Prevalencia de diarrea en las unidades de pacientes en estado crítico de España: estudio multicéntrico

Abstract

Introduction Diarrhea is a frequent complication in patients admitted to intensive care and nursing consumes a significant percentage of time for them. Although this is a common condition, the exact size of the problem is unknown. The main objective of this study has been to determine the prevalence of diarrhea in hospitalized patients in critical care units (CCU)in Spain. Method An observational, cross-sectional, prospective and multicenter study including the month of April 2008 on patients in CCUs. Variables recorded were age, gender, diagnosis, severity (Apache II, Sofa), stool frequency and consistency, skin condition, pressure ulcer risk scale according to Norton, average time for hygiene, mortality, associated treatments, diet, mortality. Statistical analysis method: SPSS 14.00. Results Twenty-five critical care units, to which 2,114 patients were admitted, participated. 162 questionnaires corresponding to different diarrhea episodes of 141 patients were received. Mean prevalence was 6.4% (range 0.01%-30%). Age 59 ± 14.6 years, 56.7% men. Principal medical diagnoses: Patients with respiratory condition 36 (25.5%), patients with sepsis and multi-organ failure 26 (18.4%) postoperatory patients with varied etiology 21 (14.9%), subarachnoid hemorrhage 15 (10.6%), heart patients 13 (9.2%), polytraumatized patients 12 (8.5%), severe pancreatitis 10 (7.1%), autoimmune diseases 7 (5%) and others (0.7%). Apache II: 12.54 ± 9 (10). Admission Norton Scale: 9.38 ± 4 percent. Days of stay 15.9 ± 9.5, percentage of patients administered sedoanalgesia: 61.7% (we calculated the percentage of each medical treatment over the 162 episodes registered) (some patients received more than one medication simultaneously): morphine (25.5%), benzodiazepines (34.84%), propofol (33.3%), remifentanil (17%), inotropos (38.3%), antibiotics (93.2%), antifungals (41.3%), laxatives (21.6%), selective digestive decontamination (30.2%), enteral nutrition (67.3%), parenteral (24.1%), oral (24.7%). Average frequency of stools per day was 5.3. Consistency was liquid slurry in 59.3% and 40.7% of cases. 4.9% of patients had positive culture for Clostridium difficile. The skin condition was unchanged in 61.7% of cases, stage I lesions (17.9%), stage II lesion (13.6%), stage III lesion (3.7%) and stage IV (2.5%). Average time used for hygiene performed with the diarrhea was 2 h 45. Average staff involved was 14 nurses, 14 auxiliaries and 9 guards. To control diarrhea, medication was used (9.9%), pot (1.2%), diapers and absorbent pads (98.1%), fecal collection device (10.5%) and rectal probes (9.3%). Conclusions This study has allowed us to determine the prevalence of diarrhea in patients in critical care units. We were able to describe the characteristics of these patients and to establish the presence of skin lesions, the time spent by staff to handle this problem as well as materials used for management.