OBJECTIVETo adapt the ICU Mobility Scale (IMS) to the area of intensive care units (ICU) in Spain and to evaluate the metric properties of the Spanish version of the IMS (IMS-Es). METHODDescriptive ...metric study developed in two phases. Phase 1, adaptation to Spanish of the IMS by a team of nurses and physiotherapists (translation, pilot, backtranslation and agreement). Phase 2, analysis of metric properties (convergent, divergent and predictive validity, interobserver reliability, sensitivity and minimum important difference) of the IMS-Es. Patient characteristics (Barthel, Charlson, BMI, sex), sedation/agitation level (RASS), ICU and hospital stays, survival, quality of life (SF-12), muscle weakness (MRC-SS) and mobility (IMS-Es) were recorded in the patients of the MOviPre national multicentre study. RESULTSAfter obtaining the IMS-Es, it was implemented in 645 patients from 80 Spanish ICUs between April and June 2017. Convergent validity: moderate correlation between IMS-Es and MRC-SS (r=.389; P<.001) and significant comparison between groups with and without ICU-acquired weakness (P<.001). Divergent validity: no correlation between IMS-Es and BMI r (95%CI): -.112 (-.232 to .011), weight r (95%CI): -.098 (-.219 to .026), Charlson r (95%CI): -.122 (-.242 to .001) and Barthel r(95%CI): -.037 (-.160 to .087) and no differences between sexes (P=.587) or BMI categories (P=.412). Predictive validity: moderate and significant correlations with post-ICU hospital stay r (95%CI): -.442 (-.502 to -.377) and physical component of SF-12 (PCS) r (95%CI): .318 (.063 to .534); patients without active mobilisation in ICU increased risk of hospital mortality OR (95%CI): 3.769 (1.428 to 9.947). Interobserver reliability: very good concordance between nurses CCI (95%CI): .987 (.983 to .990) and nurse-physiotherapist CCI (95%CI): .963 (.948 to .974). Sensitivity to change: small effect on discharge from ICU (d=.273) and moderate effect at 3months after hospital discharge (d=.709). Minimal important difference: 2-point difference cut-off point, 91.1% sensitivity and 100.0% specificity. CONCLUSIONSThe IMS-Es is useful, valid and reliable for implementation by ICU nurses and physiotherapists in assessing the mobility of critical patients.
Does sedation practice delay time to extubation? Arias-Rivera, Susana; Sánchez-Sánchez, Mar; Sánchez-Izquierdo, Raquel ...
Intensive & critical care nursing,
12/2006, Letnik:
22, Številka:
6
Journal Article
Recenzirano
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.
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.
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.
Neurological status/level of sedation is a factor in the decision whether or not to perform a spontaneous breathing trial.
Ventilator-associated pneumonia (VAP) is a common complication in mechanically ventilated patients. Other infections related to the use of invasive devices, such urinary tract infections (UTI) and ...central venous catheter-related bloodstream infections are found in patients admitted in intensive care units (ICU). Selective digestive decontamination (SDD) is a set of manoeuvres (hygiene, topic digestive antimicrobials and short course of systemic antibiotics) aimed at decreasing the incidence of nosocomial infections, mainly VAP, in ICU. The objective of this study was to describe the impact of SDD in the rates of nosocomial infections in an 18-bed medical-surgical ICU.
All patients admitted in the ICU from October 1998 to September 1999 with expected mechanical ventilation for at least 72 h or with an illness where SDD has proven to be efficacious. The infection rates during this period were compared with the infection rates of the period without SDD (October 1997 to September 1998).
VAP rates decreased from 12.38 to 3.64 per 1000 days of mechanical ventilation (RR 0.3; CI 95%: 0.16 to 0.53). Urinary tract infection rates decreased form 7.70 to 4.51 per 1000 bladder-catheter days (RR 0.6. CI 95%: 0.37 to 0.93). Central venous catheter related bloodstream infections decreased from 5.92 to 2.73 per 1000 catheter days (RR: 0.5. CI 95%: 0.24 to 0.90). There was no emergence of resistant microorganims when SDD was used.
SDD reduces infection rates in ICU without any significant adverse events.
Arterial catheters are used to extract blood samples. To maintain its permeability we use heparin solution, which may contaminate and alter the desired results. Our aim was to determine the volume of ...the minimum discards during blood extractions to avoid results that might be altered in the analysis of biochemistry.
A prospective study was carried out in 18 beds intensive care unit. Patients with arterial catheter (Seldicath) were included, maintaining 500 UI of heparin in saline of 500 ml, at a pressure of 300 mmHg through pressurizer (Tycos). The dead space (DS) in the radial arterial system is 0.8 ml and 1 ml in the femoral. We analyzed the reliability of different discards comparing the following: 3 ml + DS, 7.5 ml + DS, 12 ml + DS and 16.5 ml + DS. The statistical analysis was carried out through ANOVA and t Student.
In biochemistry, significant differences were not found except for potasium (p< 0.001) with 3 ml+DS during control, although it is not clinically relevant difference through = 0.1 mEq/l (DS 0.2). Significant differences in prothrombina (p = 0.004) were found in coagulation, comparing 3 ml+DS and 16.5 ml + DS and in cefaline, comparing 7.5 ml + DS (p< 0.0001) and 16.5 ml + DS. There were not significant differences in the studies of gases.
Our study shows that to reach a reliable analytical results, it is not necessary to discard more than 3 ml+DS in biochemistry and in blood gases, and to determine cefalina time would necessary to discard a minimum of 7.5 ml+DS.
Using a metagenomic sequencing approach, we described and compared the diversity and dynamics of the oropharyngeal and fecal eukaryotic virome of nine asymptomatic children in a semi-rural community ...setting located in the State of Morelos, Mexico. Ninety oropharyngeal swabs and 97 fecal samples were collected starting 2 weeks after birth and monthly thereafter until 12 months of age. In both niches, more than 95% of the total sequence reads were represented by viruses that replicate either in humans or in plants. Regarding human viruses, three families were most abundant and frequent in the oropharynx: Herpesviridae, Picornaviridae, and Reoviridae; in fecal samples, four virus families predominated: Caliciviridae, Picornaviridae, Reoviridae, and Anelloviridae. Both niches showed a high abundance of plant viruses of the family Virgaviridae. Differences in the frequency and abundance of sequence reads and diversity of virus species were observed in both niches and throughout the year of study, with some viruses already present in the first months of life. Our results suggest that the children's virome is dynamic and likely shaped by the environment, feeding, and age. Moreover, composition analysis suggests that the virome composition is mostly individual. Whether this constant exposition to different viruses has a long-term impact on children's health or development remains to be studied.
Plant viruses have been reported to be common in the gut of human adults, presumably as result of food ingestion. In this work, we report that plant viruses can also be found frequently in the gut ...and oropharynx of children during their first year of life, even when they are exclusively breast-fed. Fecal and oropharynx samples were collected monthly, from birth to 1 year of age, from three apparently healthy children in a semi-rural community and analyzed by next generation sequencing. In 100% of the fecal samples and 65% of the oropharynx samples at least one plant virus was identified. Tobamoviruses in the Virgaviridae family were by far the most frequently detected, with tropical soda apple mosaic virus, pepper mild mottle virus, and opuntia tobamovirus 2 being the most common species. Seventeen complete virus genomes could be assembled, and phylogenetic analyses showed a large diversity of virus strains circulating in the population. These results suggest that children are continuously exposed to an extensive and highly diverse collection of tobamoviruses. Whether the common presence of plant viruses at an early age influences the infant's immune system, either directly or through interaction with other members of the microbiota, remains to be investigated.
The continuous release of pharmaceuticals from WWTP effluents to freshwater is a matter of concern, due to their potential effects on non-target organisms. The occurrence of pharmaceuticals in WWTPs ...and their associated hazard have been scarcely studied in Latin American countries. This study aimed at monitoring for the first time the occurrence of 70 pharmaceutical active compounds (PhACs) in WWTPs across Costa Rica; the application of the hazard quotient (HQ) approach coupled to ecotoxicological determinations permitted to identify the hazard posed by specific pharmaceuticals and toxicity of the effluents, respectively. Thirty-three PhACs were found, with 1,7-dimethylxanthine, caffeine, acetaminophen, ibuprofen, naproxen, ketoprofen and gemfibrozil being the most frequently detected (influents/effluents). HQ for specific pharmaceuticals revealed 24 compounds with high/medium hazard in influents, while the amount only decreased to 21 in effluents. The top HQ values were obtained for risperidone, lovastatin, diphenhydramine and fluoxetine (influent/effluent samples), plus caffeine (influent) and trimethoprim (effluent). Likewise, the estimation of overall hazard in WWTP samples (sum of individual HQ, ∑HQ) demonstrated that every influent and 96% of the effluents presented high hazard towards aquatic organisms. Ecotoxicological analysis (Daphnia magna, Lactuca sativa and Microtox test) revealed that 16.7% of the effluents presented toxicity towards all benchmark organisms; the phytotoxicity was particularly frequent, as inhibition values ≥20% in the germination index for L. sativa were obtained for all the effluents. The ∑HQ approach estimated the highest hazard in urban wastewater, while the ecotoxicological results showed the highest toxicity in hospital and landfill wastewater. Likewise, ecotoxicological results and ∑HQ values showed a rather poor correlation; instead, better correlations were obtained between ecotoxicological parameters and HQ values for some individual pharmaceuticals such as cephalexin and diphenhydramine. Findings from this study provide novel information on the occurrence of pharmaceuticals and the performance of WWTPs in the tropical region of Central America.
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•Occurrence of 70 pharmaceutical compounds in WWTPs in Costa Rica.•High hazard estimated in every influent and 96% effluents towards aquatic organisms.•Risperidone, lovastatin and diphenhydramine exhibited the highest hazard in influents/effluents.•Toxicity of 16.7% effluents towards all benchmark organisms experimentally tested.•Phytotoxicity (inhibition in seed germination test) particularly critical in effluents.
We recently carried out a metagenomic study to determine the fecal virome of infants during their first year of life in a semirural community in Mexico. A total of 97 stool samples from nine children ...were collected starting 2 weeks after birth and monthly thereafter until 12 months of age. In this work, we describe the prevalence and incidence of caliciviruses in this birth cohort. We found that 54 (56%) and 24 (25%) of the samples were positive for norovirus and sapovirus sequence reads detected by next-generation sequencing, respectively. Potential infections were arbitrarily considered when at least 20% of the complete virus genome was determined. Considering only these samples, there were 3 cases per child/year for norovirus and 0.33 cases per child/year for sapovirus. All nine children had sequence reads related to norovirus in at least 2 and up to 10 samples, and 8 children excreted sapovirus sequence reads in 1 and up to 5 samples during the study. The virus in 35 samples could be genotyped. The results showed a high diversity of both norovirus (GI.3P13, GI.5, GII.4, GII.4P16, GII.7P7, and GII.17P17) and sapovirus (GI.1, GI.7, and GII.4) in the community. Of interest, despite the frequent detection of caliciviruses in the stools, all children remained asymptomatic during the study. Our results clearly show that metagenomic studies in stools may reveal a detailed picture of the prevalence and diversity of gastrointestinal viruses in the human gut during the first year of life.
Human caliciviruses are important etiological agents of acute gastroenteritis in children under 5 years of age. Several studies have characterized their association with childhood diarrhea and their presence in nondiarrheal stool samples. In this work, we used a next-generation sequencing approach to determine, in a longitudinal study, the fecal virome of infants during their first year of life. Using this method, we found that caliciviruses can be detected significantly more frequently than previously reported, providing a more detailed picture of the prevalence and genetic diversity of these viruses in the human gut during early life.
The Omicron subvariant BA.1 of SARS-CoV-2 was first detected in November 2021 and quickly spread worldwide, displacing the Delta variant. In this work, a characterization of the spread of this ...variant in Mexico is presented.
The time to fixation of BA.1, the diversity of Delta sublineages, the population density, and the level of virus circulation during the inter-wave interval were determined to analyze differences in BA.1 spread.
BA.1 began spreading during the first week of December 2021 and became dominant in the next three weeks, causing the fourth COVID-19 epidemiological surge in Mexico. Unlike previous variants, BA.1 did not exhibit a geographically distinct circulation pattern. However, a regional difference in the speed of the replacement of the Delta variant was observed.
Viral diversity and the relative abundance of the virus in a particular area around the time of the introduction of a new lineage seem to have influenced the spread dynamics, in addition to population density. Nonetheless, if there is a significant difference in the fitness of the variants, or if the time allowed for the competition is sufficiently long, it seems the fitter virus will eventually become dominant, as observed in the eventual dominance of the BA.1.x variant in Mexico.
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