-Soler
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario Carlos Haya, Málaga, España
| | | | - Anna Falcó-Pegueroles
- Departamento de Enfermería Fundamental y Medicoquirúrgica, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - Sandra Alcolea-Monge
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España
| | - Rocío Fernández Lorenzo
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España
| | | | - Irene Molina-Gallego
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, España
| | - Cristina Potes-Rojas
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Silvia Gesti-Senar
- Unidad de Cuidados Intensivos Pediátrica, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Rocío Orozco-Gamez
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - M Ángeles Saz-Roy
- Departamento de Enfermería de Salud Pública, Salud Mental y Maternoinfantil. Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España
| | - Iolanda Jordan
- Unidad de Cuidados Intensivos Pediátrica, Hospital Sant Joan de Déu de Barcelona, Barcelona, España
| | - Sylvia Belda-Hofheinz
- Unidad de Cuidados Intensivos Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España
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Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. ENFERMERIA INTENSIVA 2019; 31:19-34. [PMID: 31253585 DOI: 10.1016/j.enfi.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/06/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS thematic content analysis. Data saturation was achieved. RESULTS Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.
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Acevedo-Nuevo M, González-Gil MT. Creating an environment of empowerment in the intensive care units: From containment to mobilisation. ENFERMERIA INTENSIVA 2019; 28:141-143. [PMID: 29055515 DOI: 10.1016/j.enfi.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- M Acevedo-Nuevo
- Hospital Universitario Puerta de Hierro Majadahonda, , Majadahonda, Madrid, España; Sección departamental de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | - M T González-Gil
- Sección departamental de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España; Miembro del Grupo de Trabajo de delirio y contenciones mecánicas-GTDC-SEEIUC
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Zheng J, Gao Y, Xu X, Kang K, Liu H, Wang H, Yu K. Correlation of bispectral index and Richmond agitation sedation scale for evaluating sedation depth: a retrospective study. J Thorac Dis 2018; 10:190-195. [PMID: 29600048 DOI: 10.21037/jtd.2017.11.129] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to verify the correlation of bispectral index (BIS) and Richmond agitation sedation scale (RASS) for evaluating these and explore possibility of replacing RASS with BIS. Methods This retrospective cohort study consisted of 74 patients who were collected from the third Intensive Care Unit (ICU) ward of XXX Hospital between May 2012 and June 2015 in this retrospective study. Sedation levels were evaluated using the 10-grade RASS and were continuously monitored with a BIS monitor during the procedure every 5 minutes. BIS values and RASS scores were recorded. Results Patients were divided into dexmedetomidine (n=31) and midazolam (n=43) groups, and 342 paired data were collected. A statistically significant correlation existed between BIS values and RASS scores either in all patients undergoing flexible fiberoptic bronchoscopy (FFB) or in dexmedetomidine and midazolam groups at different time points. Correlation coefficient was higher in midazolam group compared with dexmedetomidine group at different time points (P<0.05). Conclusions A correlation was observed between BIS and RASS for evaluating depth of sedation in ICU patients undergoing FFB (P<0.05). Study results indicated that BIS monitoring is a meaningful tool, which can be applied as an adjunctive and alternative method to assess sedation, especially for high-risk patients who are prone to be under- or over-sedation.
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Affiliation(s)
- Junbo Zheng
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yang Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Xiaoyu Xu
- Department of Critical Care Medicine, Hegang People's Hospital, Hegang 154100, China
| | - Kai Kang
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Haitao Liu
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin 150081, China
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin 150081, China.,Institute of Critical Care Medicine, Sino Russian Medical Research Center of Harbin Medical University, Harbin 150081, China
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