Prevalents aspects in attention to the severe trauma patients in Critical Care: length of stay, infection, administration of tranexamic acid

Introducción: No existen definiciones estandarizadas acerca de lo que es un trauma grave o un paciente traumatizado grave, por lo que para describirlo se utilizan diferentes escalas de gravedad, lesionales o clasificaciones que varían en función de las interpretaciones de quienes las emplean. Actualmente, la acepción más extendida es que el paciente politraumatizado o traumatizado grave es aquel que presenta diversas lesiones traumáticas donde alguna de ellas supone un riesgo vital. En términos generales, este tipo de pacientes precisan de ingreso en las Unidades de Cuidados Intensivos (UCIs). La evidencia muestra que el pronóstico del paciente con enfermedad traumática grave se ve influido en gran parte por la calidad y la aplicación de Planes de Cuidados, por lo que los cuidados proporcionados por los profesionales de Enfermería, cuya misión principal es cuidar al paciente, deben ser de alta calidad con el objetivo de disminuir la incidencia de complicaciones derivadas del proceso de enfermedad y de las técnicas invasivas que precisan los pacientes ingresados en las UCIs (úlceras por presión, infecciones nosocomiales por procedimientos invasivos, extubaciones accidentales, detección de efectos adversos de medicamentos, hemorragias etc...), según los estándares prefijados por la sociedad científica y profesional. Se parte de la hipótesis de que unos Cuidados de Enfermería de calidad, en términos de menor incidencia de aparición de complicaciones, generan menores secuelas y una temprana alta hospitalaria en los pacientes traumatizados graves. Objetivo General: Determinar aspectos más prevalentes en la atención al paciente trauma grave en cuidados críticos: larga estancia, infecciones y administración de ácido tranexámico (TXA). Entre los Objetivos Específicos: Establecer relaciones entre la incidencia de complicaciones (Hemorragias, ulceras por presión, infecciones nosocomiales, etc…) y el tiempo de estancia en la UCI. Conocer y analizar qué factores pueden estar relacionados con la adquisición de infecciones por el paciente con trauma grave en una UCI de un Hospital General de tercer nivel del sur de España, perteneciente al Sistema Nacional de Salud. Evaluar la necesidad de transfusión de hemoderivados, la necesidad de neurocirugía, el tiempo de estancia en la UCI, el estado funcional, los eventos tromboembólicos y el aumento del volumen de sangrado intracraneal en los pacientes traumatizados tratados con TXA. Material y Métodos: El estudio se llevó a cabo en dos fases. En origen, se planteó un estudio retrospectivo. Los datos y conclusiones obtenidas aconsejaron el diseño y desarrollo de una revisión sistemática y meta-análisis relacionado con la administración de TXA en los pacientes traumatizados graves. En la primera fase: Estudio analítico, observacional, longitudinal (dos observaciones) retrospectivo a partir de las bases de datos de la UCI de un Hospital de tercer nivel del sur de España. Se estudiaron registros de los pacientes mayores de 17 años ingresados por patología traumática, entendiéndose como tal aquella codificada en la Clasificación Internacional de Enfermedades, versión nueve (CIE-9) con cualquiera de los códigos que se encuentra entre el 800.0 y el 959.9. Registros correspondientes al periodo 2012-2016. Variables de estudio: Sexo, Edad, Patología crónica (hipertensión arterial, obesidad, diabetes, EPOC, otras…), Mecanismo lesional, Variables de la asistencia en urgencias hospitalarias/prehospitalarias (intubación endotraqueal prehospitalaria, vía aérea alternativa, traslado en helicóptero, traslado en uvi móvil, inmovilización realizada, situación al ingreso en urgencias, preaviso hospitalario), Valoración de Enfermería al ingreso en UCI según el modelo de Virginia Henderson, Gravedad del paciente, Úlceras por presión, Extubaciones, Complicaciones médicas (sepsis, fallos orgánicos, hipertensión craneal), Días de estancia en UCI, Número de fallecimientos, Diagnósticos, Intervenciones y Resultados de Enfermería. Instrumentos: Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), taxonomías NANDA, NIC y NOC. El proyecto se presentó al Comité de Ética de la Investigación de referencia con informe favorable (Acta Nº 263/ref. 3453). Cumplimiento de la Ley Orgánica 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Personal y el Real Decreto 994/99 del Estado Español, normativa vigente en el periodo de estudio. En la segunda fase, se llevó a cabo una revisión sistemática y meta-análisis relacionada con la administración de TXA. Las bases de datos consultadas fueron: Medline, Embase, The Cochrane Library, Web of Science y TheClinicalTrials.gov. Los criterios de inclusión fueron: ensayos clínicos, publicados entre el 1 de enero de 2008 y 1 de agosto de 2018, en los que participaran pacientes que sufrían un traumatismo y a los que se les administró TXA en los servicios de urgencias hospitalarias en las primeras 8 horas tras el traumatismo. Se extrajeron variables clínicas de la intervención y las relacionadas con la estrategia PICO. Resultados: Los datos obtenidos en el estudio retrospectivo, se pudieron agrupar en 8 categorías temáticas: Impacto de los fallos orgánicos, de las infecciones adquiridas en la UCI, de las técnicas invasivas, del reemplazo en la necesidad de respiración, de las intervenciones para mantener la necesidad de higiene corporal e integridad de la piel y la de moverse y mantener una postura adecuada; así como sobre la relación de la estancia en UCI con las escalas de gravedad y con la procedencia del paciente al ingreso en la UCI.De todo ello se obtuvo como significativo, que la prolongación de la estancia en la UCI se incrementa con el uso de terapias de sustitución o soporte de funciones vitales y necesidades básicas como la ventilación mecánica invasiva, técnicas de depuración renal, sondajes vesical y rectal, o alimentación enteral…. Asimismo, las medidas y técnicas invasivas (monitor de presión intracraneal, el número de días conectado a ventilación mecánica invasiva y la administración de hemoderivados) junto con la estancia en UCI mayor a una semana y el desarrollo del fallo orgánico durante la estancia, aumentaban las posibilidades de contraer una infección nosocomial. Con relación a la administración de TXA, se incluyeron 5 ensayos clínicos para la revisión sistemática y 4 para el meta-análisis (20697 pacientes). Se detectó una disminución de la mortalidad [OR 0,89 (IC95% 0,83-0,96); p=0,004; I2=0%] y un mejor estado funcional [OR 0,60 (IC95% 0,39-0,94); p=0,02; I2=0%] tras la administración de TXA en estos pacientes en comparación con placebo. Por el contrario, se encontró una estancia en la UCI más larga [MD 2,55 (IC95% 0,04-5,06); p=0,05; I2=0%]. Conclusiones: Déficit de registros. De forma genérica, las complicaciones clínicas y nosocomiales (infecciones) aumentan la estancia en la UCI de los pacientes con trauma grave. Los factores relacionados con las estancias más prolongadas de pacientes con traumatismo grave en la UCI son: ser hombre, insuficiencia de órganos importantes, infecciones, técnicas invasivas, ulceras por presión, movilidad reducida y el ingreso en la UCI proveniente de otro lugar del hospital diferente a urgencias. Los factores predominantes en la aparición de infecciones han sido: la monitorización de la presión intracraneal, la ventilación mecánica invasiva, la administración de hemoderivados, el fallo orgánico durante la estancia en la UCI y la estancia prolongada en la unidad mayor a una semana. El control de la hemorragia y el soporte circulatorio forman parte de la evaluación primaria y de soporte vital al paciente traumatizado en general y severo en particular. El TXA disminuye la mortalidad de los pacientes traumatizados graves, así como mejora el estado funcional de los mismos. Implicaciones para la práctica clínica y de Enfermería Se han hecho muchos esfuerzos en las últimas décadas para mejorar la eficiencia y la eficacia de la atención de Enfermería en las Unidades de Cuidados Intensivos. Si bien, a pesar de la implementación de sistemas de registro precisos para promover la cultura de registro, hay una importante falta de registros clínicos. En este sentido, se requieren intervenciones motivacionales y conductuales para sensibilizar al profesional de la salud sobre la importancia del registro y su influencia en la prevención de eventos adversos. La capacitación específica en la práctica de Enfermería basada en el modelo de Cuidados de sustitución o de ayuda de Virginia Henderson reduciría las largas estancias y procesos nosocomiales en la UCI. Las enfermeras deben extremar los cuidados que ofrecen para evitar complicaciones y efectos adversos al tiempo que promueven la autonomía de los pacientes. La persistencia en los resultados obtenidos en las diferentes revisiones y meta-análisis sobre los efectos beneficiosos del TXA, puede permitir controlar la incertidumbre clínica y favorecer la realización de más ensayos clínicos en el entorno de las urgencias y emergencias a fin de evidenciar y utilizar el TXA de una forma preventiva. Si bien, y al igual que se indica en la literatura revisada de modo reiterado, se considera necesario seguir realizando investigación para afianzar la evidencia en cuanto a la eficacia y seguridad del TXA.Introduction: There are no standardized definitions about what is a serious trauma or a serious traumatized patient, so different scales of severity, injuries or classifications are used, that vary according to the interpretations of those who use them. Currently, the most common meaning is that the trauma or serious traumatized patient is when a person suffered various traumatic injuries with a threat for vital functions. In general terms, this type of patients require admission to Intensive Care Units (ICUs). The evidence shows that the prognosis of the patient with severe traumatic disease is largely influenced by the quality and application of Care Plans. Hence the care provided by Nursing professionals, whose main mission is to take care of the patient, should be of high quality with the aim of reducing the incidence of complications derived from the disease process and the invasive techniques required by patients admitted to the ICU (pressure ulcers, nosocomial infections due to invasive procedures, accidental extubations, detection of adverse effects of medications, haemorrhages etc...), according to the standards set by the scientific and profesional society. Our hypothesis is based on the assumption that quality nursing care, in terms of a lower incidence of complications, generates fewer sequelae and early hospital discharge in severely traumatized patients. General Objective: To determine the most prevalent aspects in the care of patients with severe trauma in critical care: long stay, infections and administration of tranexamic acid (TXA). Among the Specific Objectives: To establish relationships between the incidence of complications (haemorrhages, pressure ulcers, nosocomial infections, etc ...) and the length of stay in the ICU. To know and analyse what factors may be related to the acquisition of infections by severe trauma patients in an ICU of a third level General Hospital of southern Spain, belonging to the Spanish National Health System. To assess the need for transfusion of blood products, the need for neurosurgery, the length of stay in the ICU, the functional status, thromboembolic events and the increased volume of intracranial bleeding in traumatized patients treated with TXA. Material and methods: The study was carried out in two phases. Originally, a retrospective study was proposed. The design and development of a systematic review and meta-analysis related to the administration of TXA in severely traumatized patients was advised by the data and conclusions of the first phase. In the first phase: Analytical, observational, longitudinal (two observations) retrospective study using ICU databases of a third level Hospital of southern Spain. Records of patients older than 17 years admitted for traumatic pathology, codified in the International Classification of Diseases, version nine (ICD-9) with any of the codes that is between 800.0 and 959.9, were studied. Records corresponding to the period to 2012-2016. Study variables: Sex, Age, Chronic pathology (arterial hypertension, obesity, diabetes, COPD, others ...), Mechanism of injury, Variables of hospital / prehospital emergency care (pre-hospital endotracheal intubation, alternative airway, helicopter transfer, transfer in ambulance, immobilization performed, situation on admission to the emergency room, prior notice to hospital), Nursing assessment on admission to the ICU according to the Virginia Henderson’s model, Patient severity, Pressure ulcers, Extubations, Medical complications (sepsis, organ failure, cranial hypertension), Days of stay in ICU, Number of deaths, Nursing Diagnoses, Interventions and Results. Instruments: Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), NANDA, NIC and NOC taxonomies. The project was submitted to the Research Ethics Committee with a favourable report (Act No. 263 / ref 3453). Compliance with Organic Law 15/1999, of December 13, Protection of Personal Data and Royal Decree 994/99 of the Spanish State, regulations in consideration during the study period. In the second phase: a systematic review and meta-analysis related to the administration of TXA was carried out. The databases consulted were: Medline, Embase, The Cochrane Library, Web of Science and The ClinicalTrials.gov. The inclusión criteria were: clinical trials published between January 1, 2008 and August 1, 2018, in which patients suffered trauma and were administered TXA in the hospital emergency services in the first 8 hours after the trauma. Clinical variables of the intervention and those related to the PICO strategy were extracted. Results: The data obtained in the retrospective study were grouped into 8 thematic categories: Impact of organic failures, infections acquired in the ICU, invasive techniques, replacement in the need for breathing, interventions to maintain the need for body hygiene and integrity of the skin, move and maintain a proper posture; as well as on the relationship of the ICU stay with the severity scales and with the patient's origin upon admission to the ICU.All above considered, it was proved significantly that the prolongation of the ICU stay is increased with the use of replacement therapies or support of vital functions and basic needs such as invasive mechanical ventilation, renal clearance techniques, bladder and rectal catheterization, or enteral feeding. Likewise, the invasive measures and techniques (intracranial pressure monitor, the number of days connected to invasive mechanical ventilation and the administration of blood products) together with an ICU stay for more than a week and the development of organic failure during the stay, increased the possibilities of contracting a nosocomial infection. Regarding the administration of TXA, 5 clinical trials were included for the systematic review and 4 for the meta-analysis (20,697 patients). A decrease in mortality was detected [OR 0.89 (95% CI 0.83-0.96); p=0.004; I2=0%] and a better functional status [OR 0.60 (IC95% 0.39-0.94); p = 0.02; I2=0%] after administration of TXA in these patients compared to placebo. On the contrary, a longer stay in the ICU was found [MD 2.55 (95% CI 0.04-5.06); p=0.05; I2=0%]. Conclusions Lack of clinical records. In general, clinical and nosocomial complications (infections) increase the stay in the ICU of patients with severe trauma. The factors related to the longer stays of patients with severe trauma in the ICU are: being a man, failure of important organs, infections, invasive techniques, pressure ulcers, reduced mobility and admission to the ICU from another place in the hospital. The predominant factors in the appearance of infections were: the monitoring of the intracranial pressure, the invasive mechanical ventilation, the administration of blood products, the organic failure during the ICU stay and the prolonged stay in the unit for more than a week. The control of the haemorrhage and the circulatory support are part of the primary evaluation and of vital support to the traumatized patient in general and severe in particular. TXA decreases the mortality of serious traumatized patients, as well as improving their functional status. Implications for clinical and nursing practice Many efforts have been made in recent decades to improve the efficiency and effectiveness of nursing care in ICUs. Although, despite the implementation of accurate registration systems, to promote the culture of registration, there is a significant lack of clinical records. In this sense, motivational and behavioural interventions are required to sensitize the health professional about the importance of registration and its influence on the prevention of adverse events. Specific training in nursing practice based on Virginia Henderson's substitution or assistance model would reduce long hospital stays and hospital procedures in the ICU. Nurses must take extreme care to avoid complications and adverse effects while promoting the autonomy of patients. The persistence in the results obtained in the different reviews and meta-analyzes on the beneficial effects of the TXA, can allow to control the clinical uncertainty and favour the realization of more clinical trials in the environment of the accident and emergency units in order to evidence and use the TXA in a preventive way. Although, and as indicated in the literature reviewed repeatedly, it is considered necessary to continue carrying out research to strengthen the evidence regarding the efficacy and safety of TXA

Adrenaline on cardiac arrest: systematic review and meta-analysis

Premio extraordinario de Trabajo Fin de Máster curso 2014-2015. Metodología de la Investigación en Ciencias de la SaludIntroducción. La adrenalina es una droga vasoactiva utilizada en el tratamiento de la parada cardiaca. Las guías de recomendación de reanimación cardiopulmonar establecen que se debe administrar 1mg de adrenalina cada 3-5 minutos. Nosotros hemos realizado esta revisión sistemática y meta-análisis con el objetivo de evaluar la efectividad de la adrenalina en la parada cardiaca y su efecto en la supervivencia y en el estado neurológico. Material y métodos. Revisión sistemática en Medline, Embase y Cochrane desde enero de 2005 hasta 28 de febrero de 2015 de ensayos clínicos y estudios observacionales. Meta-análisis utilizando un modelo de efectos aleatorios. Outcome primario: supervivencia al alta/30 días. Outcomes secundarios: supervivencia al alta/30 días con estado neurológico favorable, supervivencia al año, supervivencia al año con estado neurológico favorable y retorno de circulación espontanea. Resultados. Cumplieron criterios de inclusión y control de calidad 9 ensayos clínicos aleatorizados y 17 estudios observacionales. Se observó aumento en las tasas de retorno de circulación espontanea con la administración de adrenalina (OR 2.02; 95% IC 1.49-2.75; p<0.001; I2=95%) frente a la no administración de adrenalina. El meta-análisis mostró un aumento de la supervivencia al alta/30 días en la administración de adrenalina (OR 1.23; 95% IC 1.05-1.44; p<0.001; I2=83%). Estratificado por FV/TV y AESP se mostró un aumento de la supervivencia en AESP/asistolia (OR 1.52; 95% IC 1.29-1.78; p=0.11; I2=42%). También se observó un incremento en la supervivencia al alta/30 días en la administración de adrenalina antes de 10 minutos frente a la administración tardía (OR 2.03; 95% IC 1.77-2.32; p=0.45; I2=0%). Cuando las dosis de adrenalina eran altas (mayores a 5,5 mg), se incrementó la mortalidad hospitalaria (OR 2.82; 95% IC 1.64-4.85) y el estado neurológico desfavorable (OR 2.95; 95% IC 1.67-5.22). Conclusiones. La administración de adrenalina parece incrementar la tasa de retorno de circulación espontánea pero no se ha encontrado un efecto positivo en las tasas de supervivencia ni en las tasas de pacientes con estado neurológico favorable, en comparación con otras terapias o la no administración de adrenalina.Introduction. Adrenaline is a vasoactive drug used in the treatment of cardiac arrest. Recommendation guidelines state that CPR should be administered 1 mg of adrenaline each 3-5 minutes. The evidence for adrenaline in cardiac arrest resuscitation is inconclusive. We systematically reviewed the efficacy of epinephrine for survival and good neurological outcome for adult cardiac arrest. Material and Methods. Systematic review in MEDLINE, EMBASE, Cochrane from January 2005 to February 2015 of randomized controlled trials (RCTs) and observational studies. Meta-analyses were performed using random effects modeling, the primary outcome was survival to discharge/30 days and the secondary outcome survival to discharge/30 days with good neurological outcome, survival to year, survival to year with good neurological outcome and return of circulation spontaneous (ROSC). Results. 9 RCTs and 17 observational studies met inclusion criteria and quality control. It observed improve in the rates of return of spontaneous circulation with the administration of adrenaline. We observed improve of survival to discharge/30 days in administration of adrenaline group to non-adrenaline group adrenaline (OR 1.23; 95% IC 1.05-1.44; p<0.001). Stratified by VF/VT and PEA it showed improve of survival in PEA/asystole (OR 1.52; 95% CI 1.29-1.78; p=0.11). Also we observed an increase in survival to discharge/ 30 days in the administration of adrenaline before ten minutes, versus late administration (OR 2.03; 95% IC 1.77-2.32; p=0.45). When doses of adrenaline were high (greater than 5 mg), increased mortality in-hospital (OR 2.82; 95% IC 1.64-4.85), and unfavorable neurological outcome (OR 2.95; 95% IC 1.67-5.22). Conclusions. The administration of adrenaline improves rates of ROSC but we find improves on good neurological outcome and survival to year, compared to other therapies or not administration of adrenaline

Impact of sound levels on physiological and consciousness state of cardiovascular patients

This research received specific grants from the Regional Ministry of Health and Families, Government of Andalusia. Reference: PIGE-0462-2019. Principal investigator: Morales-Cané I/Reference: PI-0360-2017. Principal investigator: López-Soto PJ.ETHICS STATEMENT The project was approved by the reference research ethics committee (Act no. 277, reference 3878) and carried out in accordance with the ethical principles established in the Declaration of Helsinki on Human Rights and Biomedicine, as well as the Spanish legislation on personal data protection.Background Patients treated in intensive care units (ICUs) experience life-threatening medical conditions but some external factors in ICUs do not help or even adversely affect and complicate their evolution. Among others, such factors include noise pollution due to alarms and medical clinical equipment, as well as the activities of the health care personnel themselves. Aim This study aimed to evaluate the influence of elevated sound levels on physiological variables and the consciousness state of patients treated in a cardiovascular area in an ICU. Design A longitudinal study with several observations was carried out during 1 month in the cardiovascular area of an ICU of a third-level hospital in southern Spain. Methods Sound levels were monitored in different work shifts and patients' physiological data and consciousness status were recorded. Generalized additive mixed models (GAMMs) were developed to detect the variability of the sound levels together with the vital parameters of the patients in the ICU. Results Thirty-eight patients were included. The mean sound level was 54.09 dBA. The GAMM sound levels analysis showed a significant increase in sound levels from 4:30 p.m. to 8:00 p.m. (1.83 dBA; P < .001) and 8:00 p.m. to 11:30 p.m. (3.06 dBA; P < .001). An increase in heart rate (3.66 bpm; P < .001), respiratory rate (2.62 rpm; P < .001) and the Glasgow Coma Scale (0.50 units; P = .002) was detected during the 4:30 p.m.–8:30 p.m. period. Conclusions Elevated sound levels in cardiovascular ICUs seem to influence positively the physiological and consciousness status of patients. Given the importance of the findings for patient safety, future intervention studies are recommended. Relevance to Clinical Practice The finding of this study could translate into structural changes in ICU facilities, as well as the development of clinical practice guidelines that influence the behaviour of health care professionals.Regional Ministry of Health and Families, Government of Andalusia. Reference: PIGE-0462-201

Epinephrine in cardiac arrest: systematic review and meta-analysis

Objetivo: avaliar a efetividade da adrenalina na parada cardíaca e seu efeito na sobrevivência e no estado neurológico. Métodos: revisão sistemática da literatura científica com meta-análise utilizando um modelo de efeitos aleatórios. Revisão em Medline, Embase e Cochrane, desde 2005 até 2015 de ensaios clínicos e estudos observacionais. Resultados: observou-se aumento nas taxas de retorno de circulação espontânea com a administração de adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparadas com a não administração de adrenalina. A meta-análise mostrou um aumento da sobrevivência na alta ou depois de 30 dias da administração de adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). Quando estratificados por ritmos desfibrilháveis e não desfibrilháveis apareceu um aumento da sobrevivência nos ritmos não desfibrilháveis (OR 1,52; 95% IC 1,29-1,78; I2=42%). Também observou-se um incremento de sobrevivência na alta ou depois de 30 dias, quando administrada a adrenalina antes de 10 minutos, isto comparado com administração tardia (OR 2,03; 95% IC 1,77-2,32; I2=0%). Conclusão: a administração de adrenalina parece incrementar a taxa de retorno da circulação espontânea, mas não se tem encontrado um efeito positivo nas taxas de sobrevivência nem nas taxas de pacientes com estado neurológico favorável, em comparação com outras terapias.Objective: evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method: systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results: when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion: administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status.Objetivo: evaluar la efectividad de la adrenalina en el paro cardíaco y su efecto en la supervivencia y en el estado neurológico. Métodos: revisión sistemática de la literatura científica con metaanálisis utilizando un modelo de efectos aleatorios. Revisión en Medline, Embase y Cochrane, desde 2005 hasta 2015, de ensayos clínicos y estudios observacionales. Resultados: se observó aumento en las tasas de retorno de circulación espontánea cuando administrada adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparada con la no administración de adrenalina. El metaanálisis mostró un aumento de la supervivencia al alta hospitalaria o a los 30 días cuando administrada adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). La estratificación por ritmos desfibrilables y no desfibrilables mostró un aumento de la supervivencia en ritmos no desfibrilables (OR 1,52; 95% IC 1,29-1,78; I2=42%). También, se observó un incremento en la supervivencia al alta hospitalaria o a los 30 días en la administración de adrenalina antes de 10 minutos comparada con la administración tardía (OR 2,03; 95% IC 1,77-2,32; I2=0%). Conclusión: la administración de adrenalina parece incrementar la tasa de retorno de circulación espontánea, pero no se ha encontrado un efecto positivo en tasas de supervivencia ni en tasas de pacientes con estado neurológico favorable, en comparación con otras terapias

Environmental pollution in North-Eastern Italy and its influence on chronic obstructive pulmonary disease: Time series modelling and analysis using visibility graphs

The impact on human health from environmental pollution is receiving increasing attention. In the case of respiratory diseases such as chronic obstructive pulmonary disease (COPD), the relationship is now well documented. However, few studies have been carried out in areas with low population density and low industrial production, such as the province of Belluno (North-Eastern Italy). The aim of the study was to analyze the effect of exposure to certain pollutants on the temporal dynamics of hospital admissions for COPD in the province of Belluno. Daily air pollution concentration, humidity, precipitations, and temperature were collected from the air monitoring stations in Belluno. Generalized additive mixed models (GAMM) and visibility graphs were used to determine the effects of the short-term exposure to environmental agents on hospital admissions associated to COPD. In the case of the city of Belluno, the GAMM showed that hospital admissions were associated with NO2, PM10, date, and temperature, while for the city of Feltre, GAMM produced no associated variables. Several visibility graph indices (average edge overlap and interlayer mutual information) showed a significant overlap between environmental agents and hospital admission for both cities. Our study has shown that visibility graphs can be useful in establishing associations between environmental agents and COPD hospitalization in sparsely populated areas

Individual Circadian Preference, Eating Disorders and Obesity in Children and Adolescents: A Dangerous Liaison? A Systematic Review and a Meta-Analysis

Obesity and other eating disorders are an actual public health problem, especially in childhood and adolescents, and could be also related with chronotype. The aim of this systematic review was to determine the relationship between eating disorders, obesity and the different chronotypes in children and adolescents. Methods: A systematic review of observational studies evaluating young populations dealing with and evaluating chronotype was conducted. Electronic searches were performed in six international databases. A qualitative thematic-categorical analysis was carried out and a random-effects model was used for the quantitative analysis (meta-analysis). Results: Fifteen studies were included, but quantitative analysis was only carried out in three of them. Children and adolescents with an evening chronotype had higher body mass index, consumed more junk food or were more predisposed to suffer from food addiction and night eating syndrome. Conclusions: Children and adolescents with evening chronotype had higher tendency to incorrect eating behaviors and were suffering from overweight/obesity. Environment but also lifestyle factors should be considered in the association between chronotype and eating disorders and obesity

Mortality and critical conditions in COVID-19 patients at private hospitals: weekend effect?

OBJECTIVE: The aim of the study was to find factors associated with the mortality of admission to the intensive care unit (ICU) in patients with COVID-19. MATERIALS AND METHODS: Retrospective observational study with a database of 1987 patients with COVID-19 who had attended the emergency department of a private hospital network between February 2020 and April 2020 were analyzed. Clinical variables and some laboratory parameters were studied. The Charlson and Elixhauser comorbidity indices were calculated. The dependent variables were mortality and admission to the ICU. A descriptive and correlational analysis was performed. Logistic regression models and Kaplan-Meier survival curves were established. RESULTS: Positive correlations were observed between age, creatinine, and D-dimer levels, as well as with the scores obtained with the Charlson and Elixhauser indices. Differences in the levels of these parameters were also observed when analyzing variables such as mortality, sex or admission to the ICU. Mortality was associated with high creatinine and D-dimer levels and advanced age. Survival curves indicated longer survival in patients not admitted to the ICU, admitted to the hospital during the week, and in those with lower creatinine and D-dimer levels. CONCLUSIONS: Mortality in Spanish patients with COVID-19 admitted to private hospitals was associated with high creatinine and D-dimer levels and advanced age. Longer survival was obtained on weekdays. This study provides valuable information on the management and nursing care of these patients in order to optimize resources in pandemic situations.S

Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.32 million deaths in 2019. COPD management has increasingly become a major component of general and hospital practice and has led to a different model of care. Nurse-led interventions have shown beneficial effects on COPD patient satisfaction and clinical outcomes. This systematic review was conducted to identify and assess nurse-led interventions in COPD patients in terms of mental, physical, and clinical status. The review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The relevance of each manuscript was assessed according to the inclusion criteria, and we retrieved full texts, as required, to reach our conclusions. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Forty-eight articles were included in the analysis, which focused on the management of COPD patients by hospital, respiratory and primary nursing care. Nursing management was shown to be highly effective in improving quality of life, emotional state, and pulmonary and physical capacity in COPD patients. In comparison, hospital and respiratory nurses carried out interventions with higher levels of effectiveness than community nurses

Epinephrine in cardiac arrest: systematic review and meta-analysis

abstract Objective: evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method: systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results: when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion: administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status

Transferencia de los resultados de investigación al aula: registros de incidencias de las caídas

Background: Complete and correct records of fall events help to implement prevention measures. However, there is lack of knowledge among healthcare personnel about the existence of a recording system or the need to record such events. The purpose of this study was that the nursing students make quality records of the fall events, and consequently to develop and implement a system to record patient fall incidents (REOC) for use during the clinical practicums of nursing students. Method: Participatory action research (critical incident analysis) was carried out at a nursing school in southern Spain and its reference hospital. Among other variables, the implementation of the REOC (intervention), the complexity of records and the students’ learning outcomes were assessed. Results: The recording instrument had a significant impact on patients’ health outcomes. The REOC was of medium (42.9%) and low complexity (42.9%), while 71.4% acquired new skills through the implementation. Learning outcomes were of an average level in 71.5% of the cases and positive in 28.6%. Implications for Practice: The proposed project is an example of an innovation-research-innovation experience carried out in a teaching-learning setting using a cyclical knowledge transfer and feedback process.Antecedentes: Los registros completos y correctos de los eventos de caídas ayudan a implementar las medidas de prevención. Sin embargo, existe un desconocimiento entre el personal de salud sobre la existencia de un sistema de registro o la necesidad de registrar dichos eventos. El propósito de este estudio fue que los estudiantes de Enfermería realizaran registros de calidad de los eventos de caída y, en consecuencia, desarrollar e implementar un sistema de registro de incidentes de caída de pacientes (REOC) para su uso durante las prácticas clínicas de los estudiantes de enfermería. Método: La investigación-acción participativa (análisis de incidentes críticos) se llevó a cabo en una Facultad de enfermería del sur de España y su hospital de referencia. Entre otras variables, se evaluó la implementación del REOC (intervención), la complejidad de los registros y los resultados de aprendizaje de los estudiantes.Resultados: El instrumento de registro tuvo un impacto significativo en los resultados sanitarios de los pacientes. El REOC fue de complejidad media (42,9%) y baja (42,9%), mientras que el 71,4% adquirió nuevas habilidades a través de la implementación. Los resultados de aprendizaje fueron de nivel medio en el 71,5% de los casos y positivos en el 28,6%.Implicaciones para la práctica: El proyecto propuesto es un ejemplo de una experiencia de innovación-investigación-innovación llevada a cabo en un entorno de enseñanza-aprendizaje utilizando un proceso cíclico de transferencia de conocimientos y retroalimentación.