Critical Patient Unit Research Articles

Convalescent Plasma Therapy in Severe COVID-19: A Pilot Study at the Beginning of the Pandemic Outbreak in Southern Chile.

We designed a quasi-experimental study that included 156 patients with SARS-CoV-2 infection confirmed by RT-qPCR and severe symptoms who received CP. As a control group, we selected a historical cohort of 113 individuals admitted with COVID-19 and severe symptomatology before the starting date of the study. Clinical status and mortality during the study period were recorded. There were no adverse reactions to CP administration. In the CP group, days on mechanical ventilation were significantly lower than the control group (2.8±5.08 days vs. 4.7±6.19 days; p= 0.0081). Moreover, a significant difference was observed in the number of days stayed in the critical patient unit (CPU) in CP vs. controls (4.2±5.47 vs. 5.8±6.39 days, p= 0.0281). We observed no association between CP administration and survival at 14 days. Treatment with CP was safe and not associated with adverse events. In addition, using CP was associated with a reduction in both stay at the CPU and connection to mechanical ventilation.

Obesity Is Associated with Changes in Laboratory Biomarkers in Chilean Patients Hospitalized with COVID-19.

It is reported that patients with obesity are more frequently hospitalized for COVID-19, and evidence exists that obesity is a risk factor, regardless of other comorbidities. The objective of this study was to evaluate the association of obesity with changes in laboratory biomarkers in hospitalized Chilean patients. A total of 202 hospitalized patients (71 with obesity and 131 without obesity) with a diagnosis of COVID-19 were included in the study. Demographic, clinical, and laboratory (days 1, 3, 7, 15) data were obtained. We performed a statistical analysis, assuming significance with a value of p < 0.05. Significant differences in chronic respiratory pathology are observed between patients with and without obesity. The inflammatory markers CPR, ferritin, NLR, and PLR are elevated during the evaluated period, while changes in leukocyte populations are present on day 1 (eosinophils) and day 3 (lymphocytes). Finally, a persistent elevation of D-dimer level is observed, presenting significant differences on day 7 between patients with and without obesity. Obesity had a positive correlation with admission to the critical patient unit, invasive mechanical ventilation, and length of hospital stay. Patients with obesity hospitalized for COVID-19 present marked elevations of inflammatory and hemostasis parameters, with a correlation between obesity, changes in laboratory biomarkers, and the risk of adverse clinical outcomes also observed.

Experiences of the health care team in a critical patient unit during pandemic

Introduction: Since March 3, 2020, the SARS-COV-2 pandemic begins in Chile. Generating an impact to everyone and to different social groups, such as nursing and the health team, for the performance in the care of critical patients, impacting in different areas, such as physical and psychoemotional. Objective: To reveal the experiences of nurses and other members of the health team regarding the care of patients with SARS-COV-2 in an Adult Critical Patient Unit. Methodology: A qualitative phenomenological study was carried out in 12 people with questions that facilitate dialogue, with respective analysis in Atlas.ti. Results: Identifying three Metacategories; effects of the pandemic for nursing and other members of the health team, facilitating and hindering elements in nursing experiences and other members of the health team. Conclusion: There are nursing staff and a health team worn out as a result of direct care for critical patients, mainly in the physical and psycho-emotional aspect, without coping tools, not intervened and/or with late interventions. In addition, non-compliance with Law No. 16744, with low coverage in the Occupational Health and Safety Management System.

Potential Antioxidant Multitherapy against Complications Occurring in Sepsis.

Septic shock currently represents one of the main causes of mortality in critical patient units with an increase in its incidence in recent years, and it is also associated with a high burden of morbidity in surviving patients. Within the pathogenesis of sepsis, oxidative stress plays an important role. The excessive formation of reactive oxygen species (ROS) leads to mitochondrial damage and vasomotor dysfunction that characterizes those patients who fall into septic shock. Currently, despite numerous studies carried out in patients with septic shock of different causes, effective therapies have not yet been developed to reduce the morbidity and mortality associated with this pathology. Despite the contribution of ROS in the pathophysiology of sepsis and septic shock, most studies performed in humans, with antioxidant monotherapies, have not resulted in promising data. Nevertheless, some interventions with compounds such as ascorbate, N-acetylcysteine, and selenium would have a positive effect in reducing the morbidity and mortality associated with this pathology. However, more studies are required to demonstrate the efficacy of these therapies. Taking into account the multifactorial features of the pathophysiology of sepsis, we put forward the hypothesis that a supplementation based on the association of more than one antioxidant compound should result in a synergistic or additive effect, thus improving the beneficial effects of each of them alone, potentially serving as a pharmacological adjunct resource to standard therapy to reduce sepsis complications. Therefore, in this review, it is proposed that the use of combined antioxidant therapies could lead to a better clinical outcome of patients with sepsis or septic shock, given the relevance of oxidative stress in the pathogenesis of this multi-organ dysfunction.

MORTE ENCEFÁLICA: VIVÊNCIA DA EQUIPE DE SAÚDE JUNTO AOS PAIS DE CRIANÇAS E ADOLESCENTES

ABSTRACT Objective to understand the health team’s experience with parents of children and adolescents during the brain death protocol stages. Method a qualitative and exploratory research developed in two health institutions of high complexity and reference in the care of children and adolescents with polytrauma. Participants were health professionals from critical patient units. Data collection took place between October and December 2019 through semi-structured interviews. For content analysis, we used the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires as support. Results twenty-one professionals (physicians, nurses and nursing technicians) participated in the study. The general corpus consisted of 21 texts, separated into 123 segments, with the emergence of four classes. The study shows feelings of support and compassion at all brain death protocol stages. In the protocol opening stage, the team’s emotions are focused on the actions of clarifying and revealing information in this process, in addition to pointing out the need for the team to detail the step by step of the exams to be performed. In the communication of death stage, the feeling of being, caring for and welcoming the family relates to other feelings experienced by them. Conclusion the study reveals that the health team experiences unique feelings during the brain death protocol in the reality of children and adolescents, revealing the team’s concern with being with the family, paying attention and caring for the pain of loss.

Pediatric Multisystemic Inflammatory Syndrome Temporarily associated with COVID-19: Clinical characteristics and management in a Pediatric Critical Care Unit.

In April 2020, the pediatric multisystem inflammatory syndrome temporarily associated with COVID-19 (MIS-C) was described for the first time. MIS-C could have a severe course and may require critical care support. To describe the clinical, laboratory, and management characteristics of hospitalized children who meet MIS-C criteria with severe presentation in a pediatric critical pa tient unit. Descriptive prospective study of children with severe MIS-C mana ged by treatment phases with immunoglobulin and methylprednisolone, according to their clinical response. Epidemiological, clinical, laboratory and imaging data were obtained. Phenotypes were classified into Kawasaki and not Kawasaki, comparing their findings. 20 patients were analy zed, the median age was 6 years, 60% were female, and 40% presented comorbidity. SARS-CoV-2 was detected in 90% of the patients. They presented fever as the first symptom, followed by brief and early gastrointestinal symptoms (70%). 75% presented the Kawasaki phenotype. They evolved with lymphopenia, hypoalbuminemia, coagulation alterations, and elevated systemic and cardiac in flammatory parameters. 80% of the cases presented echocardiographic alterations and 90% shock that required critical care support. All the patients had a short and favorable evolution. All patients responded to the established therapy, but 40% required a second phase of treatment. There were no differences when comparing phenotypes. No deaths were reported. MIS-C is a new childhood disease whose presentation could be life-threatening. It requires early suspicion, immuno modulatory management, critical care support, and a multidisciplinary approach to obtain the best results and optimize its prognosis.

Profile of users receiving Speech-Language Therapy service at a Critical Patient Unit

ABSTRACT Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit. Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p&lt;0.05. Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary. Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.

Experiencia de reconversión de un servicio clínico anestésico-quirúrgico en unidad de pacientes críticos COVID-19 en un hospital universitario

Introduction: The experience of restructuring a clinical surgical-anesthetic unit into a critical patient unit in charge of surgical-anesthetic personnel is presented during the period from May to July 2020 in the context of a SARS-CoV-2 pandemic. Objectives: Describe the unit’s restructuring process, considering technical aspects, changes in staff functions, clinical outcomes of the patients, quality indicators obtained and the psychological impact on the healthcare team. Matherial and Methods: The strategies implemented by the responsible experts were described (ie: engineering). Clinical data were obtained from an institutional database and electronical medical records. The management of human resources was described using administrative records of the services of anesthesiology, OR and critical patient unit. The psychological impact on the unit staff was evaluated by applying the Maslach questionnaire. The quality of the clinical management of the unit was obtained from the compilation of standardized quality indicators for the critical patient units of the institution. Results: 25 patients were admitted in the unit. The mean age was 62 ± 12 years. About the complications, 52% had pulmonary embolism, 36% had acute kidney injury, and 1 patient died. The prevalence of Burnout Syndrome was 73.6%. The occurrence of adverse events was minimal. Discussion: The transformation of an anesthetic-surgical unit into a COVID critical patient one, demands a complex net of coordinated strategies to allow facing the attention demand with positive clinical results, at the expense of the health care team mental health. © 2021 Sociedad de Anestesiologia de Chile. All rights reserved.

Comparación entre uso y no uso de antibióticos profilácticos en pancreatitis aguda grave. Ensayo Clínico Aleatorizado. Reporte preliminar.

Introducción: La pancreatitis aguda es una enfermedad frecuente en el país, con una tasa de mortalidad de 10-30%. La administración profiláctica de antibióticos ha sido parte del tratamiento de pancreatitis aguda grave (PAG), por la teórica prevención de complicaciones infecciosas y reducción de mortalidad. Sin embargo, la evidencia científica disponible es controversial.Objetivo: Demostrar que los antibióticos profilácticos no disminuyen las complicaciones locales y/o sistémicas, requerimiento de UPC, ni mortalidad en PAG. Definimos PAG como APACHE II ≥ 8 o PCR ≥150 o falla multiorgánica.Material y método: Ensayo clínico aleatorizado, con aleatorización simple mediante tabla electrónica (uso o no uso de antibióticos profilácticos) de pacientes con PAG. En el grupo que usó antibióticos profilácticos se utilizó ciprofloxacino y metronidazol por 7 días. El resto del manejo no tuvo variación.Resultados: n= 71, dos grupos aleatorizados; Grupo 1 (n=35), sin uso de antibióticos profilácticos, y grupo 2 (n=36) con uso de profilaxis antibiótica. 12 pacientes (16%) requirieron UPC; 6 pacientes del grupo 1, y 6 del grupo 2 (p=0,957). Siete pacientes (9,8%) tuvieron algún tipo de complicación, 3 en el grupo 1 y 4 en el grupo 2 (p=0,516). El promedio de estancia hospitalaria fue 18,2 ± 9,5 días en el grupo 1, y 22,6 ± 29.2 días en el grupo 2 (p=0,495). Mortalidad: 1 paciente (1,41%) en el grupo 2 (p= 0,493).Conclusión: En este reporte preliminar, el uso de antibióticos profilácticos en PAG no mostró reducir las complicaciones, necesidad de cama en UPC, ni la mortalidad.

NURSING PROFESSIONALS AND ADVERSE EVENT REPORTING

ABSTRACT Objective: to identify how nurses report adverse events; to know what elements influence adverse event reporting and which reporting strategies they suggest. Method: qualitative study with a convergent care research design, conducted in a critical patient unit of a private health center in the region of Magallanes, Chile. Thirteen nurses participate in the study, through interviews and a discussion group. Results: the nurses who report adverse events do so verbally and in writing to the nurse coordinator immediately. Failure to report adverse events is mainly due to lack of knowledge of the safety culture, fear of reprisals and punishment within the workplace. As adverse event reporting strategies, they suggest continuing education about the safety culture, raising awareness and trust in that error reporting will not be met with punishment and that the error will lead to an improvement plan that avoids committing the same error on another occasion, improving communication and leadership. Conclusion: although nurses report adverse events, they are concerned with punishment, indicating the need to review the patient safety culture at a critical care unit in the study context.

PERCEPCIONES DE LOS PROFESIONALES DE ENFERMERÍA SOBRE SU ROL EN LA VOLUNTAD ANTICIPADA

Las Voluntades Anticipadas son una forma de defensa de la autonomía y dignidad de los usuarios en el final de la vida. En Chile, no existen leyes que la validen, por lo cual los enfermeros toman especial relevancia por ser quienes otorgan cuidados en todo el ciclo vital. &#x0D; Objetivo: Conocer la percepción de los profesionales de enfermería de una Unidad de Paciente Crítico sobre su rol en la voluntad anticipada en el final de la vida. &#x0D; Metodología: Estudio cualitativo, paradigma post positivista con enfoque de estudio de caso. Realizado entre Octubre y Noviembre del 2017. Se logró la saturación teórica mediante la realización de 6 entrevistas de tipo semiestructuradas. Se utilizó análisis de contenido. &#x0D; Resultados: Ningún profesional de enfermería manejaba el concepto, sin embargo, varios lograban identificar elementos vinculados a la temática. Además, se identificó un escaso abordaje del tema durante la formación de pre y postgrado y la necesidad sentida de ampliar los conocimientos. Algunos asociaron el rol con la educación y apoyo, otros no lograron identificar la vinculación. Se evidenciaron algunas prácticas que apuntan a respetar las voluntades de las personas, con diversas disyuntivas en el proceso. &#x0D; Conclusión: Falta un largo camino por recorrer en cuanto al respeto de las preferencias de las personas al final de la vida, y para lograrlo es esencial el aumentar el conocimiento que poseen los enfermos sobre la temática. Posteriormente, es importante el establecer claramente su forma de aplicación y estrategias para facilitar el proceso, además de incorporarlo en el lenguaje cotidiano.

REFLEXIONES SOBRE EL COMPROMISO DE PALABRA Y EL DESARROLLO DE LA ESPECIALIDAD PEDIÁTRICA EN EL HOSPITAL CLÍNICO DE LA UNIVERSIDAD DE CHILE

El Hospital Clínico de la Universidad de Chile declara su misión de otorgar soluciones integrales de salud a la comunidad. La medicina pediátrica debería ser parte activa de esta declaración. Sin embargo, en los últimos 2 años, el progreso en el proyecto de desarrollo pediátrico, representado por la puesta en marcha de la Unidad de Paciente Crítico Pediátrico del Servicio de Pediatría, ha sido mínimo. &#x0D; Esto ¿es sólo una involuntaria omisión directiva? o ¿la medicina pediátrica no pertenece realmente a esta institución? Hemos decidido realizar una reflexión a partir de los hechos que nos presenta la historia y los acontecimientos recientes. Nuestras interrogantes son: ¿ha existido un desarrollo conjunto de la Universidad de Chile a través de su hospital clínico y la medicina pediátrica? ¿De qué forma? ¿Cómo se ha manifestado? &#x0D; Buscamos la respuesta en antecedentes históricos, acontecimientos recientes e intentamos definir si hay compromisos pendientes para fortalecer dicho desarrollo conjunto. Desde sus inicios, la historia del hospital ha mantenido una relación con la atención de los niños enfermos. Una relación difícil, con muchas adversidades pero donde ha sobresalido el esfuerzo, la tenacidad, el compromiso y la excelencia de médicos pediatras que han luchado por una medicina y una universidad de carácter asistencial, docente y social. &#x0D; En lo reciente, la Universidad de Chile y su Hospital Clínico reconocen, apoyan y explicitan públicamente que la medicina pediátrica es parte de su historia y que debe seguir en ella. La apertura de una Unidad de Paciente Crítico Pediátrico es un compromiso pendiente que permitiría mejorar la experiencia clínica en pacientes complejos, así como incorporarse progresivamente a la formación de subespecialistas pediátricos en cuidados intensivos y consolidar lo realizado hasta ahora. &#x0D; La medicina pediátrica es una realidad existencial que es necesario reconocer y fortalecer, y a la cual sólo cabe una alternativa: dar cumplimiento a los compromisos pendientes.

Carga mental de trabajo en enfermeras/os de unidades de paciente crítico: estudio piloto

Objetivo: determinar la percepción de carga mental de trabajo en los enfermeros/as de una unidad de pacientes críticos de un Hospital Regional en Chile. Material y método: estudio con diseño descriptivo, trasversal y exploratorio. Se censó a 10 enfermeras/os que se desempeñan en un turno de la Unidad de Pacientes Críticos de un Hospital Regional de Chile. Para recopilar los datos se utilizaron dos instrumentos: Escala Subjetiva de Carga Mental de Trabajo y Antecedentes biopsicosociodemográficos. Para la realización de este estudio se consideraron los requisitos éticos de E. Emanuel. Resultados: en promedio 3,8 (D.E= 0.66) los trabajadores/as de la UPC participante de este estudio, perciben sobrecarga mental al realizar su trabajo. Conclusión: la sobrecarga mental de trabajo, pudiera generar consecuencias en su salud física y mental de los enfermeros/as participantes, por lo que es prioritario tomar medidas tendientes a mantener una carga mental adecuada.

High prevalence of CTX-M-1 group in ESBL-producing enterobacteriaceae infection in intensive care units in southern Chile

Enterobacteria-producing extended-spectrum β-lactamases (ESBL) play an important role in healthcare infections, increasing hospitalization time, morbidity and mortality rates. Among several ESBLs that emerge from these pathogens, CTX-M-type enzymes had the most successful global spread in different epidemiological settings. Latin America presents high prevalence of CTX-M-2 in ESBL-producing enterobacterial infections with local emergence of the CTX-M-1 group. However, this high prevalence of the CTX-M-1 group has not yet been reported in Chile. The aim of this study was to identify ESBLs among enterobacteria isolated from clinical samples of critically ill patients from southern Chile. One-hundred thirty seven ESBL-producing bacteria were isolated from outpatients from all critical patient units from Hernán Henríquez Aravena Hospital. Phenotype characterization was performed by antibiogram, screening of ESBL, and determination of minimum inhibitory concentration (MIC). PCR was used for genetic confirmation of resistance. Molecular typing was performed by ERIC-PCR. ESBL-producing isolates were identified as Klebsiella pneumoniae (n=115), Escherichia coli (n=18), Proteus mirabilis (n=3), and Enterobacter cloacae (n=1), presenting multidrug resistance profiles. PCR amplification showed that the strains were positive for blaSHV (n=111/81%), blaCTX-M-1 (n=116/84.7%), blaTEM (n=100/73%), blaCTX-M-2 (n=28/20.4%), blaCTX-M-9 (0.7%), blaPER-1 (0.7%), and blaGES-10 (0.7%). The multiple production of ESBL was observed in 93% of isolates, suggesting high genetic mobility independent of the clonal relationship. The high frequency of the CTX-M-1 group and a high rate of ESBL co-production are changing the epidemiology of the ESBL profile in Chilean intensive care units. This epidemiology is a constant and increasing challenge, not only in Chile, but worldwide.

LIMITACIÓN DEL ESFUERZO TERAPÉUTICO: EXPERIENCIAS DE ENFERMERAS EN UNA UNIDAD DE CUIDADOS INTENSIVOS

El proposito de este estudio fue comprender como es la experiencia de las enfermeras en cuanto a vivenciar la limitacion del esfuerzo terapeutico (LET) en unidades de paciente critico de un hospital publico de la region de Valparaiso. Se opta por un estudio de tipo cualitativo, de trayectoria fenomenologica, se realizo entrevista en profundidad a 3 enfermeras, con la pregunta orientadora ?Que experiencia tiene usted como enfermera de Unidad de Cuidados Intensivos (UCI) con respecto a la LET? Los discursos fueron interpretados bajo el referencial de Fenomeno Situado de Joel Martins. En los relatos se evidencia el uso de las palabras “manejo proporcional” como sinonimo, el rol de enfermeria es confuso en la toma de decision respecto a la LET pero se releva al momento del cuidado al final de la vida. Se concluye que las enfermeras son quienes deben asumir un rol mas protagonico en el cuidado de la persona en esta situacion, participando activamente en la toma de decisiones del binomio familia-paciente. Se recomienda la creacion de protocolos para la LET, detallando la defnicion de la LET junto con el rol de enfermeria y del equipo de salud, con el objetivo de no prolongar la vida innecesariamente, no aumentar la esperanza familiar y asegurar el cuidado al final de la vida.

Validity of scales for the functional assessment of critically ill patients

The decrease in mortality in critical patient units led to an increase in intensive care unit acquired weakness (ICUAW), which significantly affects the functional performance and quality of life of patients. There are several scales that measure functionality in critical patients. The aim of this systematic review is to determine the criterion validity and reliability of the scales that evaluate functionality in critically ill adult patients. We considered studies in critically ill adult subjects of both genders that determined the psychometric properties of the scales that evaluate functionality. Six minutes' walk test (6MWT), timed up and go (TUG), the Medical Research Council sum score (MRC-SS), grip strength, discharge destination and need for rehabilitation at discharge were considered as gold standards. Three scales were identified: PFIT-s, Perme MS, and DEMMI. PFIT-s has a positive correlation with 6MWT, MRC-SS and grip strength, and a negative correlation with TUG. It also predicts the need for rehabilitation at discharge and discharge to the home. DEMMI has a positive correlation with MRC-SS. the interobserver reliability was evaluated in three articles, demonstrating an almost perfect association. The intraobserver agreement was considered good in one report. With this information, it is not possible to determine which is the instrument with better measurement properties.

Manejo del paciente disfágico por técnicos paramédicos: evaluación y capacitación en un hospital chileno

The aim of this article is to present the results of an analytical study in the management of patients with dysphagia by paramedics at San Juan de Dios Hospital in Santiago, Chile, and the development of skills after the implementation of a training program. First of all, a survey validated by three speech therapists was applied to determine the level of knowledge and suitability of 145 paramedics of the Critical Patient Unit, Surgery and Medicine. This survey found that 61% had a “non-desirable” management in patients, and 39% a “middle” level. Secondly, they participated in a 3-days theoretical and practical program, which lasted 21 hours. The classes were taught by an interdisciplinary team that attend the pathology (Doctor, Nurse, Speech Therapist, Physiotherapist, Occupational Therapist and Nutritionist), where at the end they were re-applied the survey to determine the new data by statistical analysis. After the intervention, 57% achieved a “desirable” level, 41% a “middle” level, while only 2% a “non-desirable” level. In conclusion, the technical training of paramedics does not provide them with the necessary tools for the management of patients with dysphagia; therefore, it is the health institution’s work to train them in order to avoid risks in patients.

Physician's adherence to medical indications for invasive procedures in the critical care unit of a university hospital

Physicians' adherence to pre-established criteria for the indication and/or maintenance of invasive devices is a weak point in infection control programs. Fulfillment of the recommendations for preventing infections associated with invasive devices is essential to reduce their risk. To assess the adherence of physicians to the standardized criteria for indication of central venous catheter (CVC) and permanent urinary catheter (PUC) and to the application of supervision guidelines. During a period of 7 months, residents of the Critical Patient Unit monitored the adherence to criteria for indication of CVC and PUC recorded in patients' medical records. This information was compared with current regulations to assess compliance. Between April and September 2009, 2078 supervision guidelines were applied. Invasive devices were identified in 47.7%. 10.4% of CVCs and 19.2% of PUCs did not meet criteria for installation and / or maintenance at the time of monitoring. Adherence of our medical staff to criteria for installation and /or maintenance of CVC and CUP should be improved. Monitoring can be efficiently performed by residents and could reduce infections associated with invasive procedures.

Modelos de Enfermería en Unidades de Paciente Crítico: un paso hacia el cuidado avanzado

This article aims to reflect on the use of nursing models in critical patient units in Chile, in order to provide advanced care in these units. The advanced nursing care is based on the use of nursing models in clinical practice to enable delivery of quality care with nursing theoretical support. Critical patient units are units that are related to nursing care focused on the task, in the management of technology and routine activities. In this scenario it is necessary to identify nursing models that can be implemented in these units and thus be a step toward advanced nursing care in critical patient units.

Infecciones asociadas a la atención en salud (IAAS) en pacientes pediátricos post-operados de cardiopatías congénitas

Nosocomial infections generate high morbidity and mortality in children undergoing cardiac surgery. To determine risk factors for nosocomial infections in children after congenital heart surgery. A retrospective case-control study, in patients younger than 15 years undergoing surgery for congenital heart disease from January 2007 to December 2011 admitted to the Pediatric Critical Patient Unit (UPC-P) in a university hospital. For cases, the information was analyzed from the first episode of infection. 39 patients who develop infections and 39 controls who did not develop infection were enrolled. The median age of cases was 2 months. We identified a number of factors associated with the occurrence of infections, highlighting in univariate analysis: age, weight, univentricular heart physiology, complexity of the surgical procedure according to RACHS-1 and cardiopulmonary bypass (CPB) time ≥ 200 minutes. Multivariate analysis identified CPB time ≥ 200 minutes as the major risk factor, with an OR of 11.57 (CI: 1.04 to 128.5). CPB time ≥ 200 minutes was the mayor risk factor associated with the development of nosocomial infections.