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Raurell-Torredà M, Fernández-Castillo RJ, Rodríguez-Delgado ME, Arias-Rivera S, Basco-Prado L. Best practices for iatrogenic anaemia prevention in the intensive care unit: Blood-sparing techniques. Nurs Crit Care 2024. [PMID: 38654607 DOI: 10.1111/nicc.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/30/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
Anaemia is a common issue in patients who are admitted to intensive care units and worsens their condition throughout the stay due to the extraction of blood for diagnostic purposes. It is also well-known that an important amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing and manufacture, storage or distribution of blood components. This must be taken into account to perform nursing interventions consistent with the idea of sustainable health care. In this regard, within patient blood management bundles, with the objective of minimizing the use of blood products, it is recommended to use blood-sparing techniques: small volume tubes (SVT) or closed-blood sampling devices (CBSD). Published studies before 2014 (excepting two more recent ones) have shown that by themselves, both techniques reduce drawn volume but do not decrease haemoglobin reduction and/or need of transfusion. Given the lack of cost-effectiveness studies, it may be easier to implement the use of CBSD as it does not require prior consensus on the discard volume or adaptations in the processing of laboratory tests, as is the case with SVT.
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Affiliation(s)
- Marta Raurell-Torredà
- Departament d'Infermeria Fonamental i Clínica, Universitat de Barcelona, Barcelona, Spain
| | - Rafael-Jesús Fernández-Castillo
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
- Intensive Care Clinical Unit, University Hospital Virgen Macarena, Seville, Spain
| | | | | | - Luis Basco-Prado
- Departament d'Infermeria Fonamental i Clínica, Universitat de Barcelona, Barcelona, Spain
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Arias-Rivera S, Raurell-Torredà M, Fernández-Castillo RJ, Campos-Asensio C, Thuissard-Vasallo IJ, Andreu-Vázquez C, Rodríguez-Delgado ME. Blood glucose monitoring in critically ill adult patients: type of sample and method of analysis. Systematic review and meta-analysis. Enferm Intensiva (Engl Ed) 2024; 35:45-72. [PMID: 37474427 DOI: 10.1016/j.enfie.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/15/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION The clinical guideline for the management of sepsis, recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units (ICU) revealed that 85.4% of ICUs used capillary puncture. OBJECTIVE To analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards. METHODOLOGY Systematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). PROTOCOL https://osf.io/ DOI 10.17605/OSF.IO/T8KYP. RESULTS A total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs laboratory samples [bias (95%CI): 0.01 (-0.12 to 0.14) mg/dL]. In contrast, arterial samples with a gasometer did significantly overestimate [bias (95%CI): 0.12 (0.01 to 0.24) mg/dL]. The same trend is seen in capillaries with a glucometer, although not significantly [bias (95%CI): 0.07 (--0.02 to 0.15) mg/dL]. There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment. CONCLUSIONS The evidence to date recommends the use of arterial blood with a blood glucose meter for better reliability of glycaemic analysis and less effect of possible confounding variables, frequently present in the critically ill adult patient.
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Affiliation(s)
- S Arias-Rivera
- Enfermera Investigación, Hospital Universitario de Getafe, Madrid, Spain
| | - M Raurell-Torredà
- Departamento Enfermería, Fundamental y Médico Quirúrgica, Universitat de Barcelona, Barcelona, Spain.
| | - R-J Fernández-Castillo
- Unidad de Cuidados Críticos Hospital Universitario Virgen Macarena, Departamento de Enfermería, Facultad de Enfermería, Sevilla, Spain
| | - C Campos-Asensio
- Bibliotecaria Médica, Hospital Universitario de Getafe, Madrid, Spain
| | - I-J Thuissard-Vasallo
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - C Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - M E Rodríguez-Delgado
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain
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Manzanedo-Basilio L, Arias-Rivera S. [Streamlining of patient discharge and intra-hospital transfer processes using Lean methodology]. J Healthc Qual Res 2024; 39:23-31. [PMID: 37981472 DOI: 10.1016/j.jhqr.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/06/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION The application of Lean methodology in the hospital environment can help to improve interprofessional communication and reduce non-value adding activities (waste). OBJECTIVE To determine the effectiveness of the implementation of a visual management tool, in the ability to reduce the number of trips, to determine the location of patients in real time in the process of intra-hospital transfers (ITH) and discharges in a hospital. MATERIAL AND METHODS Before-after study in a hospital internal medicine unit. Several time wastes due to unnecessary transfers were detected. A multiprofessional group was formed to design a visual management tool for the resolution of these identified problems. The opinion of the professionals on the tool was evaluated and variables of staff displacement and completion of the tool were measured before and after its implementation. RESULTS The personnel involved was trained. Completion of the tool improved over time, both in HIT and in discharges, reducing the number of trips. CONCLUSIONS The application of a visual management tool in care processes, including all the personnel involved is effective and saves waste.
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Affiliation(s)
- L Manzanedo-Basilio
- Supervisora de la Unidad de Hospitalización de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - S Arias-Rivera
- Unidad de Investigación, Enfermera de Investigación, Hospital Universitario de Getafe, Getafe, Madrid, España
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Arias-Rivera S, Sánchez-Sánchez MM, Romero de-San-Pío E, Santana-Padilla YG, Juncos-Gozalo M, Via-Clavero G, Moro-Tejedor MN, Raurell-Torredà M, Andreu-Vázquez C. Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00060-5. [PMID: 38001020 DOI: 10.1016/j.enfie.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge. OBJECTIVES To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge. METHODOLOGY Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. VARIABLES pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. STATISTICS descriptive and multivariate analysis. RESULTS 254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge. CONCLUSIONS CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.
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Affiliation(s)
- S Arias-Rivera
- Investigación de Enfermería, Hospital Universitario de Getafe, Madrid, Spain
| | - M M Sánchez-Sánchez
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, Spain
| | - E Romero de-San-Pío
- Unidad de Cuidados Intensivos, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Y G Santana-Padilla
- Unidad de Cuidados Intensivos, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - M Juncos-Gozalo
- Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Via-Clavero
- Unidad de Cuidados Intensivos, Hospital Universitario de Bellvitge, Barcelona, Spain, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Grupo de Investigación en Enfermería (GRIN-IDIBELL), Barcelona, Spain
| | - M N Moro-Tejedor
- Unidad de Apoyo a la Investigación en Enfermería, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Escuela Universitaria de Enfermería de la Cruz Roja, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Raurell-Torredà
- Departamento de Enfermería Fundamental y Médico Quirúrgica, Universidad de Barcelona, Barcelona, Spain.
| | - C Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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Raurell-Torredà M, Arias-Rivera S, Rodríguez-Delgado ME, Campos-Asensio C, Fernández-Castillo RJ. Effectiveness of closed blood sampling systems in intensive care patients: a scoping review. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00026-5. [PMID: 37423775 DOI: 10.1016/j.enfie.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Anemia associated with blood extraction for diagnostic purposes is a highly prevalent entity in intensive care units (ICU) for adults. The evidence recommends its prevention through different strategies, among which we can find the use of closed blood sampling systems (CBSS). Different experimental studies support the use of these devices. OBJECTIVE To identify knowledge gaps regarding the effectiveness of CBSS in ICU patients. METHODS Scoping review with search in PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs Institute databases, between September-2021 and September-2022. No time, language, or other limits were applied to ensure the recovery of all relevant studies. Gray literature sources: DART-Europe, OpenGrey and Google Scholar. Two researchers independently reviewed titles and abstracts and assessed full texts against the inclusion criteria. The following data was extracted for each study: design and sample, inclusion and exclusion criteria, variables, type of CBSS, results and conclusions. RESULTS 18 articles were included in the final review, 11 clinical trials (RCTs) published between 1992 and 2014. Three systematic reviews were found, but they only analyzed the effect of CBSS in reducing blood loss, hemoglobin stabilization, and the need for transfusion. Five of the RCTs analyzed the risk of infection, one catheter complications, and two alterations in blood pressure readings. CONCLUSIONS The use of CBSS is recommended to reduce blood loss in ICUs. However, there are discrepancies about their ability to prevent anemia and/or the need for blood transfusion. Its use does not increase catheter-related infection rates or alter the measurement of mean arterial pressure.
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Affiliation(s)
- M Raurell-Torredà
- Departament Infermeria Fonamental i Medicoquirúrgica, Universitat de Barcelona, Barcelona, Spain
| | - S Arias-Rivera
- Enfermera Investigación, Hospital Universitario de Getafe, Madrid, Spain
| | - M E Rodríguez-Delgado
- Unidad de Cuidados Intensivos. Hospital Universitario Clínico San Cecilio, Granada, Spain.
| | | | - R-J Fernández-Castillo
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
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6
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Zaragoza-García I, Arias-Rivera S, Frade-Mera MJ, Martí JD, Gallart E, San José-Arribas A, Velasco-Sanz TR, Blazquez-Martínez E, Raurell-Torredà M. Enteral nutrition management in critically ill adult patients and its relationship with intensive care unit-acquired muscle weakness: A national cohort study. PLoS One 2023; 18:e0286598. [PMID: 37285356 DOI: 10.1371/journal.pone.0286598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE To assess the incidence and determinants of ICU-acquired muscle weakness (ICUAW) in adult patients with enteral nutrition (EN) during the first 7 days in the ICU and mechanical ventilation for at least 48 hours. METHODS A prospective, nationwide, multicentre cohort study in a national ICU network of 80 ICUs. ICU patients receiving invasive mechanical ventilation for at least 48 hours and EN the first 7 days of their ICU stay were included. The primary outcome was incidence of ICUAW. The secondary outcome was analysed, during days 3-7 of ICU stay, the relationship between demographic and clinical data to contribute to the onset of ICUAW, identify whether energy and protein intake can contribute independently to the onset of ICUAW and degree of compliance guidelines for EN. RESULTS 319 patients were studied from 69 ICUs in our country. The incidence of ICUAW was 153/222 (68.9%; 95% CI [62.5%-74.7%]). Patients without ICUAW showed higher levels of active mobility (p = 0.018). The logistic regression analysis showed no effect on energy or protein intake on the onset of ICUAW. Overfeeding was observed on a significant proportion of patient-days, while more overfeeding (as per US guidelines) was found among patients with obesity than those without (42.9% vs 12.5%; p<0.001). Protein intake was deficient (as per US/European guidelines) during ICU days 3-7. CONCLUSIONS The incidence of ICUAW was high in this patient cohort. Early mobility was associated with a lower incidence of ICUAW. Significant overfeeding and deficient protein intake were observed. However, energy and protein intake alone were insufficient to explain ICUAW onset. RELEVANCE TO CLINICAL PRACTICE Low mobility, high incidence of ICUAW and low protein intake suggest the need to train, update and involve ICU professionals in nutritional care and the need for early mobilization of ICU patients.
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Affiliation(s)
- Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
- Invecuid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Susana Arias-Rivera
- University Hospital of Getafe, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Getafe, Spain
| | - María Jesús Frade-Mera
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
- Department of Critical Care, 12 Octubre University Hospital, Madrid, Spain
| | | | - Elisabet Gallart
- Department of Critical Care, Vall Hebron University Hospital, Barcelona, Spain
| | - Alicia San José-Arribas
- Escola Universitaria d'Infermeria Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Tamara Raquel Velasco-Sanz
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
- Department of Critical Care, San Carlos University Hospital, Madrid, Spain
| | | | - Marta Raurell-Torredà
- Department d'Infermeria Fonamental i medicoquirúrgica, Facultat d'Infermeria, Universitat de Barcelona, Barcelona, Spain
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7
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Baldia PH, Wernly B, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Bruno RR, Binnebößel S, Wolff G, Erkens R, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Leaver S, De Lange DW, Guidet B, Jung C, Joannidis M, Mesotten D, Reper P, Swinnen W, Serck N, DEWAELE ELISABETH, Brix H, Brushoej J, Kumar P, Nedergaard HK, Balleby IR, Bundesen C, Hansen MA, Uhrenholt S, Bundgaard H, Innes R, Gooch J, Cagova L, Potter E, Reay M, Davey M, Abusayed MA, Humphreys S, Galbois A, Charron C, Berlemont CH, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, PLANTEFEVE G, Vanderlinden T, Jurcisin I, Megarbane B, Chousterman BG, Dépret F, Garnier M, Besset S, Oziel J, Ferre A, Dauger S, Dumas G, Goncalves B, Vettoretti L, Thevenin D, Schaller S, Schaller S, Kurt M, Faltlhauser A, Schaller S, Milovanovic M, Lutz M, Shala G, Haake H, Randerath W, Kunstein A, Meybohm P, Schaller S, Steiner S, Barth E, Poerner T, Simon P, Lorenz M, Dindane Z, Kuhn KF, Welte M, Voigt I, Kabitz HJ, Wollborn J, Goebel U, Stoll SE, Kindgen-Milles D, Dubler S, Jung C, Fuest K, Schuster M, Papadogoulas A, Mulita F, Rovina N, Aidoni Z, CHRISANTHOPOULOU EVANGELIA, KONDILI EUMORFIA, Andrianopoulos I, Groenendijk M, Evers M, Evers M, van Lelyveld-Haas L, Meynaar I, Cornet AD, Zegers M, Dieperink W, de Lange D, Dormans T, Hahn M, Sjøbøe B, Strietzel HF, Olasveengen T, Romundstad L, Kluzik A, Zatorski P, Drygalski T, Klimkiewicz J, Solek-pastuszka J, Onichimowski D, Czuczwar M, Gawda R, Stefaniak J, Stefanska-Wronka K, Zabul E, Oliveira AIP, Assis R, de Lurdes Campos Santos M, Santos H, Cardoso FS, Gordinho A, Banzo MJA, Zalba-Etayo B, CUBERO PATRICIAJIMENO, Priego J, Gomà G, Tomasa-Irriguible TM, Sancho S, Ferreira AF, Vázquez EM, Mira ÁP, Ibarz M, Iglesias D, Arias-Rivera S, Frutos-Vivar F, Lopez-Cuenca S, Aldecoa C, Perez-Torres D, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, de Gopegui PR, Ben-Hamouda N, Roberti A, Fleury Y, Abidi N, Dullenkopf A, Pugh R, Smuts S. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial. BMC Geriatr 2022; 22:1000. [PMID: 36575394 PMCID: PMC9794407 DOI: 10.1186/s12877-022-03709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. METHODS This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. RESULTS 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. CONCLUSION Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19. TRIAL REGISTRATION This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.
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Affiliation(s)
- Philipp Heinrich Baldia
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Department of Anaestesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- grid.154185.c0000 0004 0512 597XDepartment of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Critical Care Centre, Sabadell Hospital University Institute Parc Tauli, Sabadell Barcelona, Spain
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.411656.10000 0004 0479 0855Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan Binnebößel
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Georg Wolff
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ralf Erkens
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sviri Sigal
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Muhammed Elhadi
- grid.411306.10000 0000 8728 1538Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.5947.f0000 0001 1516 2393Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. Dep. of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.414551.00000 0000 9715 2430Multipurpose and Neurocritical Intensive Care Unit, Hospital of São José, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Susannah Leaver
- grid.451349.eGeneral Intensive Care, St George´S University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W. De Lange
- grid.7692.a0000000090126352Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, Netherlands
| | - Bertrand Guidet
- Institute Pierre Louis Epidemiology and Public Health, Medical Intensive Care Unit, Sorbonne University, UPMC, INSERM, Hôpital Saint-Antoine, Paris, France
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Acevedo-Nuevo M, Martín-Arribas MC, González-Gil MT, Solís-Muñoz M, Arias-Rivera S, Royuela-Vicente A. The use of mechanical restraint in critical care units: Characterisation, application standards and related factors. Results of a multicentre study. Enferm Intensiva (Engl Ed) 2022; 33:212-224. [PMID: 36369124 DOI: 10.1016/j.enfie.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement. METHOD Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals). RESULTS A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = -.431) and in the subgroup of patients with ETT (r = -.521). CONCLUSIONS Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.
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Affiliation(s)
- M Acevedo-Nuevo
- Organización Nacional de Trasplantes, Madrid, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain.
| | - M C Martín-Arribas
- Subdirección General de Investigación en Terapia Celular y Medicina Regenerativa, Instituto de Salud Carlos III, Madrid, Spain
| | - M T González-Gil
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - M Solís-Muñoz
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - S Arias-Rivera
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - A Royuela-Vicente
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Unidad de Bioestadística, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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López-López C, Arranz-Esteban A, Sánchez-Sánchez MM, Pérez-Pérez T, Arias-Rivera S, Solís-Muñoz M, Latorre-Marco I. Pain Behaviors Analyzed by Videorecording in Brain-Injured Patients Admitted to the Intensive Care Unit. Pain Manag Nurs 2022; 24:113-122. [PMID: 36057509 DOI: 10.1016/j.pmn.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Abstract
AIM To describe and classify pain behaviors (facial and body) in brain-injured patients with a low level of consciousness before, during, and after the performance of painful and non-painful care procedures. METHODS Facial behaviors and body movements in brain-injured patients were videotaped at rest, during the application of three care procedures (two painful and one non-painful), and 15 minutes after completion of these procedures. Each video recording was evaluated by expert evaluators blinded to each other. For each of the behaviors observed, all possible combinations between the three procedures and/or time were compared using the McNemar test. Effect size was measured by the difference in proportions using the Wilson score 95% confidence intervals. RESULTS Twenty-seven patients were included. The mean (standard deviation) Glasgow Coma Score was 5.4 (1.9). A total of 33 behaviors (29 active, four neutral) were registered. Expression of behaviors was more common during the painful procedures compared with the other time points (non-painful procedures, baseline, and final evaluation). Inter-evaluator agreement was substantial (Kappa index >0.7) in more than 50% of the observed behaviors. CONCLUSIONS In this study involving brain-injured patients with a low level of consciousness, facial, body, and ventilation-related behaviors were more common during painful procedures. Agreement between evaluators to detect the presence or absence of these behaviors was substantial. These findings underscore the need to develop pain assessment measures specific to this patient population.
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Arias-Rivera S, Jam-Gatell R, Nuvials-Casals X, Vázquez-Calatayud M. [Update of the recommendations of the Pneumonia Zero project]. Enferm Intensiva 2022; 33:S17-S30. [PMID: 35911624 PMCID: PMC9326456 DOI: 10.1016/j.enfi.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
La pandemia por el SARS-Cov-2 ha impactado negativamente en la aplicación de las recomendaciones de Neumonía Zero y se ha acompañado de un incremento de las tasas de Neumonía asociada a ventilación mecánica (NAVM) en las unidades de cuidados intensivos de España. Con el objetivo de disminuir las tasas actuales a 7 episodios por 1000 días de VM, se han actualizado las recomendaciones del proyecto inicial. Se identificaron, 27 medidas que se clasificaron en 12 medidas funcionales (posición semisentada, higiene estricta de manos, entrenamiento para manipular la vía aérea, valoración diaria de posible extubación, protocolización del destete, traqueostomía precoz, ventilación no invasiva, vigilancia microbiológica, cambio de tubuladuras, humidificación, fisioterapia respiratoria, nutrición enteral postpilórica), 7 mecánicas (control de la presión del neumotaponamiento, tubos con aspiración subglótica, nutrición con sondas de bajo calibre/en intestino delgado, aspiración de secreciones con circuitos cerrados/abiertos, filtros respiratorios, cepillado de dientes, técnicas de presión negativa en la aspiración de secreciones) y 8 farmacológicas (descontaminación selectiva digestiva, descontaminación orofaríngea, ciclo corto de antibióticos, higiene de boca con clorhexidina, antibióticos inhalados, rotación de antibióticos, probióticos, anticuerpos monoclonales). Cada medida se analizó de forma independiente, por al menos dos miembros del grupo de trabajo, mediante una revisión sistemática de la literatura y una revisión iterativa de las recomendaciones de las sociedades científicas y/o grupos de expertos. Para la clasificación de la calidad de la evidencia y fuerza de las recomendaciones se siguió la propuesta del grupo GRADE. Para determinar el grado de recomendación, cada medida fue puntuada por todos los miembros del grupo de trabajo en relación con su efectividad, tolerabilidad y aplicabilidad en las UCI españolas a corto plazo de tiempo. Se solicitó el apoyo de expertos externos en alguna de las medidas que se revisaron. Se seleccionaron aquellas medidas que alcanzaron la máxima puntuación.
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Affiliation(s)
- S Arias-Rivera
- Investigación de enfermería. Hospital Universitario de Getafe, Getafe. CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Jam-Gatell
- Área de críticos. Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - X Nuvials-Casals
- Área de Desarrollo Profesional e investigación de Enfermería, Clínica Universidad de Navarra. Universidad de Navarra. IdisNA, Instituto de Investigación Sanitaria de Navarra, Navarra, España
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Acevedo-Nuevo M, Martín-Arribas M, González-Gil M, Solís-Muñoz M, Arias-Rivera S, Royuela-Vicente A. Uso de contenciones mecánicas en unidades de cuidados críticos: caracterización, estándares de aplicación y factores relacionados. Resultados de un estudio multicéntrico. Enfermería Intensiva 2022. [DOI: 10.1016/j.enfi.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Frade-Mera MJ, Arias-Rivera S, Zaragoza-García I, Martí JD, Gallart E, San José-Arribas A, Velasco-Sanz TR, Blazquez-Martínez E, Raurell-Torredà M. The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study. Nurs Crit Care 2022; 27:772-783. [PMID: 34994034 DOI: 10.1111/nicc.12740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The ABCDE bundle is a set of evidence-based practices to systematically reduce the risks of sedation, delirium, and immobility in intensive care patients. Implementing the bundle improves clinical outcome. AIMS AND OBJECTIVES To investigate the association between patient outcomes and compliance with bundle components ABC (analgosedation algorithms), D (delirium protocol), and E (early mobilization protocol). DESIGN A Spanish multicentre cohort study of adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. METHODS The primary outcome was pain level, cooperation to permit Medical Research Council Scale administration, patient days of delirium, and mobility. The secondary outcome was cumulative drug dosing by IMV days. Tertiary outcomes (ICU days, IMV days, bed rest days, ICU mortality, ICUAW) and independent variables (analgosedation, delirium, early mobilization protocols) were also studied. RESULTS Data were collected from 605 patients in 80 ICUs and 5214 patient days with IMV. Two-thirds of the ICUs studied applied no protocols. Pain was not assessed on 83.6% of patient days. Patient cooperation made scale administration feasible on 20.7% of days. Delirium and immobility were found on 4.2% and 69.9% of days, respectively. Patients had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components (P = 0.006 and P = 0.03, respectively). Analgosedation protocols were associated with more opioid dosing (P = 0.02), and delirium and early mobilization protocols with more propofol (P = 0.001), dexmedetomidine (P = 0.001), and lower benzodiazepine dosing (P = 0.008). CONCLUSIONS The implementation rate of ABCDE bundle components was very low in our Spanish setting, but when implemented, patients had a shorter ICU stay, more analgesia dosing, and lighter sedation. RELEVANCE TO CLINICAL PRACTICE Applying some but not all the bundle components, there is increased analgesia and light sedation drug use, decreased benzodiazepines, and increased patient cooperation and mobility, resulting in a shorter ICU stay and fewer days of IMV.
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Affiliation(s)
- María Jesús Frade-Mera
- Critical Care Department, 12 Octubre University Hospital, Madrid, Spain.,Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
| | - Susana Arias-Rivera
- Department of Nursing Management, University Hospital of Getafe, Madrid, Spain.,Research Department, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Research department (Invecuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Centro de Actividades Ambulatorias, Madrid, Spain
| | - Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Department, Instituto Clínico Cardiovascular, Clinic University Hospital, Barcelona, Spain
| | - Elisabet Gallart
- Critical Care Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Alicia San José-Arribas
- Department of Nursing, Escola Universitaria d'Infermeria Sant Pau (Hospital de la Santa Creu i Sant Pau), Barcelona, Spain
| | - Tamara Raquel Velasco-Sanz
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Critical Care Department, San Carlos University Hospital, Madrid, Spain
| | | | - Marta Raurell-Torredà
- Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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13
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Raurell-Torredà M, Arias-Rivera S. Blood glucose monitoring. Nationwide multicentre study. Med Intensiva 2021; 46:164-165. [PMID: 34961689 DOI: 10.1016/j.medine.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 10/19/2022]
Affiliation(s)
- M Raurell-Torredà
- Facultad de Medicina y Ciencias de la Salud. Universidad de Barcelona, Barcelona, Spain.
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Raurell-Torredà M, Arias-Rivera S, Martí JD, Frade-Mera MJ, Zaragoza-García I, Gallart E, Velasco-Sanz TR, San José-Arribas A, Blazquez-Martínez E. Care and treatments related to intensive care unit-acquired muscle weakness: A cohort study. Aust Crit Care 2021; 34:435-445. [PMID: 33663950 DOI: 10.1016/j.aucc.2020.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/28/2020] [Accepted: 12/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Intensive care unit-acquired muscle weakness (ICUAW) has an incidence of 40-46%. Early mobilisation is known to be a protective factor. OBJECTIVE The aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW. METHODS A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse-patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3-5 of the ICU stay. RESULTS The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53-62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00-1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00-1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38-0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95-0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97-0.99]), presence of delirium (OR = 0.98; 95% CI [0.97-0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97-0.99]). CONCLUSIONS The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.
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Affiliation(s)
- M Raurell-Torredà
- Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - S Arias-Rivera
- University Hospital of Getafe, CIBER Respiratory Diseases, Carlos III Institute of Health, Madrid, Spain
| | - J D Martí
- Clinic University Hospital, Barcelona, Spain
| | - M J Frade-Mera
- 12 Octubre University Hospital, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain
| | - I Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain; Care Research Group (Invecuid), 12 de Octubre Hospital Institute of Health Research (imas12), Madrid, Spain.
| | - E Gallart
- Vall Hebron University Hospital, Barcelona, Spain
| | - T R Velasco-Sanz
- San Carlos University Hospital, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain
| | - A San José-Arribas
- Sant Pau University School of Nursing (Santa Creu i Sant Pau Hospital), Barcelona, Spain
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15
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Raurell-Torredà M, Arias-Rivera S, Martí JD, Frade-Mera MJ, Zaragoza-García I, Gallart E, Velasco-Sanz TR, San José-Arribas A, Blazquez-Martínez E. Variables associated with mobility levels in critically ill patients: A cohort study. Nurs Crit Care 2021; 27:546-557. [PMID: 34008238 DOI: 10.1111/nicc.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early mobilization in the intensive care unit (ICU) helps improve patients' functional status at discharge. However, many barriers hinder this practice. AIM AND OBJECTIVES To identify mobility levels acquired by critically ill patients and their variables. DESIGN A multi-centre cohort study was conducted in adult patients receiving invasive mechanical ventilation for at least 48 hours. METHODS The primary outcome was level of mobility according to the ICU mobility scale. The secondary outcome was human resource availability and existence of ABCDEF bundle guidelines. A logistic regression was performed, based on days 3 to 5 of the ICU stay and significant association with active mobility. RESULTS Six hundred and forty-two patients were included from 80 ICUs. Active moving in and out of bed was found on 9.9% of patient-days from day 8 of the ICU stay. Bed exercises, or passive transfers, and immobility were observed on 45.6% and 42.2% of patient-days, respectively. Patients achieving active mobility (189/642, 29.4%) were in ICUs with more physiotherapist hours. Active mobility was more likely with a 1:4 nurse-patient ratio (odds ratio [OR] 3.7 95% confidence interval [CI] [1.2-11.2]), high MRC sum-score (OR 1.05 95% CI [1.04-1.06]) and presence of delirium (OR 1.01 95% CI [1.00-1.02]). By contrast, active mobility was hindered by higher BMI (OR 0.92 95% CI [0.88-0.97]), a 1:3 nurse-patient ratio (OR 0.54 95% CI [0.32-0.93]), or a shift-dependent nurse-patient ratio (OR 0.27 95% CI [0.12-0.62]). CONCLUSIONS Immobility and passive mobilization were prevalent. A high MRC sum-score and presence of delirium are protective factors of mobilization. A 1:4 nurse-patient ratio shows a stronger association with active mobility than a 1:3 ratio. RELEVANCE TO CLINICAL PRACTICE Severity-criteria-based nurse-patient ratios hinder mobilization. Active mobilization may be enhanced by using nursing-intervention-based ratios, increasing physiotherapist hours, and achieving wider application of the ABCDEF bundle, resulting in more awake, cooperative patients.
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Affiliation(s)
- Marta Raurell-Torredà
- Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Arias-Rivera
- Department of Nursing Management, University Hospital of Getafe, Madrid, Spain.,Research Department, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Department, Instituto Clínico Cardiovascular, Clinic University Hospital, Barcelona, Spain
| | - María Jesús Frade-Mera
- Critical Care Department, 12 Octubre University Hospital, Madrid, Spain.,Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
| | - Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Research department (Invecuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Centro de Actividades Ambulatorias, Madrid, Spain
| | - Elisabet Gallart
- Critical Care Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Tamara Raquel Velasco-Sanz
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Critical Care Department, San Carlos University Hospital, Madrid, Spain
| | - Alicia San José-Arribas
- Department of Nursing, Escola Universitaria d'Infermeria Sant Pau (Hospital de la Santa Creu i Sant Pau), Barcelona, Spain
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Raurell-Torredà M, Arias-Rivera S. Blood glucose monitoring. Nationwide multicentre study. Med Intensiva 2021; 46:S0210-5691(21)00004-8. [PMID: 33551111 DOI: 10.1016/j.medin.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Affiliation(s)
- M Raurell-Torredà
- Facultad de Medicina y Ciencias de la Salud. Universidad de Barcelona, Barcelona, España.
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Torres-González JI, Arias-Rivera S, Velasco-Sanz T, Mateos DA, Planas PB, Zaragoza-García I, Raurell-Torredà M. What has happened to care during the COVID-19 pandemic? Enferm Intensiva (Engl Ed) 2020; 31:101-104. [PMID: 32739041 PMCID: PMC7834243 DOI: 10.1016/j.enfi.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- J I Torres-González
- Oficina Regional de Coordinación de Trasplantes. Servicio Madrileño de Salud. En nombre del Grupo de Trabajo ECMO de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC)
| | - S Arias-Rivera
- Hospital Universitario de Getafe. En nombre del Grupo de Trabajo Analgesia, Sedación, Delirio y Contenciones (ASCyD) de SEEIUC
| | - T Velasco-Sanz
- Hospital Clínico San Carlos. En nombre del Grupo de Trabajo Bioética de SEEIUC
| | - Dávila A Mateos
- Hospital Universitari Sant Pau i Santa Creu. En nombre del Grupo de Trabajo Terapias Extracorpóreas de SEEIUC
| | - Pascual B Planas
- Hospital Universitari Vall Hebrón. En nombre del Grupo de Trabajo Rehabilitación Precoz de SEEIUC
| | - I Zaragoza-García
- Facultad de Enfermería, Fisioterapia y Podología de la Universidad Complutense de Madrid. En nombre del GT Grupo de Trabajo de Simulación de SEEIUC
| | - M Raurell-Torredà
- Escuela de Enfermería de la Universidad de Barcelona. Presidenta SEEIUC.
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López-López C, Arranz-Esteban A, Arias-Rivera S, Solís-Muñoz M, Pérez-Pérez T, Latorre-Marco I. Application of the Behavioural Indicators of Pain Scale in patients with traumatic brain injury. J Adv Nurs 2020; 76:1862-1870. [PMID: 32338391 DOI: 10.1111/jan.14400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/03/2020] [Accepted: 03/17/2020] [Indexed: 11/28/2022]
Abstract
AIM To develop and psychometrically test the Behavioural Indicators of Pain Scale (ESCID) in patients with traumatic brain injury (TBI). DESIGN A prospective observational study to test the psychometric properties of the Behavioural Indicators of Pain Scale in patients with TBI. METHOD A convenience sample of patients with TBI, who were non-communicative and using invasive mechanical ventilation was selected. Pain was evaluated by two observers who were blinded from each other. Assessments were performed at baseline via the performance of a painful procedure (aspiration of secretions) and a non-painful procedure (rubbing with a gauze). Assessments were repeated after application of procedures on days 1 and 6 of hospitalization in an intensive care unit. Data were collected between January-December 2016. RESULTS About 134 patients were included in the study. Of these, 76.1% were men. The mean age of participants was 45.2 (SD 17.5) years. The pain score significantly increased during the painful procedure when compared with the baseline measure and non-painful procedure (p < .001). Patients displayed a greater number of pain-indicating behaviours during the painful procedure on day 6, compared with day 1 (p < .05). This finding coincided with a reduced level of sedation and a greater level of consciousness. CONCLUSION The ESCID scale detects pain behaviours and discriminates among the different types of stimulation in patients with brain injury, who are uncommunicative and with mechanical ventilation, with good reliability. The ability for patients with brain injury to express behaviours is limited because of the low level of consciousness and the deep level of sedation. IMPACT This research will have an impact on the practice of pain assessment in patients with brain injury, representing a first step to adapt the content of the ESCID.
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Affiliation(s)
- Candelas López-López
- Department of Intensive Care, 12 de Octubre University Hospital (H12O), Madrid, Spain.,Care Research Group (Invecuid), Instituto de Investigación Sanitaria, 12 de Octubre University Hospital (imas12), Madrid, Spain.,Nursery, Physiotherapy and Podiatry Facultie, Complutense University of Madrid, Madrid, Spain
| | - Antonio Arranz-Esteban
- Emergency and Trauma Intensive Care Unit, 12 de Octubre University Hospital (H12O), Madrid, Spain
| | - Susana Arias-Rivera
- Hospital Nurse and Health Care Research, Getafe University Hospital (HUG), Madrid, Spain.,CIBER Respiratory Diseases, Carlos III Health Institute, Madrid, Spain
| | - Montserrat Solís-Muñoz
- Nursing Department, Puerta de Hierro Majadahonda University Hospital (HUPHM), Madrid, Spain.,Nursing and Health Care Research Group, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Teresa Pérez-Pérez
- Department of Statistics and OR III, Complutense University of Madrid, Madrid, Spain.,Department of Statistics and Data Science, Madrid, Spain
| | - Ignacio Latorre-Marco
- Nursing and Health Care Research Group, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain.,Intensive Care Unit, Puerta de Hierro Majadahonda University Hospital (HUPHM), Madrid, Spain
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Via-Clavero G, Guàrdia-Olmos J, Gallart-Vivé E, Arias-Rivera S, Castanera-Duro A, Delgado-Hito P. Development and initial validation of a Theory of Planned Behaviour questionnaire to assess critical care nurses' intention to use physical restraints. J Adv Nurs 2019; 75:2036-2049. [PMID: 31090090 DOI: 10.1111/jan.14046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Abstract
AIMS To develop and psychometrically test a Theory of Planned Behaviour (TPB) questionnaire to assess nurses' intention to use physical restraints (PRs) in intubated patients. DESIGN A psychometric instrument validation study conducted in three phases. METHODS A theory-driven questionnaire was developed. Eight experts validated the content of the preliminary 58-item questionnaire. A pilot study was conducted including 101 critical care nurses to test the reliability of the items. Construct validity and reliability were tested in a cross-sectional study of 12 units from eight hospitals in Spain (N = 354) from October - December 2017. Participants completed the questions based on the TPB, and socio-demographic and professional variables. RESULTS The instrument comprised 48 items. All the direct and indirect constructs exhibited acceptable reliability. Confirmatory factor analysis indicated satisfactory fit indices for factorial structure according to the TPB. Nurses showed favourable attitudes, low perception of social pressure and modest perception of behaviour control. Perceived behavioural control and attitude were moderately positively correlated with the intention to use restraints, whereas subjective norm revealed the lowest correlation. Overall, the model explained 33% of the variance in intention. CONCLUSIONS The Physical Restraint TPB questionnaire is a 48-item self-reporting theoretically based instrument with acceptable reliability and construct validity to identify nurses' intentions to use PRs in intubated patients. IMPACT Unravelling the key determinants of nurses' intentions to use PRs should be examined to tailor quality improvement projects aimed at de-implementing restraints use in practice and to promote safer care.
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Affiliation(s)
- Gemma Via-Clavero
- Intensive Care Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing, Universitat de Barcelona-GRIN-IDIBELL, Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Faculty of Psychology, Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona (UB), Institute of Neuroscience (UB), Institute of Complex Systems (UB), Barcelona, Spain
| | | | | | - Aaron Castanera-Duro
- Intensive Care Department, Nursing Department, Hospital Universitari Dr. Josep Trueta, Universitat de Girona (UDG), Girona, Spain
| | - Pilar Delgado-Hito
- Faculty of Medicine and Health Sciences, Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing, Universitat de Barcelona-GRIN-IDIBELL, Barcelona, Spain
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Arias-Rivera S, López-López C, Frade-Mera MJ, Via-Clavero G, Rodríguez-Mondéjar JJ, Sánchez-Sánchez MM, Acevedo-Nuevo M, Gil-Castillejos D, Robleda G, Cachón-Pérez M, Latorre-Marco I. Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD. Enferm Intensiva (Engl Ed) 2019; 31:3-18. [PMID: 31003871 DOI: 10.1016/j.enfi.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/15/2018] [Accepted: 11/23/2018] [Indexed: 01/25/2023]
Abstract
AIMS Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients' levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. METHOD An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. RESULTS One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. CONCLUSIONS The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874).
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Affiliation(s)
- S Arias-Rivera
- Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España.
| | - C López-López
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, España; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Madrid, España
| | - M J Frade-Mera
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario 12 de Octubre, Madrid, España; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Madrid, España
| | - G Via-Clavero
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitari de Bellvitge (GRIN-IDIBELL), Hospitalet de Llobregat, Barcelona, España
| | - J J Rodríguez-Mondéjar
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Gerencia de Urgencias y Emergencias 061, Servicio Murciano de Salud, Murcia, España; Universidad de Murcia, Instituto Murciano de Investigación Biomédica del HCU Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España
| | - M M Sánchez-Sánchez
- Hospital Universitario de Getafe, Getafe, Madrid, España; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España
| | - M Acevedo-Nuevo
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España; Facultad de Ciencias de la Salud, Universidad Autónoma de Madrid, Madrid, España
| | - D Gil-Castillejos
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario Juan XXIII, Tarragona, España
| | - G Robleda
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Escuela Superior de Enfermería Mar (ESIMar), Universidad Pompeu Fabra, Barcelona, España; Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Cachón-Pérez
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - I Latorre-Marco
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), España; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
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Raurell-Torredà M, Arias-Rivera S, Martí J, Frade-Mera M, Zaragoza-García I, Gallart E, Velasco-Sanz T, San José-Arribas A, Blázquez-Martínez E, Rodríguez Delgado ME, Contreras Rodríguez AM, Oreña Cimiano E, Ortega Guerrero Á, Martínez del Aguila MDC, Rodríguez Monsalve V, Cano Herrera CL, Masegosa Pérez JM, González de la Cuesta DM, Pardo Artero MI, Palacios Laseca M, Cabello Casao AI, Vera Bellostas MBVD, Pérez Martínez C, Escuder González S, Lezcano Cisneros A, Miguel Romeo A, López Alegre I, San Pío ERD, Fernández Alonso H, Rodríguez Villanueva LM, Riaño Suárez R, Sánchez Cerviñio B, Carrasco Santos S, José Arribas AS, González García M, Linares Tavio A, Álvarez García P, Polo Hernández N, Gómez Cosío L, Pérez Loza I, Suárez Pérez Á, Crespo Rebollo S, Muñoz Camargo JC, García García J, Rojo Aguado C, Gómez López J, Sonseca Bartolomé L, José Arribas AS, Olmo Nuñez SD, García Mazo P, Siguero Torres E, Muñoz Díez I, Delgado Hito P, Garrido Martín MO, Marín Vivó G, Eseverri Rovira MDM, Guillen Dobon M, Aran Esteve M, Mirabete Rodríguez M, Mariné Méndez A, Rodríguez Fernández S, Rosselló Sancho J, Zafra Lamas V, Carmona Delgado I, Navarro Arilla À, Zariquiey Esteva G, Bueno Luna ÁL, Lerma Brianso C, Gómez García R, Planas Pascual B, Sabaté López M, Mayer Frutos AI, Roca Escrihuela R, Torrents Albà G, García Flores V, Melis Galmés J, Belmonte Moral S, Grau Pellicer M, Ruiz Eizmendi A, Garriga Moll C, de Jaureguízar EB, Cordovilla Guardia S, López Espuela F, Mateos Hinojal L, Redondo Cantos MI, Villar Redondo MDR, Vila Rey J, Sánchez Méndez S, García Fernández Y, Benítez Canosa MC, Díaz Álvarez M, Cordo Isorna JR, Estébez Penín Á, Güeto Rial G, Bouzas López E, Arias Rivera S, Frade Mera MJ, Luengo Alarcia MJ, Regueiro Díaz N, Carrasco Rodríguez-Rey LF, Hernández García MDR, Sala Gómez G, Vecino Rubio J, García González S, Sánchez Sánchez MDM, Cruzado Franco C, Martín Rivera B, González Blanco R, Sánchez de la Ventana AB, Bravo Arcas ML, Escobar Lavela J, Domingo Moreno MDP, García Arias M, Collado Saiz IC, Acevedo Nuevo M, Barrios Suárez A, Zarza Bejarano FJ, Pérez Muñoz MC, Toribio Rubio V, Martínez Chicharro P, Pascual Martínez A, López Pozo S, Sánchez Infante L, Ocaña García V, Menes Medina D, Vadillo Cortázar A, Lendínez Burgos G, Díaz Juntanez J, Godino Olivares MT, Rodríguez Mondéjar JJ, Martínez Rojo FJ, Ruiz Martínez MV, Linares Celdrán D, Ros Molina A, Sáez Sánchez J, Martínez Oliva JM, Bernal Gilar A, Hernández García MB, Ríos Cortés AT, Navarro Méndez R, Gil García S, Sánchez Garre J, Barrio Linares MD, Goñi Viguria R, Aguirre Santano R, García Díez MR, Aparicio Cilla L, Delicado Domingo M, Rodríguez Núñez C, Arrasate López A, Romero Morán Á, Paños Melgoso R, Yañez Cerón M, Mercado Martínez A, Martínez Llopis B, Vayá Albelda MJ, Inat Carbonell J, Alcayne Senent MR, Giménez García F, Fernández Gonzaga EC, Febrer Puchol L, Berenguer Ortuño S, Pastor Martínez M, Valera Talavera D, Segrera Rovira MJ, Langa Revert Y, Espí Pozuelo M, Diego Miravet MÁD, Garijo Aspas B, Asensio García MDR, Sánchez Muñoz JR, Martínez Sánchez Q, López Mateu R. Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España. Enfermería Intensiva 2019; 30:59-71. [DOI: 10.1016/j.enfi.2018.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 01/28/2023]
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López-López C, Robleda-Font G, Frade-Mera MJ, Gil-Castillejos D, Sánchez-Sánchez MM, Acevedo-Nuevo M, Via-Clavero G, Mondejar JJR, Fructuoso OV, Romeu JDM, Arias-Rivera S. Guía de práctica clínica del American College of Critical Care Medicine sobre prevención y manejo del dolor, agitación/sedación, contenciones mecánicas, delirio, inmovilidad y alteraciones del sueño del paciente adulto. Enfermería Intensiva 2019. [DOI: 10.1016/j.enfi.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sánchez-Sánchez MM, Arias-Rivera S, Fraile-Gamo P, Jareño-Collado R, López-Román S, Vadillo-Obesso P, García-González S, Pulido-Martos MT, Sánchez-Muñoz EI, Cacho-Calvo J, Martín-Pellicer A, Panadero-Del Olmo L, Frutos-Vivar F. Effect of a training programme on blood culture contamination rate in critical care. Enferm Intensiva (Engl Ed) 2018; 29:121-127. [PMID: 29609850 DOI: 10.1016/j.enfi.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 12/12/2017] [Accepted: 12/27/2017] [Indexed: 11/27/2022]
Abstract
Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%. OBJECTIVE To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence. METHOD Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request. VARIABLES demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods. RESULTS Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P=.00003). CONCLUSION An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples.
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Affiliation(s)
- M M Sánchez-Sánchez
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - S Arias-Rivera
- Enfermería de Investigación, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - P Fraile-Gamo
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - R Jareño-Collado
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - S López-Román
- Consultorio Local Moraleja de Enmedio, Moraleja de Enmedio, Madrid, España
| | | | - S García-González
- Unidad de Cuidados Intensivos, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - M T Pulido-Martos
- Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E I Sánchez-Muñoz
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - J Cacho-Calvo
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - A Martín-Pellicer
- Área de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - L Panadero-Del Olmo
- Área de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - F Frutos-Vivar
- Área de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, España
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Delgado-Hito P, Arias-Rivera S, Raurell Torredà M. [New challenges for Enfermería Intensiva (Intensive Care Nursing). Internationalisation and the impact factor]. Enferm Intensiva 2017; 27:1-3. [PMID: 26908185 DOI: 10.1016/j.enfi.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 11/27/2022]
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Arias-Rivera S, M. Sánchez-Sánchez M. ¿Es necesario « humanizar » las Unidades de Cuidados Intensivos en España? Enfermería Intensiva 2017; 28:1-3. [DOI: 10.1016/j.enfi.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/16/2022]
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Sánchez-Sánchez M, Arias-Rivera S, Thuissard-Vasallo I. Respuesta a: Intervalos de confianza para el coeficiente kappa en Sánchez-Sánchez et al. Enfermería Intensiva 2016; 27:133. [DOI: 10.1016/j.enfi.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Sánchez-Sánchez MM, Arias-Rivera S, Fraile-Gamo MP, Thuissard-Vasallo IJ, Frutos-Vivar F. [Validating the Spanish version of the Nursing Activities Score]. Enferm Intensiva 2015; 26:63-71. [PMID: 25862002 DOI: 10.1016/j.enfi.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/20/2015] [Accepted: 02/21/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Validating workload scores ensures that they are appropriate for the purpose for which they were developed. OBJECTIVE To validate the Nursing Activities Score (NAS) Spanish version. METHODOLOGY Observational and prospective study. 1,045 patients who were admitted to a medical-surgical unit and a serious burns unit in 2006 were included. The nurse in charge assessed patient workloads by Nine Equivalent of Nursing Manpower use Score and NAS. To assess the internal consistency of the measurements of NAS, item-test correlations, Cronbach's α and Cronbach's α corrected by omitting each of the items were calculated. The intraobserver and interobserver reliability were assessed with the intraclass correlation coefficient by viewing recordings and Kappa (interobserver reliability) was estimated. For the analysis of internal validity, a factorial principal components analysis was performed. Convergent validity was assessed using the Spearman correlation coefficient values obtained from the Nine Equivalent of Nursing Manpower use Score and Spanish-NAS scales. RESULTS For internal consistency, 164 questionnaires were analysed and a Cronbach's α of 0.373 was calculated. The intraclass correlation coefficient for intraobserver reliability estimate was 0.837 (95% IC: 0.466-0.950) and 0.662 (95% IC: 0.033-0.882) for interobserver reliability. The estimated kappa was 0.371. For internal validity, exploratory factor analysis showed that the first item explained 58.9% of the variance of the questionnaire. For convergent validity 1006 questionnaires were included and a Spearman correlation coefficient of 0.746 was observed. CONCLUSIONS The psychometric properties of Spanish-NAS are acceptable.
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Affiliation(s)
- M M Sánchez-Sánchez
- Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - S Arias-Rivera
- Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España.
| | - M P Fraile-Gamo
- Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | | | - F Frutos-Vivar
- Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
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Argilaga-Molero E, Arias-Rivera S. [Advanced practice in nursing in the intensive care units of Spain]. Enferm Intensiva 2013; 24:135-6. [PMID: 24210436 DOI: 10.1016/j.enfi.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Affiliation(s)
- E Argilaga-Molero
- Área del Paciente Crítico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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Arias-Rivera S, Sánchez-Sánchez M, Sánchez-Izquierdo R, Gallardo-Murillo M, Santos-Díaz R, Frutos-Vivar F. Implementación de un protocolo de sedación dirigido por enfermería: efecto sobre el nivel de sedación y la retirada accidental de tubos y catéteres. Enfermería Intensiva 2008; 19:71-7. [DOI: 10.1016/s1130-2399(08)72747-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Arias-Rivera S, Copete-Vega A, Vadillo-Obesso P, Corrochano-Varas S, Sánchez-Izquierdo R, Sánchez-Sánchez MM, Sáiz-Sanz AI, Frutos-Vivar F, Pascual-Durán T. [Reliability of the measurement of glucose at the bedside of critical patients]. Enferm Intensiva 2007; 18:15-24. [PMID: 17397609 DOI: 10.1016/s1130-2399(07)74385-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The objective of this study is to measure the reliability of three measurement methods at the bedside of the patient, of glucose in the critical patient compared with the measurement of glucose in the central laboratory. MATERIAL AND METHODS Observational, perspective study developed in a polyvalent unit of 18 beds for four months. Patients who had arterial catheter were included. Eight samples obtained at the patient's bedside were compared with the plasma glucose (gold Standard): three in capillary blood, four in arterial blood and one in arterial blood gases from a syringe. The measurements at bedside were conducted with reactive strips MediSense Optium Plus and glucometer MediSense Optium. A comparison was made of the means used in the Student's T test and Bland and Altman analysis. RESULTS We obtained 630 samples in 70 patients. Mean glucose (SD) in mg/dl was: a) capillary samples: 149 (38), 149 (35), 147 (37); b) arterial samples: 140 (34), 142 (35), 143 (35), 142 (34); arterial gas sample syringe: 143 (33); c) plasma glucose: 138(33). There were significant differences (p < 0.001) between plasma glucose and capillary samples but not with arterial samples (p=0.2). In the arterial samples, the presence of some factors, such as vasoactive drugs, glycated solution perfusion, insulin perfusion and plasma concentration of hemoglobin, increase error and dispersion regarding the gold standard. CONCLUSIONS The measurement of glucose at bedside in critical patients is more reliable in arterial samples than in capillary ones.
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Affiliation(s)
- S Arias-Rivera
- Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, España.
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Arias-Rivera S, Sánchez-Sánchez M, Sánchez-Izquierdo R, Santos-Díaz R, Gallardo-Murillo J, Frutos-Vivar F. Does sedation practice delay time to extubation? Intensive Crit Care Nurs 2006; 22:378-82. [PMID: 17011780 DOI: 10.1016/j.iccn.2006.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/19/2006] [Accepted: 08/08/2006] [Indexed: 11/16/2022]
Abstract
UNLABELLED Criteria for performing a spontaneous breathing trial (SBT) have not been evaluated in controlled trials. An important component of these criteria is neurological status. The objective of this study was to evaluate whether physicians take mental status into consideration before performing an SBT in mechanically ventilated patients. METHODS This was a prospective, observational study which included 355 mechanically ventilated patients. Daily assessments were made of whether the patients met criteria for performing a SBT. On the day a patient met the criteria, the level of sedation was evaluated using the Glasgow Coma Scale as modified by Cook and Palma (GCS-Cook) and it was registered whether or not the physician carried out an SBT. RESULTS Two hundred and four patients (57%) underwent an SBT on the day they met the criteria (cohort 1) and in 151 patients (cohort 2) the SBT was delayed a median time of 1 day (interquartile range 1-2). There were differences in the GCS-Cook score on the day the criteria were met for performing an SBT (mean 13+/-3 points in cohort 1 versus 9+/-3 points in cohort 2; P<0.001). There were differences (P<0.001) between the cohorts in days of intubation and length of stay in the intensive care unit. CONCLUSIONS Neurological status/level of sedation is a factor in the decision whether or not to perform a spontaneous breathing trial.
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Affiliation(s)
- Susana Arias-Rivera
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo Km. 12,500, 28905 Getafe, Madrid, Spain.
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