E. Alted López

Hospital Universitario 12 de Octubre, Madrid, Madrid, Spain

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Publications (24)33.29 Total impact

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    ABSTRACT: En las unidades de cuidados intensivos (UCI) la familia considera la necesidad de comunicación como una de las más importantes.
    Enfermería Intensiva 11/2014; 25(4). DOI:10.1016/j.enfi.2014.09.001
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    ABSTRACT: Communication is referred as one of the most important needs by the families of intensive care unit patients. To analyze nursing perception of the communication process with the family members of an intensive care unit patient. Transversal study (December 2012) with a questionnaire Nurse Activities for Communicating with Families (NACF), cross-culturally adapted by Santana Cabrera et al. Participants: intensive care unit nurses from a third level university hospital. Descriptive analysis of variables and inferential statistics with Chi-square and Kruskal-Wallis, statistic program SPSS 17.0; significant P<.05. Complementation was of 80% (132 out of 166 nurses). The average experience was of 9.6±7.95years. 55.9% sometimes explain to families the treatment and equipment of the patient and a 37% almost always. Nurses talk to the families about the disease and the treatment given to the patient always/almost always in 59% of the cases and sometimes in a 35.38%. 54,6% talk to the family about their feelings sometimes and a 28.46% almost always. A 47.8% notify always/almost always changes on the care plan. 87.9% ensure patient comfort always/almost always. There is no relation between years of experience in ICU and the outcomes of the questionnaire. There is a relation between the different kinds of ICUs and the information given about disease and treatment. Nurses tend to inform more about technical aspects than feelings related to the families. Patient comfort is the most referred item regardless of years of experience and the kind of intensive care unit. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
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    ABSTRACT: Aims Quantifying and evaluating the response to the bedside monitor alarms (BMA) by nurses in intensive care unit (ICU). Metodology: Prospective observational study (October 2011-January 2012). Randomized blind audit on alarm management. Alarm programming and alarm limits were related to experience in ICU. We evaluated the response to BMA with the variables: alarm type (relevant/not relevant/alert) and response type. Descriptive analysis of variables for multivariate ANOVA and Chi-square test with SPSS 17.0. Results 434 audits were analyzed. The programming was: Blood pressure (BP) 88.25%, heart rate (HR) 98.62% O2 saturation (SO) 96.79%, respiratory rate (FR) 65.75%. The alarms originated were BP 49.73%, 10.75% HR, 39.25% SO, 3.27% FS. The nurse responded to 93.3% of them and 50% were treated before 10 sec. 56.16% of the alarms were not relevant, 25.12% relevant and 18.72% alerting. 41.8% were due to handling. Conclusion The alarms are programmed/attended by the nurse and there is uniformity in programming/selection limits. 25% of BMA carried therapeutic attitude.
    Enfermería Intensiva 07/2014; 25(3). DOI:10.1016/j.enfi.2013.11.008
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    ABSTRACT: Quantifying and evaluating the response to the bedside monitor alarms (BMA) by nurses in intensive care unit (ICU). Metodology: Prospective observational study (October 2011-January 2012). Randomized blind audit on alarm management. Alarm programming and alarm limits were related to experience in ICU. We evaluated the response to BMA with the variables: alarm type (relevant/not relevant/alert) and response type. Descriptive analysis of variables for multivariate ANOVA and Chi-square test with SPSS 17.0.
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    ABSTRACT: To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. A prospective and observational study from October to December 2011 was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5minutes before, during and 15minutes after the 3procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student's T test/ANOVA for multivariate analysis with SPSS 17.0. A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and 14.7% wound care were performed in 29 patients. ESCID score was 0.4±1 before, 3.4±2.7 during and 0.4±1 after for wound care; 0.4±1.1 before, 3.6±2.2 during and 1.1±0.5 for tracheal suctioning; 0.5±1.1 before, 3±2.8 during and 0.2±0.8 after for mobilization. These increased significantly during the performance of the 3procedures before-during/during-after: P=.000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P=.000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before, 15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%. An increase on the ESCID score was observed while performing the procedures.
    Enfermería Intensiva 10/2013;
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    ABSTRACT: Objective To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. Material and method A prospective and observational study from October to December 2011 was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5 minutes before, during and 15 minutes after the 3 procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student's T test/ANOVA for multivariate analysis with SPSS 17.0. Results A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and 14.7% wound care were performed in 29 patients. ESCID score was 0.4 ± 1 before, 3.4 ± 2.7 during and 0.4 ± 1 after for wound care; 0.4 ± 1.1 before, 3.6 ± 2.2 during and 1.1 ± 0.5 for tracheal suctioning; 0.5 ± 1.1 before, 3 ± 2.8 during and 0.2 ± 0.8 after for mobilization. These increased significantly during the performance of the 3 procedures before-during/during-after: P = .000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P = .000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before, 15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%. Conclusion An increase on the ESCID score was observed while performing the procedures.
    Enfermería Intensiva 10/2013; 24(4):137–144. DOI:10.1016/j.enfi.2013.07.003
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    ABSTRACT: Purpose The development of a contralateral extraaxial hematoma has repeatedly been described in small series and descriptive studies. However, the evidence available to date is limited. Objectives To evaluate the incidence and risk factors leading to the development of a contralateral extraaxial hematoma and to describe the characteristics of cases. Methods A retrospective cohort study with prospective data collection was undertaken. All patients admitted to an intensive care unit (ICU) from 2006 to 2010 were studied. The inclusion criteria were as follows: severe trauma [Injury Severity Score (ISS ≥ 16)], neurosurgery (NeuroSx) in the first 24 h. The following were excluded: subacute/chronic subdural hematomas, first bilateral NeuroSx. Cases were those who required immediate contralateral NeuroSx after the first NeuroSx due to the occurrence of a new extraaxial injury or significant growth of a previous one. Controls were those patients those who did not require second NeuroSx or who required reoperation due to ipsilateral lesions. The variables considered were: demographics, neurological assessment, traumatic injuries and severity, image and surgical findings, clinical course, and outcome. Statistics analysis comprised descriptive, inferential, and multivariate analysis by logistic regression. Results A total of 120 patients were included, among which there were 11 cases (incidence 9.2 %). The cases showed a significantly higher frequency of coma or severe traumatic brain injury (TBI) at admission, contralateral injury and contralateral skull fracture in the preoperative computed tomography (CT) scan, as well as decompressive craniectomy. There were no significant differences in the severity scores, clinical course, or outcomes. The presence of contralateral fracture was identified as an independent risk factor [relative risk (RR) 47.9, 95 % confidence interval (CI) 5.2–443]. Conclusions Contralateral extraaxial hematoma is a rare entity, although it has a high mortality rate. Therefore, it requires a high index of suspicion, especially in patients with severe TBI, with minimal contralateral injury and mainly with contralateral skull fracture on the initial CT scan.
    European Journal of Trauma and Emergency Surgery 06/2013; 39(3). DOI:10.1007/s00068-013-0268-4 · 0.38 Impact Factor
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    ABSTRACT: Objective: To study usefulness of the video recording in the evaluation of the quality of care in hospital initial care of patients with severe trauma. Patients and methods: Prospective observational study over a period of 6 months. We included all adult patients with traumatic injury admitted to the ICU from the pre-hospital means. Continuous recording took place in video of the initial resuscitation, with subsequent review by a multidisciplinary group. Epidemiological characteristics, adherence to the established protocol, time management and the incidence of errors or system failures were analyzed. Results: 117 patients admitted were included. Of these, 71% were male, with an average age of 43 years and Injury Severity Score (ISS) 19.8 ± 15.6. Overall protocol compliance in the primary and secondary survey was 79.9% and 70% respectively. The evaluation of trauma team performance were: leadership 87%, team organization 88%, care organization 75% and roles follow-up 76%. Resuscitation took 43 minutes. Conclusion: The video-recording of trauma resuscitation allows to analyze the presence of errors and/or delays affecting the quality of the assistance provided.
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    ABSTRACT: OBJECTIVE: To validate a safety tool used in high-risk sectors (safety briefing) in intensive care medicine. DESIGN: A prospective, observational and analytical study was carried out. SETTING: Trauma and emergency intensive care unit in a tertiary hospital. PATIENTS: Patients with severe trauma (Injury Severity Score ISS≥16). INTERVENTION: Documentation of incidents related to patient safety (PS). VARIABLES: Patients characteristics, state of the Unit, patient safety incidents, aspects of the tool (SP) and safety culture impact. RESULTS: We included 441 patients (75.15% males, mean age 39.9±17.5 years), with blunt trauma in 89% and a 10.5% mortality rate. The tool was applied in 586 out of 798 possible shifts (73.4%), and documented 942 events (2.20 incidents per patient). The incidents were more frequently associated with medication (20.7%), devices (placement 4.03%, and maintenance 17.8%) and airway and mechanical ventilation (MV) (17.09%). A correlation was established between the occurrence of incidents and the characteristics of the patient (higher Injury Severity Score, presence of MV, and continuous renal replacement therapies) and the status of the Unit (more than 6 patients per shift out of 8 possible, and holiday period). The tool significantly influenced different aspects of the safety culture of the unit (communication frequency, number of events, punitive loss and active work in PS). CONCLUSIONS: Safety briefing is a tool for the documentation of incidents that is simple and easy to use, and is useful for implementing improvements and in influencing safety culture.
    Medicina Intensiva 01/2012; 36(7):481-487. DOI:10.1016/j.medin.2011.11.023 · 1.24 Impact Factor
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    ABSTRACT: AimsTo determine compliance of the standard “semirecumbent position between 30–45o in patients with artificial airway (AA)”. To know the opinion of the professionals on this issue.
    World Pumps 07/2011; 22(3):117-124. DOI:10.1016/j.enfi.2010.11.005
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    ABSTRACT: The clinical value of routine chest X-rays in critical care has been questioned, but has not been studied in the trauma environment to date. The objective of this study was to identify easy to use clinical predictors of utility in this setting. A prospective observational study was made in an 8-bed traumatology ICU. Severe trauma patients (ISS > 15), aged 15 or older and admitted for 48 h or longer were included. Pregnant women and radiographs obtained during initial care or for reasons other than routine indication were excluded. A staff physician, separated from clinical duties, independently reviewed the films in search of changes, as described in a closed checklist. Following closed criteria, the attending physicians reported previous day clinical events and changes in clinical management after chest X-ray obtainment. Demographic and epidemiological data were also recorded. The associations among variables were studied by univariate and multivariate analysis. A total of 1440 routine chest X-rays were obtained from 138 consecutive patients during one year. Young males prevailed (82%; 39 ± 16 years). The most common process was severe blunt trauma (97%). Fifty-two percent suffered severe chest trauma. The mean length of stay was 12.9 ± 10.1 days. Mechanical ventilation was used in 86.8% of the cases. A median of 10.4 ± 9.3 films were obtained from each patient. A total of 14% of the X-rays showed changes, most commonly malpositioning of an indwelling device (6.8%) or infiltrates (4.9%). Those findings led to a change in care in 84.6% of the cases. Multivariate analysis identified the following significant (p < 0.05) risk factors for radiographic changes: first two days of evolution, mechanical ventilation, worsening of PaO₂/FiO₂, worsening of lung compliance and changes in respiratory secretions. Based on the results obtained, the risk of not identifying dangerous conditions by restricting routine chest X-rays prescription to the described conditions is low. Observing this policy would probably mean substantial savings and a reduction in radiation exposure.
    Medicina Intensiva 06/2011; 35(5):280-5. DOI:10.1016/j.medine.2011.03.002 · 1.24 Impact Factor
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    ABSTRACT: Background The clinical value of routine chest X-rays in critical care has been questioned, but has not been studied in the trauma environment to date. The objective of this study was to identify easy to use clinical predictors of utility in this setting.
    Medicina Intensiva 06/2011; 35(5):280-285. DOI:10.1016/j.medin.2011.03.006 · 1.24 Impact Factor
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    ABSTRACT: To determine compliance of the standard "semirecumbent position between 30-45° in patients with artificial airway (AA)". To know the opinion of the professionals on this issue. An observational, prospective study was carried out in December 2009 in the ICU department of a tertiary hospital that excluded the limitation of therapeutic effort, prone position and antitrendelemburg. Data collected: headrest angle, professional experience of the nurse, shift, perception of the auditor, diagnostic, type of AA (tracheostomy or endotracheal tube), mechanical ventilation (MV) (yes/no) and enteral nutrition (EN). Nurses were surveyed to verify if they knew the standard, if they complied with it, the method used and their suggestions. We used the Student's t test and ANOVA for multivariable analysis, and Fisher's χ2; p<0.05=significant. A total of 546 valid measurements were obtained from 53 patients, of which 40.9% had the correct semirecumbent position (30-45°). Professionals with <1 year of experience were those who raised the headrest the least, with only 26.4% of these measurements over 30°. The standard was met in only 34.8% of the neurocritical patients (NC) vs non NC (46.7%) (p<0.05). It was <30° in 29.2% of patients with tracheostomy vs 44% measurements performed on patients with TOT (p<0.05). There were no differences between shifts, the use of MV or EN. Diagnostic accuracy of the auditor: sensitivity: 91.6%; specificity: 72.5%; positive predictive value: 70.2%; negative predictive value (NPV): 92.4%. 97.9% of responders know the standard. Visual judgment was used in 97.2% of the cases. Measured compliance was less than 50% although the standard is well known by the nursing team. Even though the subjective perception has a high NPV, it does not achieve the standard.
    Enfermería Intensiva 01/2011; 22(3):117-24.
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    ABSTRACT: Objective To analyze diagnostic (blood drawings) and iatrogenic (Continuous Renal Replacement Therapy, CRRT) blood losses (BL) in severe trauma patients.
    Enfermería Intensiva 07/2010; 21(3). DOI:10.1016/j.enfi.2010.04.001
  • E Alted López
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    ABSTRACT: Trauma is a pandemic disease in the current society. In an attempt to minimize its impact, trauma care systems have been developed, the basic component being the Trauma Centers (TC). Management of the patient with severe trauma in the TC is supported by moderate scientific evidence, with many studies, but of weak quality. It is described how the volume, experience, availability of resources and other aspects are able to decrease mortality and achieve functional improvement in the TC in severe trauma patients.
    Medicina Intensiva 04/2010; 34(3):188-93. · 1.24 Impact Factor
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    E. Alted López
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    ABSTRACT: Trauma is a pandemic disease in the current society. In an attempt to minimize its impact, trauma care systems have been developed, the basic component being the Trauma Centers (TC). Management of the patient with severe trauma in the TC is supported by moderate scientific evidence, with many studies, but of weak quality. It is described how the volume, experience, availability of resources and other aspects are able to decrease mortality and achieve functional improvement in the TC in severe trauma patients.
    Medicina Intensiva 04/2010; 34(3):188-193. DOI:10.1016/j.medin.2009.11.011 · 1.24 Impact Factor
  • E. Alted López · S. Bermejo · M. Chico
    Medicina Intensiva 11/2009; 33(8):409-410. DOI:10.1016/j.medin.2009.05.009 · 1.24 Impact Factor
  • E. Alted Lopez · S. Bermejo · M. Chico
    Medicina Intensiva 11/2009; 33(8):409-410. · 1.24 Impact Factor
  • E Alted López · S Bermejo · M Chico
    Medicina Intensiva 11/2009; 33(8):409-10. · 1.24 Impact Factor
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    Article: Sedation
    Intensive Care Medicine 09/2005; 18:S157-S158. DOI:10.1007/BF03216358 · 5.54 Impact Factor