array:24 [
  "pii" => "S2173572719300712"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2019.01.006"
  "estado" => "S300"
  "fechaPublicacion" => "2019-05-01"
  "aid" => "1306"
  "copyright" => "Elsevier España, S.L.U. and SEMICYUC"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Med Intensiva. 2019;43:195-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 304
    "formatos" => array:3 [
      "EPUB" => 66
      "HTML" => 140
      "PDF" => 98
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S021056911930018X"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2019.01.002"
      "estado" => "S300"
      "fechaPublicacion" => "2019-05-01"
      "aid" => "1306"
      "copyright" => "Elsevier España, S.L.U. y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Med Intensiva. 2019;43:195-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1318
        "formatos" => array:3 [
          "EPUB" => 122
          "HTML" => 754
          "PDF" => 442
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Pr&#225;cticas de analgosedaci&#243;n y delirium en las UCI espa&#241;olas"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "195"
            "paginaFinal" => "196"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Analgosedation and delirium practices in Spanish ICUs"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "N&#46; Nin Vaeza"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Nin Vaeza"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572719300712"
          "doi" => "10.1016/j.medine.2019.01.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300712?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056911930018X?idApp=WMIE"
      "url" => "/02105691/0000004300000004/v4_201907180823/S021056911930018X/v4_201907180823/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572719300566"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2019.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "1193"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2019;43:197-206"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 348
      "formatos" => array:3 [
        "EPUB" => 66
        "HTML" => 157
        "PDF" => 125
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Conventional monitoring is not sufficient to assess respiratory effort during assisted ventilation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "197"
          "paginaFinal" => "206"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La monitorizaci&#243;n convencional no es suficiente para valorar el esfuerzo respiratorio durante la ventilaci&#243;n asistida"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 3389
              "Ancho" => 2420
              "Tamanyo" => 293303
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Linear regression analysis and 95&#37; confidence interval with Bland&#8211;Altman diagram&#58; mean difference between the two signals and limits of agreement &#40;confidence interval&#41;&#46;</p> <p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Delta Pe-Pmus&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Ruiz Ferr&#243;n, J&#46;M&#46; Serrano Sim&#243;n"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Ruiz Ferr&#243;n"
            ]
            1 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Serrano Sim&#243;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S021056911830069X"
        "doi" => "10.1016/j.medin.2018.02.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056911830069X?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300566?idApp=WMIE"
    "url" => "/21735727/0000004300000004/v2_201905020913/S2173572719300566/v2_201905020913/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217357271930061X"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2018.09.011"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "1268"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Med Intensiva. 2019;43:193-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 377
      "formatos" => array:3 [
        "EPUB" => 67
        "HTML" => 215
        "PDF" => 95
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Tell me what you need&#46; I hear you"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "193"
          "paginaFinal" => "194"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "D&#237;game qu&#233; necesita&#46; Le escucho"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "&#193;&#46; Alonso-Ovies, G&#46; Heras la Calle"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "&#193;&#46;"
              "apellidos" => "Alonso-Ovies"
            ]
            1 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Heras la Calle"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569118302638"
        "doi" => "10.1016/j.medin.2018.09.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118302638?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271930061X?idApp=WMIE"
    "url" => "/21735727/0000004300000004/v2_201905020913/S217357271930061X/v2_201905020913/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Analgosedation and delirium practices in Spanish ICUs"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "195"
        "paginaFinal" => "196"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "N&#46; Nin Vaeza"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "N&#46;"
            "apellidos" => "Nin Vaeza"
            "email" => array:1 [
              0 => "niconin&#64;hotmail&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Coordinador de la Unidad de Cuidados Intensivos&#44; Hospital Espa&#241;ol&#44; Montevideo&#44; Uruguay"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Pr&#225;cticas de analgosedaci&#243;n y delirium en las UCI espa&#241;olas"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Assessing the practices of analgesia&#44; sedation&#44; and delirium in intensive care units &#40;ICUs&#41; is essential for the analysis and improvement of this commonly used process that happens to be one of the most important among critically ill patients&#46; Among the recommendations for the management of critically ill patients established by the SEMICYUC Work Groups the four recommendations made on this topic were&#58; having one analgosedation protocol available at the ICUs&#44; the adequate monitoring of pain&#44; the use of appropriate sedation&#44; the monitoring and treatment of delirium and&#44; in patients with neuromuscular blockers&#44; the monitoring with control and sedation systems and neuromuscular blockade&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are several countries in the medical literature that have conducted studies based on situation surveys on this topic&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#8211;8</span></a> However&#44; a study like this had not been conducted in Spain until now&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> The importance of this study is that it has been the first nationwide survey ever conducted in Spain&#44; with a significant representation covering 166 ICUs&#44; and 1567 patients with representation both in the public and private sectors&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the most relevant results&#44; it stands out that 61&#37; of the ICUs had a sedation protocol available while 75&#37; monitored sedation and agitation&#44; being the RASS scale the most commonly used one&#46; Concomitantly&#44; pain was monitored only in half of the ICUs&#44; while the scales for the diagnosis and assessment of delirium were rarely used&#44; only in 21&#37; of the patients&#44; being the CAM-ICU being the most commonly used one&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">When it comes to the practices for the optimization of analgosedation&#44; a relevant fact was that the use of monitoring with bispectral index in cases of deep sedation or neuromuscular blockade occurred in 29&#37; of the patients&#44; while in 32&#37; of the patients with neuromuscular blockade the train-of-four monitoring was used as a measure to quantify the degree of blockade&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The most widely used drug for sedation in continuous perfusion was propofol &#40;19&#37;&#41;&#44; followed by midazolam &#40;17&#37;&#41;&#46; When it comes to analgesia&#44; the most commonly used drug was fentanyl &#40;12&#37;&#41; and&#44; almost in the same percentage&#44; morphine &#40;11&#37;&#41;&#46; In patients on non-invasive ventilation&#44; analgesia with opiates was used in almost half the patients&#46; Also&#44; within non-opiate analgesics&#44; paracetamol was the most widely used now in 18&#37; of the patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">With respect to delirium&#44; it was confirmed that 12&#37; of the patients had shown agitation and 9&#37; delirium as assessed by a scale of some sort&#46; In this group of patients&#44; haloperidol was the most commonly used neuroleptic in almost 9&#37; of the patients while dexmedetomidine had a very low frequency of use &#40;&#60;1&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Another very important fact was the use of non-pharmacological measures such as music&#44; television and the press &#8211; only used in less than 3&#37; of the patients&#46; Another issue&#58; family stays at the ICU with the patient represented 25&#37;&#44; while the reduction of night time nurse monitoring was 12&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Several very relevant facts and rooms for improvement emerge from this study&#46; First&#44; that monitoring analgesia and delirium continue to have a very low prevalence&#46; Secondly&#44; that in the most critically ill patients that require deep sedation and muscular relaxation&#44; the use of blockade and sedation monitoring by bispectral index and train-of-four monitoring occurs in one third of the patients only&#46; And lastly&#44; that non-pharmacological measures are very rarely used at the ICU setting&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Therefore&#44; this study of paramount importance reveals the situation of analgosedation in Spain and several processes that still have a huge room for improvement&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Nin Vaeza N&#46; Pr&#225;cticas de analgosedaci&#243;n y delirium en las UCI espa&#241;olas&#46; Med Intensiva&#46; 2019&#59;43&#58;195&#8211;196&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units &#40;SEMICYUC&#41; for the management of adult critically ill patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Hern&#225;ndez-Tejedor"
                            1 => "O&#46; Pe&#241;uelas"
                            2 => "G&#46; Sirgo Rodr&#237;guez"
                            3 => "J&#46;A&#46; Llompart-Pou"
                            4 => "E&#46; Palencia Herrej&#243;n"
                            5 => "A&#46; Estella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2017"
                        "volumen" => "41"
                        "paginaInicial" => "285"
                        "paginaFinal" => "305"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sedation in French intensive care units&#58; a survey of clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "The SRLF Trial Group"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Intensive Care"
                        "fecha" => "2013"
                        "volumen" => "3"
                        "paginaInicial" => "24"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sedation practice in Nordic and non-Nordic ICUs&#58; a European survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Egerod"
                            1 => "J&#46;W&#46; Albarran"
                            2 => "M&#46; Ring"
                            3 => "B&#46; Blackwood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nurs Crit Care"
                        "fecha" => "2013"
                        "volumen" => "18"
                        "paginaInicial" => "166"
                        "paginaFinal" => "175"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Worldwide Survey of the &#8220;Assessing Pain&#44; Both Spontaneous Awakening and Breathing Trials&#44; Choice of Drugs&#44; Delirium Monitoring&#47;Management Early Exercise&#47;Mobility&#44; and Family Empowerment&#8221; &#40;ABCDEF&#41; bundle"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Morandi"
                            1 => "S&#46; Piva"
                            2 => "E&#46;W&#46; Ely"
                            3 => "S&#46;N&#46; Myatra"
                            4 => "J&#46;I&#46;F&#46; Salluh"
                            5 => "D&#46; Amare"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2017"
                        "volumen" => "45"
                        "paginaInicial" => "e1111"
                        "paginaFinal" => "e1122"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A national multicenter survey on management of pain&#44; agitation&#44; and delirium in intensive care units in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Wang"
                            1 => "Z&#46;Y&#46; Peng"
                            2 => "W&#46;H&#46; Zhou"
                            3 => "B&#46; Hu"
                            4 => "X&#46; Rao"
                            5 => "J&#46;G&#46; Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0366-6999.205852"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chin Med J"
                        "fecha" => "2017"
                        "volumen" => "130"
                        "paginaInicial" => "1182"
                        "paginaFinal" => "1188"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28485318"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National survey and point prevalence study of sedation practice in UK critical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Richards-Belle"
                            1 => "R&#46;R&#46; Canter"
                            2 => "G&#46;S&#46; Power"
                            3 => "E&#46;J&#46; Robinson"
                            4 => "H&#46; Reschreiter"
                            5 => "H&#46; Wunsch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2016"
                        "volumen" => "20"
                        "paginaInicial" => "355"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sedation management in Australian and New Zealand intensive care units&#58; doctors&#8217; and nurses&#8217; practices and opinions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; O&#8217;Connor"
                            1 => "T&#46; Bucknall"
                            2 => "E&#46; Manias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Crit Care"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "285"
                        "paginaFinal" => "295"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delirium recognition and sedation practices in critically ill patients&#58; a survey on the attitudes of 1015 Brazilian critical care physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;I&#46; Salluh"
                            1 => "F&#46; Dal-Pizzol"
                            2 => "P&#46;V&#46; Mello"
                            3 => "G&#46; Friedman"
                            4 => "E&#46; Silva"
                            5 => "J&#46;M&#46; Teles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "55662"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pr&#225;cticas de analgo-sedaci&#243;n y delirium en UCI espa&#241;olas&#58; Encuesta 2013-2014&#46; Management of analgesia&#44; sedation and delirium in Spanish intensive care unit&#58; a national&#44; two-part survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Garc&#237;a S&#225;nchez"
                            1 => "J&#46; Caballero-L&#243;pez"
                            2 => "I&#46; Ceniceros-Rozal&#233;n"
                            3 => "C&#46; Gim&#233;nez-Esparza Vich"
                            4 => "M&#46;A&#46; Romera Ortega"
                            5 => "C&#46; Pardo Rey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2019"
                        "volumen" => "43"
                        "paginaInicial" => "225"
                        "paginaFinal" => "233"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004300000004/v2_201905020913/S2173572719300712/v2_201905020913/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "401"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000004/v2_201905020913/S2173572719300712/v2_201905020913/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300712?idApp=WMIE"
]
Share
Journal Information
Vol. 43. Issue 4.
Pages 195-196 (May 2019)
Vol. 43. Issue 4.
Pages 195-196 (May 2019)
Editorial
Full text access
Analgosedation and delirium practices in Spanish ICUs
Prácticas de analgosedación y delirium en las UCI españolas
Visits
4455
N. Nin Vaeza
Coordinador de la Unidad de Cuidados Intensivos, Hospital Español, Montevideo, Uruguay
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text

Assessing the practices of analgesia, sedation, and delirium in intensive care units (ICUs) is essential for the analysis and improvement of this commonly used process that happens to be one of the most important among critically ill patients. Among the recommendations for the management of critically ill patients established by the SEMICYUC Work Groups the four recommendations made on this topic were: having one analgosedation protocol available at the ICUs, the adequate monitoring of pain, the use of appropriate sedation, the monitoring and treatment of delirium and, in patients with neuromuscular blockers, the monitoring with control and sedation systems and neuromuscular blockade.1

There are several countries in the medical literature that have conducted studies based on situation surveys on this topic.2–8 However, a study like this had not been conducted in Spain until now.9 The importance of this study is that it has been the first nationwide survey ever conducted in Spain, with a significant representation covering 166 ICUs, and 1567 patients with representation both in the public and private sectors.

Among the most relevant results, it stands out that 61% of the ICUs had a sedation protocol available while 75% monitored sedation and agitation, being the RASS scale the most commonly used one. Concomitantly, pain was monitored only in half of the ICUs, while the scales for the diagnosis and assessment of delirium were rarely used, only in 21% of the patients, being the CAM-ICU being the most commonly used one.

When it comes to the practices for the optimization of analgosedation, a relevant fact was that the use of monitoring with bispectral index in cases of deep sedation or neuromuscular blockade occurred in 29% of the patients, while in 32% of the patients with neuromuscular blockade the train-of-four monitoring was used as a measure to quantify the degree of blockade.

The most widely used drug for sedation in continuous perfusion was propofol (19%), followed by midazolam (17%). When it comes to analgesia, the most commonly used drug was fentanyl (12%) and, almost in the same percentage, morphine (11%). In patients on non-invasive ventilation, analgesia with opiates was used in almost half the patients. Also, within non-opiate analgesics, paracetamol was the most widely used now in 18% of the patients.

With respect to delirium, it was confirmed that 12% of the patients had shown agitation and 9% delirium as assessed by a scale of some sort. In this group of patients, haloperidol was the most commonly used neuroleptic in almost 9% of the patients while dexmedetomidine had a very low frequency of use (<1%).

Another very important fact was the use of non-pharmacological measures such as music, television and the press – only used in less than 3% of the patients. Another issue: family stays at the ICU with the patient represented 25%, while the reduction of night time nurse monitoring was 12%.

Several very relevant facts and rooms for improvement emerge from this study. First, that monitoring analgesia and delirium continue to have a very low prevalence. Secondly, that in the most critically ill patients that require deep sedation and muscular relaxation, the use of blockade and sedation monitoring by bispectral index and train-of-four monitoring occurs in one third of the patients only. And lastly, that non-pharmacological measures are very rarely used at the ICU setting.

Therefore, this study of paramount importance reveals the situation of analgosedation in Spain and several processes that still have a huge room for improvement.

References
[1]
A. Hernández-Tejedor, O. Peñuelas, G. Sirgo Rodríguez, J.A. Llompart-Pou, E. Palencia Herrejón, A. Estella, et al.
Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients.
Med Intensiva, 41 (2017), pp. 285-305
[2]
The SRLF Trial Group.
Sedation in French intensive care units: a survey of clinical practice.
Ann Intensive Care, 3 (2013), pp. 24
[3]
I. Egerod, J.W. Albarran, M. Ring, B. Blackwood.
Sedation practice in Nordic and non-Nordic ICUs: a European survey.
Nurs Crit Care, 18 (2013), pp. 166-175
[4]
A. Morandi, S. Piva, E.W. Ely, S.N. Myatra, J.I.F. Salluh, D. Amare, et al.
Worldwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management Early Exercise/Mobility, and Family Empowerment” (ABCDEF) bundle.
Crit Care Med, 45 (2017), pp. e1111-e1122
[5]
J. Wang, Z.Y. Peng, W.H. Zhou, B. Hu, X. Rao, J.G. Li.
A national multicenter survey on management of pain, agitation, and delirium in intensive care units in China.
Chin Med J, 130 (2017), pp. 1182-1188
[6]
A. Richards-Belle, R.R. Canter, G.S. Power, E.J. Robinson, H. Reschreiter, H. Wunsch, et al.
National survey and point prevalence study of sedation practice in UK critical care.
Crit Care, 20 (2016), pp. 355
[7]
M. O’Connor, T. Bucknall, E. Manias.
Sedation management in Australian and New Zealand intensive care units: doctors’ and nurses’ practices and opinions.
Am J Crit Care, 19 (2010), pp. 285-295
[8]
J.I. Salluh, F. Dal-Pizzol, P.V. Mello, G. Friedman, E. Silva, J.M. Teles, et al.
Delirium recognition and sedation practices in critically ill patients: a survey on the attitudes of 1015 Brazilian critical care physicians.
J Crit Care, 24 (2009), pp. 55662
[9]
M. García Sánchez, J. Caballero-López, I. Ceniceros-Rozalén, C. Giménez-Esparza Vich, M.A. Romera Ortega, C. Pardo Rey, et al.
Prácticas de analgo-sedación y delirium en UCI españolas: Encuesta 2013-2014. Management of analgesia, sedation and delirium in Spanish intensive care unit: a national, two-part survey.
Med Intensiva, 43 (2019), pp. 225-233

Please cite this article as: Nin Vaeza N. Prácticas de analgosedación y delirium en las UCI españolas. Med Intensiva. 2019;43:195–196.

Copyright © 2019. Elsevier España, S.L.U. and SEMICYUC
Download PDF
Idiomas
Medicina Intensiva (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?