Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone

OBJECTIVE

To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU.

DESIGN

A prospective, 5-month observational and descriptive study was carried out.

SETTING

ICU of Marqués de Valdecilla University Hospital, Santander (Spain).

SUBJECTS

Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives.

INTERVENTION

Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers.

RESULTS

An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement.

CONCLUSIONS

The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.

Hospital mortality prognostication in sepsis using the new biomarkers suPAR and proADM in a single determination on ICU admission

PURPOSE

The soluble form of the urokinase-type plasminogen activator receptor (suPAR) and proadrenomedullin (proADM) are two new and promising sepsis biomarkers. We assessed the prognostic value of a single determination of proADM and suPAR, comparing them with C-reactive protein (CRP) and procalcitonin (PCT), and evaluating whether their addition to severity scores (APACHE II and SOFA) could improve their prognostic accuracy.

METHODS

A single-centre prospective observational study conducted in an adult intensive care department at Marques de Valdecilla University Hospital in Spain. APACHE II and SOFA scores, CRP, PCT, suPAR and proADM levels on the day of ICU admission were collected.

RESULTS

A total of 137 consecutive septic patients were studied. The best area under the curve (AUC) for the prediction of in-hospital mortality was for APACHE II (0.82) and SOFA (0.75) scores. The ROC curve for suPAR yielded an AUC of 0.67, higher than proADM (0.62), CRP (0.50) and PCT (0.44). Significant dose-response trends were found between hospital mortality and suPAR (OR Q4 = 4.83, 95% CI 1.60-14.62) and pro-ADM (OR Q4 = 3.00, 95% CI 1.06-8.46) quartiles. Non-significant associations were found for PCT and CRP. The combination of severity scores and each biomarker did not provide superior AUCs.

CONCLUSIONS

SuPAR and, to a lesser extent, proADM levels on ICU admission were better tools in prognosticating in-hospital mortality than CRP or PCT. However, neither of the two new biomarkers has been demonstrated to be excessively useful in the current setting. The prognostic accuracy was better for severity scores than for any of the biomarkers.

Cytomegalovirus hemorrhagic gastritis

A 36-year-old male with acquired immune deficiency syndrome (AIDS) presented with intractable nausea and vomiting of 1 week's duration that was not attributable to his medications. An esophagogastroduodenoscopy showed hemorrhagic and necrotic gastric mucosa but no ulcers were found. Histopathology revealed viral inclusions consistent with cytomegalovirus (CMV) disease of the stomach. The patient received 6 weeks of intravenous ganciclovir with resolution of symptoms and endoscopic findings. Cytomegaloviral involvement of the stomach is rare, even in immunocompromised patients. Characteristic findings on upper endoscopy are punched-out gastric ulcers. This is a rare case of CMV disease of the stomach presenting as hemorrhagic, necrotic gastritis with inflammatory bridging.

[Family dysfunction as predisposing factor of mental disease. Does that relationship exist?]

OBJECTIVES

The purpose is to describe the relationship between family disfunction and mental disorder. The secondary objective is to know the prevalence and distribution of mental disorders in primary care attended population.

DESIGN

A cross-sectional study was conducted in a primary care setting.

PATIENTS AND METHODS

Random sample was selected over 280 subjects from consultant population. The variables (family function, family structure, social and economic conditions and mental disorders) were collected through interview. APGAR test and Mini International Neuropsychiatric Interview test were performed.

RESULTS

264 patients were finally included (64% women). Mean age was 45.6 years (SD 16.7). Mental disorders were detected in 87 patients (33%). The most prevalent disorders were generalized anxiety disorder, dysthymia and major depression, family disfunction was found in 32 patients (12.3%). Prevalence of mental disorders wasn't statistically different in the group with family disfunction.

CONCLUSION

Mental disorders are a common problem between primary care attended population. There wasn't any association between family disfunction and mental disorders, because of the limitations in the APGAR test in detecting family disfunction.