Abstract
Aim
To translate and culturally adapt the FRAIL scale into Spanish and perform a preliminary test of diagnostic accuracy in patients admitted to intensive care units.
Design
Cross‐sectional ...diagnostic study.
Methods
Five intensive care units (ICU) in Spain were participated. Stage 1: Three native Spanish‐speaking bilingual translators familiar with the field of critical care translated the scale from English into Spanish. Stage 2: Three native English‐speaking bilingual translators familiar with critical care medicine. Stage 3: Authors of the original scale compared the English original and back‐translated versions of the scale. Stage 4: Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the comprehension and relevance of each of the items of the Spanish version in 30 patients of 3 different age ranges (<50, 50–65 and >65 years).
Results
The FRAIL scale was translated and adapted cross‐culturally for patients admitted to intensive care units in Spain. The process consisted of four stages: translation, back translation, comparison and pilot test. There was good correspondence between the original scale and the Spanish version in 100% of the items. The participating patients assessed the relevance (content validity) and comprehensibility (face validity) of each of the items of the first Spanish version. The relevance of some of the items scored low when the scale was used in patients younger than 65 years.
Conclusions
We have cross‐culturally adapted the FRAIL scale, originally in English, to Spanish for its use in the critical care medical setting in Spanish‐speaking countries.
Implications for Professionals
Physicians and nurses can apply the new scale to all patients admitted to the intensive care units. Nursing care can be adapted according to frailty, trying to reduce the side effects of admission to these units for the most fragile patients.
Reporting Method
The manuscript's authors have adhered to the EQUATOR guidelines, using the COSMIN reporting guideline for studies on the measurement properties of patient‐reported outcome measures.
Patient or Public Contribution
In a pilot clinical study, we applied the first version of the FRAIL‐Spain scale to intensive care unit (ICU) patients. Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the relevance (content validity) and comprehensibility (face validity) of the five items of the first Spanish version. Relevance was assessed using a 4‐point Likert scale ranging from 1 (no relevance) to 4 (high relevance), and comprehensibility was assessed as poor, acceptable or good. Each health professional applied the scale to three patients (total number of patients = 30) of three different age ranges (<50, 50–65 and >65 years) and recorded the time of application of the scale to each patient. Although the frailty scales were initially created by geriatricians to be applied to the elders, there is little experience with their application in critically ill patients of any age. Therefore, more information is needed to determine the relevance of using this scale in critical care patients. In this pilot study, we considered that nurses and critical care physicians should evaluate frailty using this adapted scale in adult patients admitted to the Intensive Care Units.
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to ...Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organisation (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the intensive care services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.
En enero de 2020 China identificó un nuevo virus de la familia de los Coronaviridae como causante de varios casos de neumonía de origen desconocido. Inicialmente confinado a la ciudad de Wuhan, se extendió posteriormente fuera de las fronteras chinas. En España, el primer caso se declaró el 31 de enero de 2020. El 11 de marzo, la Organización Mundial de la Salud declaró el brote de coronavirus como pandemia. El 16 de marzo había 139 países afectados. Ante esta situación, las Sociedades Científicas SEMICYUC y SEEIUC han decidido la elaboración de este plan de contingencia para dar respuesta a las necesidades que conllevará esta nueva enfermedad. Se pretende estimar la magnitud del problema e identificar las necesidades asistenciales, de recursos humanos y materiales, de manera que los servicios de medicina intensiva del país tengan una herramienta que les permita una planificación óptima y realista con que responder a la pandemia.
Programa Doctorat de "Medicina", línia Fisiopatologia de les Malalties Medicoquirúrgiques, grup de recerca Malalt Crític i Emergències.
Antecedents del tema
Posteriorment a l’estudi de Van den ...Berghe, es van anar aplicant a les diferents UCI’s els protocols de Intensive Insulin Therapy (IIT, insulinoteràpia intensiva) en base a la disminució de la morbimortalitat en pacients tractats amb IIT respecte el tractament amb Conventional Insulin Therapy (CIT, insulinoteràpia subcutània convencional amb sliding-scales). Els protocols de IIT van comportar un increment de la incidència d’hipoglicèmia greu, que es va relacionar amb la mortalitat, a l’igual que la variabilitat de la glicèmia. Cal considerar l’extracció de mostres de sang a través del catèter arterial, per evitar les puncions capil•lars de repetició per l’anàlisi de la glicèmia.
Objectius
Analitzar la hipoglicèmia, hiperglicèmia i variabilitat de la glicèmia en pacients tractats amb dos protocols diferents de IIT vs CIT, en funció del tipus de mostra utilitzada per l’anàlisi de la glicèmia. Avaluar les complicacions associades al catèter arterial quan s’utilitza per l’extracció horària de mostres de sang, comparant dos tipus de circuits arterials diferents. Analitzar la fiabilitat dels valors de glicèmia obtinguts de sang arterial i glucòmetres portàtils (POC).
Metodologia
Article 1: estudi descriptiu de la prevalença de hipoglicèmia greu (<50 mg/dL) i moderada (entre 50-80 mg/dL) associada al tipus de insulinoteràpia, i segons tipus de mostra utilitzada per l’anàlisi, sempre amb POC. Article 2: estudi prospectiu de cohorts amb dos períodes d’estudi: període 1, protocol IIT amb rang de control glicèmic estricte (110-140 mg/dL) vs període 2, IIT amb rang més laxe (140-180 mg/dL) comparant la incidència d’hipoglicèmia, hiperglicèmia (> 216 mg/dL) i variabilitat de la glicèmia entre protocols IIT i CIT. Article 3: assaig clínic obert a 90 pacients portadors de catèter arterial radial randomitzats a circuit arterial xeringa vs connector clau (needleless). Les glicèmies obtingudes de sang arterial i punció capil•lar amb POC es van comparar amb les obtingues de sang venosa i anàlisi al laboratori de l’hospital.
Resultats
En l’article 1, es van analitzar 6636 glicèmies de 144 pacients crítics. Es van detectar més hipoglicèmies moderades en sang arterial que per punció capil•lar (4,5% vs 2,8%; P = 0,014). No es van trobar diferències en el nombre d’hipoglicèmies entre IIT vs CIT al comparar només glicèmies obtingudes per punció capil•lar (2,3% vs 2,8%; P = 0,213). Hipoglicèmia greu igual en ambdós tractaments. En l’article 2: es van estudiar 221 pacients, amb 12825 valors de glicèmia. La hipoglicèmia es va relacionar amb ingesta nutricional discontínua, rang de control glicèmic de 110-140 mg/dL i IMC baix (P = 0,002). La hiperglucèmia es va relacionar exclusivament amb l’antecedent de diabetis mellitus (OR 2,6 IC95% 1,6-4,5). La variabilitat de la glicèmia es va relacionar amb una ingesta nutricional discontínua, IMC baix, insulinització amb CIT, ser diabètic, edat avançada i APACHE II elevat (P < 0,001). En l’article 3, cap dels 90 pacients randomitzats va presentar bacterièmia per catèter arterial (12776 manipulacions) en comparació al grup control (0,38 episodis x 1000 catèters/dia, 13075 manipulacions). Les complicacions del catèter no foren significatives en cap de les branques. La glicèmia obtinguda de sang arterial i POC fou igual de fiable que l’obtinguda per sang venosa i anàlisi al laboratori excepte quan l’hematòcrit era < 25%.
Conclusions
Els protocols de IIT són efectius per disminuir la variabilitat de la glicèmia i controlar la hiperglicèmia en comparació a la CIT. Un rang òptim de 110-140 mg/dL és segur sense augmentar la incidència d'hipoglicèmia greu (< 50 mg/dL). El nombre d'hipoglicèmies moderades (entre 50-80 mg/dL) és major respecte el tractament amb CIT, però només es detecten quan s'utilitzen mostres de sang arterial per l'anàlisi de la glicèmia. Per aquest motiu, caldria utilitzar el catèter arterial per l'extracció horària de les mostres de sang arterial, ja que l'alta freqüència en la manipulació del catèter i la reintroducció del volum de rebuig per evitar l'anèmia iatrogènica, no incrementa les complicacions associades al catèter.
Background
Van den Berghe reported lower morbidity and mortality rates with Intensive Insulin Therapy (IIT) than with sliding-scale, Conventional Insulin Therapy (CIT). Intensive care units implemented IIT protocols, and severe hypoglycemia incidence (associated with mortality, as was glycemic variability) increased. Frequent glycemia testing is needed; drawing blood from arterial catheters is preferable to repeated fingersticks. However, accuracy of each method requires analysis.
Objectives
To analyze hypoglycemia, hyperglycemia, and glucose variability incidence in two patient groups treated with different IIT protocols vs CIT, based on sample type (arterial or fingerstick). To evaluate complications associated with hourly arterial catheter handling, comparing two types of arterial setup. To assess the accuracy of glycemia values obtained from arterial blood samples using point-of-care (POC) glucometers.
Methodology
Article 1: descriptive study of severe (<50 mg/dL) and mild (50-80 mg/dL) hypoglycemic events by type of insulin therapy and type of blood sample analyzed at POC.
Article 2: two-level prospective cohort study: IIT protocol with strict glycemic control (110-140 mg/dL) vs IIT with higher range (140-180 mg/dL), comparing hypoglycemia, hyperglycemia (>216 mg/dL), and glucose variability index for IIT protocols and CIT.
Article 3: open clinical trial; 90 patients with radial arterial catheter, randomized to an arterial circuit with a syringe or needleless setup. Glycemia values in POC analysis of arterial and fingerstick blood were compared with venipuncture samples analyzed by the hospital laboratory (gold standard).
Results
Article 1: 6636 glycemias, 144 critical patients. Moderate hypoglycemia was more frequent in arterial than fingerstick samples (4.5% vs 2.8%; P=0.014), with no differences between IIT and CIT in number of hypoglycemias in fingerstick samples (2.3% vs 2.8%; P=0.213) or in severe hypoglycemias.
Article 2: 12,825 glycemias, 221 patients. Hypoglycemia was related to nutritional disruption, glycemic range 110-140 mg/dL and low body mass index (BMI) (P=0.002). Hyperglycemia was related only to history of diabetes mellitus (OR 2.6 95%CI 1.6-4.5). Glucose variability was related to nutritional disruption, low BMI, CIT, diabetes, age, and high APACHE II (P<0.001, all).
Article 3: 90 patients, randomized. No bacteremia in 12776 catheter manipulations; control group had 0.38 episodes x1000 catheter-day in 13075 manipulations. Catheter-related complications were nonsignificant. Glycemic values in arterial blood (POC) did not differ from gold standard results except when hematocrit was <25%.
Conclusions
Both IIT protocols produced lower glucose variability and controlled hyperglycemia better than CIT. Blood glucose target of 11-140 mg/dL was accurate without increasing severe hypoglycemia incidence. Mild hypoglycemia was more frequent in arterial blood, compared to CIT. Arterial catheters are preferable for hourly blood extractions; frequent handling and reintroduction of clearing volume to avoid iatrogenic anemia did not increase catheter-related complications.
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