Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts. / Prevención y tratamiento de las lesiones cutáneas asociadas a la ventilación mecánica no invasiva. Recomendaciones de expertos.

INTRODUCTION: In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. OBJECTIVES: To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. METHODOLOGY: Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel. RESULTS: Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet® hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. CONCLUSIONS: The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis.

Standardized language systems for the design of high-fidelity simulation scenarios: A Delphi study.

PURPOSE: This study aimed to identify which of the standardised Nursing Interventions Classification (NIC) activities should be used in the design of clinical cases with high fidelity simulation for educational preparation of undergraduate nursing students in non-technical skills. DESIGN AND METHODS: A three-round Delphi study was carried out: the first round with taxonomy experts, the second round with academic and clinical lecturers with limited experience in the simulation-based learning methodology, and the third round with academic and clinical lecturers having at least two years of simulation experience. The NIC interventions were grouped into two levels of competence in accordance with the undergraduate nursing degree curriculum (1st- and 2nd-year students, the "novice" level; 3rd- and 4th-year students, the "advanced" level). The NIC allows the description of nurse student competencies in multiple clinical scenarios and throughout various contexts: theory, clinical practice and simulation. FINDINGS: The experts identified 163 interventions in 8 areas as relevant and feasible, selecting 42 for the "novice" students, in Nursing Fundamentals (13) and Adult Nursing Care 1 (29), and 97 for the "advanced" students: Maternity Care and Child Health Nursing (18), Mental Health (13), Nursing Care of Older People (12), Community Health Nursing (20) and Adult Nursing Care 2 (34). In addition, 24 interventions were identified as cross-cutting, with training to be provided across all four years of the degree. CONCLUSION: A total of 163 interventions of the NIC list were selected by experts as being both relevant and feasible to nursing undergraduate education. This creates the favourable framework to design high-fidelity scenarios for the training of non-technical skills according to the competences required and in line with the health care reality. Therefore, enabling an optimal combination of theoretical education by academic lecturers with practical training by clinical lecturers and staff nurses.

Recomendaciones del uso de antimicrobianos en heridas crónicas / Recommendations on the application of antimicrobials in chronic wounds

En este artículo, basado en el documento técnico n.º VIII del GNEAUPP, se actualizan algunos conceptos relacionados con los antimicrobianos y se añaden nuevas herramientas terapéuticas para prevenir y luchar frente a uno de los factores más importantes que impiden que cicatrice una herida: los problemas relacionados con los microorganismos, clásicamente la infección y, ahora, también el impacto de los biofilms. Se asume el sistema propio del GNEAUPP de gradación de la evidencia, que clasifica la fuerza de la recomendación en alta, moderada o baja. Los antimicrobianos analizados mediante su modo de actuación, presentación comercial, recomendaciones de uso, contraindicaciones y efectividad sobre el biofilm son: el alcohol, la clorhexidina, el hipoclorito sódico, la octenidina, la plata y los yodóforos. También los efectos de los llamados agentes antibiofilm, aunque la mayoría se han realizado in vitro. Para finalizar, se realizan una serie de recomendaciones dirigidas a los investigadores para generar nuevas evidencias relacionadas con los antimicrobianos y su aplicabilidad clínica (AU)

This article, based on GNEAUPP Technical Paper No. VIII, updates some concepts related to antimicrobials and adds new therapeutic tools to prevent and fight against one of the most important factors that prevent wound healing: problems related to microorganisms, classically infection and now also the impact of biofilms. The GNEAUPP's own evidence grading system is used, which classifies the strength of the recommendation as high, moderate or low. The antimicrobials analyzed in terms of their mode of action, commercial presentation, recommendations for use, contraindications and effectiveness on biofilm are: alcohol, chlorhexidine, sodium hypochlorite, octenidine, silver and iodophors. Also the effects of the so-called antibiofilm agents, although most of them have been performed in vitro. Finally, a series of recommendations are made to researchers to generate new evidence related to antimicrobials and their clinical applicability (AU)

Asignatura sobre el cuidado de las personas con lesiones cutáneas en el grado de enfermería: competencias y propuesta de contenidos / A course on care for people with skin lesions for the undergraduate nursing programme: competencies and proposed contents

El presente artículo pretende desarrollar una propuesta marco sobre una asignatura sobre el cuidado de las personas con lesiones cutáneas en el grado de enfermería. Esta ha sido realizada por consenso de expertos, profesores con experiencia en el cuidado de heridas y fue sometida a modificaciones en el marco del Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. Con ello se presenta una propuesta de competencias sobre el cuidado de las personas con lesiones cutáneas para la enfermera graduada, así como la propuesta curricular, con su estructura pedagógica basada en unidades didácticas y la propuesta de carga docente y ubicación de la asignatura de cuidados de las personas con lesiones cutáneas en el grado en enfermería. Finalmente se presentan documentos de apoyo al profesorado y estudiantado para la creación de la asignatura de cuidados de las personas con lesiones cutáneas para el grado en enfermería (AU)

This article aims to develop a framework proposal for a course on the care of people with skin lesions in the nursing degree. It has been developed by consensus of experts, professors with experience in wound care and was subject to modifications in the framework of the Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. This includes a proposal of competencies on the care of people with skin lesions for the graduate nurse, as well as the Curricular proposal, with its pedagogical structure based on didactic units and the proposed teaching load and location of the subject of care for people with skin lesions in the nursing degree. Finally, support documents are presented for the teaching staff and students for the creation of the subject of care of people with skin lesions for the degree in nursing (AU)

Prevención y tratamiento de las lesiones cutáneas asociadas a la ventilación mecánica no invasiva. Recomendaciones de expertos / Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts

Introducción: En las 2 últimas décadas la ventilación mecánica no invasiva (VNI) se ha consolidado como estrategia inicial para el abordaje de la insuficiencia respiratoria en el paciente crítico adulto y pediátrico. Objetivos: Identificar los factores de riesgo y estrategias preventivas para disminuir la incidencia de lesiones cutáneas asociadas a dispositivos clínicos (LESADIC) relacionadas con la VNI, así como el tratamiento más eficaz para las lesiones que no se han podido evitar. Metodología: Revisión en las bases de datos MEDLINE, CINAHL y Cochrane de estudios publicados en los últimos 10años para llegar al consenso mediante panel de expertos. Resultados: Los conocimientos acerca de cómo medir la talla correcta de máscara y la protección de la piel con apósitos de espuma o hidrocoloides son factores relacionados con la incidencia de LESADIC, pues condiciona el grado de presión-fricción y cizalla que la interfaz ejerce sobre la piel. La interfaz que menos LESADIC causa y es mejor tolerada es la máscara facial. Cuando hay lesiones, lo primero es retirar la interfaz que provoca presión sobre la piel dañada, recomendando como alternativa el casco Helmet(R), tratar la infección, gestionar el exudado y estimular piel perilesional. Conclusiones: La máscara de elección es la facial, siempre con uso de apósitos de espuma o hidrocoloides en el puente nasal. Evaluar el estado de la piel debajo la interfaz y arnés entre las 4 h (recomendable) y 11 h (máximo). Valorar la estrategia de rotación de la interfase a las 24 h si la VNI sigue siendo necesaria de forma continuada

Introduction: In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. Objectives: To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. Methodology: Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10 years to reach consensus through an expert panel. Results: Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet(R) hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. Conclusions: The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4 hours (recommended) and 11 hours (maximum). Evaluate the rotation strategy of the interface at 24 hours if the NIV is still needed on an ongoing basis

Carta al director en respuesta a «Prevención de lesiones cutáneas asociadas a ventilación mecánica no invasiva» / Letter to the editor in response to «Prevention of skin injuries associated with non-invasive mechanical ventilation»

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