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Resumen Objetivo Estudiar la concordancia entre los grados de satisfaccion de los pacientes y sus familiares (ambos pertenecientes a un mismo nucleo familiar) en cuanto a los cuidados y atenciones proporcionados durante su estancia en la UCI. Diseno Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ambito UCI del Hospital Universitario Marques de Valdecilla de Santander. Sujetos Pacientes mayores de 18 anos con estancia mayor de 24 h que fueron dados de alta de la UCI durante el periodo de estudio y familiares de dichos pacientes. Intervencion Instrumento: cuestionario FS-ICU 34 para evaluar la satisfaccion de los familiares de pacientes ingresados en la UCI y adaptacion de dicho cuestionario para el paciente. Se determina el grado de concordancia mediante el indice de kappa ponderado para muestras pareadas. Resultados Se analizaron todos los cuestionarios procedentes de un mismo nucleo familiar, obteniendose un total de 148 pares de cuestionarios (296 encuestas). Se obtuvieron indices kappa que oscilaron entre 0,278 y 0,558, lo que indica grados de concordancia entre debiles y moderados. Conclusiones Los familiares de los pacientes ingresados en la UCI no pueden ser considerados unos representantes adecuados, al menos para el subgrupo de pacientes competentes. En estos casos debemos acudir a esos pacientes para conocer de primera mano sus sentimientos, percepciones y vivencias durante su estancia en la UCI. Solo cuando los pacientes no estan en condiciones de participar activamente en el proceso asistencial debemos acudir a sus familias.

Resumen Objetivo Conocer el grado de satisfaccion de los familiares de los pacientes dados de alta de la UCI y el del propio paciente. Diseno Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ambito UCI del Hospital Universitario Marques de Valdecilla de Santander. Sujetos Familiares y pacientes que fueron dados de alta de la UCI durante ese periodo. Intervencion Instrumento: encuesta Family Satisfaction Intensive Care Unit (FS-ICU 34) para familiares de pacientes ingresados en UCI (que sobrevivieron o no) y adaptacion de la FS-ICU en cuanto a cuidados se refiere, para el propio paciente. Resultados Se obtuvieron un total de 385 encuestas, 192 de familiares de supervivientes, 31 de familiares de fallecidos y 162 de pacientes. La mayor parte de los familiares encuestados estaban satisfechos con los cuidados recibidos y el proceso de decisiones (supervivientes: 83,46 ± 11,83 y 79,42 ± 13,58, respectivamente; fallecidos: 80,41 ± 17,27 y 79,61 ± 16,93, respectivamente). Los pacientes encuestados estaban muy satisfechos con los cuidados recibidos (84,71 ± 12,85). Conclusiones El grado de satisfaccion de los familiares y de los propios pacientes ingresados en la UCI es elevado. Aun asi, existen varios puntos que deberian ser mejorados, como el ambiente de la sala de espera y el ambiente propio de la UCI en cuanto a ruido, intimidad e iluminacion se refiere, asi como algunos aspectos del proceso de toma de decisiones, entre ellos la esperanza suministrada acerca de la recuperacion de su familiar.

To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU.A prospective, 5-month observational and descriptive study was carried out.ICU of Marqués de Valdecilla University Hospital, Santander (Spain).Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives.Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers.An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement.The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.

Fundamento Los pacientes sometidos a trasplante pulmonar presentan un elevado riesgo de complicaciones en el postoperatorio inicial, entre las que destaca la infeccion. El objetivo de este trabajo es estudiar la incidencia de dichas complicaciones Pacientes y metodo Un total de 63 pacientes sometidos a trasplante pulmonar entre 1991 y 1998 ingresados en el periodo postoperatorio en la unidad de cuidados intensivos (UCI) Se trata de un estudio retrospectivo en el que se analizan las complicaciones desarrolladas, asi como diversas variables relacionadas con el paciente durante el periodo pre y peroperatorio y su asociacion con la aparicion temprana de infeccion Resultados La edad media fue de 44 anos, se efectuo trasplante unipulmonar en 30 casos (48%) y bipulmonar en 33 (52%). La estancia media en la UCI fue de 17 dias y los pacientes precisaron ventilacion mecanica durante un promedio de 11 dias. En 18 pacientes se produjo hemorragia perioperatoria grave; en 29 casos se diagnostico una lesion de reimplantacion y en 11 un rechazo agudo. Un total de 37 pacientes (59%) desarrollo 61 episodios infecciosos, de los cuales 46 (75%) eran de origen respiratorio. En 41 episodios (67%) la aparicion fue anterior al dia 15 del postoperatorio, sin que se hallara ninguna relacion significativa entre la aparicion temprana de infeccion y diversos factores, como el tipo de trasplante, la duracion de la ventilacion mecanica o la colonizacion del injerto o del huesped, previa al acto quirurgico. La mortalidad intra-UCI fue del 25% (16 casos), pero tan solo en 3 casos fue atribuida a la infeccion Conclusiones La infeccion fue una complicacion frecuente en el postoperatorio inicial del trasplante pulmonar, siendo en la mayor parte de los casos de origen respiratorio. La infeccion fue mas frecuente durante el periodo precoz y su presencia tuvo poca repercusion en la evolucion de los pacientes durante su estancia en la UCI

To determine the value of Vd/Vt as a predictor of extubation failure in patients with mechanical ventilation admitted to the intensive care units.A prospective, observational cohort study conducted from 1 September 2010 to 1 March 2011.General intensive care unit (G-ICU) of a third level university hospital.The study included patients on mechanical ventilation (MV) for over 12 hours, and who in the process of weaning were subjected to low-level pressure support. Exclusion criteria were age under 18 years, ventilation via tracheotomy and patients failing to cooperate for different reasons. During the study, 392 patients were admitted to the G-ICU; of these, 214 required MV. The weaning process was started in 154 cases. Fifty-four patients were excluded from the study, and 24 were not extubated from MV. A total of 76 patients were finally extubated and analyzed.Vd/Vt was calculated as the ratio (PaCO(2)-Pє CO(2))/PaCO(2), with the recorded parameters.Logistic regression analysis showed a significant association between the Vd/Vt and extubation failure, with OR=1.52 (95%CI 1.11 to 2.09, p=0.008). The area under the ROC curve with respect to the prediction of extubation failure according to the Vd/Vt value was 0.94 (95%CI 0.86 to 0.98, p0.0001).Vd/Vt is a powerful predictor of extubation failure in patients on MV.

To validate the "Risk Quantification of Early Outcome After Lung Transplantation" (RQLT) scale in a cohort of lung transplantation patients.The parameters included in the RQLT scale were recorded prospectively.A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008.This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test.The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58.The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients.

To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al.Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups.The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6+/-4.52 days) and patients from the group with no discrepancy (15.42+/-8.99).The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100%.

To make an independent evaluation of the capacity for exercise as a predictive factor in lung transplant recipients.Retrospective study.Lung transplant unit of the Intensive Care Unit (ICU) of a university hospital.We analyzed 132 lung transplants in a total of 130 patients. The patients were monitorized up to June 18, 2005 or their death.An evaluation was made of their pre-operative exercise capacity with the 6-minute walking test (6MWT). Long-term survival in relationship with the walking test value was also assessed. The survival curves were estimated using the Kaplan-Meier method. Comparison between curves was made with the Log-Rank methods and the hazard ratios were estimated by Cox regression.The association between mortality and the walking test value showed a hazard ratio of 0.99 (95% CI: 0.99-1.00) per metric unit (meter), (p = 0.282). The patients were classified according to the distance covered in the 4 groups: group 1 (distance covered less than 100 meters), group II (distance covered between 101-200 meters), group III (distance covered between 201 and 300 meters) and group IV (distance greater than 301 meters). No significant differences were found when comparing the survival curves of the four groups (p = 0.709). The multivariant analysis also did not show any statistical significance.We do not believe that the distance covered in the 6MWT conducted in the study protocol in the lung transplant candidates is useful as a marker to predict long-term mortality in patients undergoing lung transplant.