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Resumen Objetivo Conocer la practica clinica real de las UCI espanolas en relacion con la analgosedacion y delirium, y valorar como se ajusta a las recomendaciones actuales. Diseno Estudio transversal descriptivo elaborado mediante encuesta nacional sobre practicas de analgosedacion y delirium de los pacientes ingresados en UCI los dias 16 de noviembre de 2013 y 16 de octubre de 2014. Se envio un cuestionario a traves de Internet con el aval de la SEMICYUC. Ambito UCI tanto publicas como privadas de todo el territorio nacional. Resultados Se incluyeron un total de 166 UCI y a 1.567 pacientes. El 61,4% de las UCI contaban con un protocolo de sedacion. El 75% de las UCI monitorizaban la sedacion y agitacion, con RASS como la escala empleada con mayor frecuencia. El dolor se monitorizaba en algo mas de la mitad de las UCI, pero las escalas conductuales eran de muy baja implantacion. El delirium tambien presentaba un bajo nivel diagnostico. Entre los pacientes en ventilacion mecanica el midazolam continuaba siendo un sedante de muy amplio uso. Conclusiones Esta encuesta es la primera realizada en Espana sobre analgosedacion y delirium y nos muestra una fotografia sobre estas practicas, senala algunos aspectos como los relacionados con la monitorizacion y usos de escalas, junto con el manejo del delirium, en los que los resultados del estudio animan a desarrollar proyectos docentes que acerquen la practica clinica real a las recomendaciones nacionales e internacionales.

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.

Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.

To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations.A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC.Spanish ICUs in public and private hospitals.A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent.This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

Objetivo Describir el perfil de los pacientes con sindrome coronario agudo sin elevacion del segmento ST (SCASEST) por lesion aguda del tronco comun de la arteria coronaria izquierda (TCI). Diseno Serie de casos consecutivos (enero 2002 a febrero 2003) con seguimiento hasta el alta hospitalaria. Ambito Unidad Coronaria y Unidad de Hemodinamica y Cardiologia Intervencionista de un hospital general. Pacientes y metodo Se estudio a 6 pacientes con SCASEST y lesion aguda del TCI en la coronariografia. Se analizan la clinica, el electrocardiograma (ECG) basal y con dolor, los marcadores cardiacos, el ecocardiograma y los hallazgos del cateterismo cardiaco. Resultados De los 6 enfermos (varones; 43-76 anos), 2 presentaban angina inestable y 4 infarto agudo de miocardio sin onda Q (IAMNQ) con shock cardiogenico (n = 2), edema pulmonar (n = 1) o fibrilacion ventricular (n = 1). El ECG con dolor mostro cambios del segmento ST en ≥7 derivaciones con descenso en DI (1-4 mm), DII (1-2 mm), V4-V6 (1-4 mm) y ascenso en aVR (0,5-2,5 mm), y un sumatorio en valor absoluto (∑ST [DI, DII, aVR, V4-V6]) ≥10 mm. La coronariografia (1-48 h) evidencio una estenosis ≥70% del TCI, por lo que en 2 pacientes se procedio a cirugia y en 4 a angioplastia e implante de stent, con buen resultado final. Conclusiones En los pacientes con SCASEST y disfuncion ventricular izquierda severa, arritmias ventriculares graves o ECG con cambios marcados del segmento ST en ≥7 derivaciones que incluyan DI, DII, aVR, V4, V5, V6, se debe sospechar una lesion aguda del TCI y plantear una estrategia invasiva urgente o incluso de emergencia.