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1.
Medwave ; 22(3): e002550, 29-04-2022.
Article in English, Spanish | LILACS | ID: biblio-1368126

ABSTRACT

Los avances tecnológicos de la ventilación mecánica han sido parte esencial del aumento de la sobrevida en las unidades de cuidados intensivos. Desde la conexión a la ventilación mecánica, comúnmente se utiliza ventilación controlada sin la consecuente participación de los músculos respiratorios del paciente, con el fin de favorecer la protección pulmonar. El retiro de la ventilación mecánica implica un periodo de transición hacia la respiración espontánea, utilizando principalmente ventilación mecánica asistida. En esta transición, el desafío de los clínicos es evitar la sub y sobre asistencia ventilatoria, minimizando el esfuerzo respiratorio excesivo, daño diafragmático y pulmonar inducidos por la ventilación mecánica. La monitorización con balón esofágico permite mediciones objetivas de la actividad muscular respiratoria en tiempo real, pero aún hay limitaciones para su aplicación rutinaria en pacientes ventilados mecánicamente en la unidad de cuidados intensivos. Al igual que el balón esofágico, la electromiografía de los músculos respiratorios y la ecografía diafragmática son herramientas que permiten monitorizar la actividad muscular de la respiración, siendo mínimamente invasivas y con requerimiento de entrenamiento específico. Particularmente, durante la actual pandemia de enfermedad por coronavirus se ha extendido el uso de herramientas no invasivas disponibles en los ventiladores mecánicos para monitorizar el impulso (drive), esfuerzo y trabajo respiratorio, para promover una ventilación mecánica ajustada a las necesidades del paciente. Consecuentemente, el objetivo de esta revisión es identificar las definiciones conceptuales de impulso, esfuerzo y trabajo respiratorio utilizadas en el contexto de la unidad de cuidados intensivos, e identificar las maniobras de medición no invasivas disponibles en los ventiladores de cuidados intensivos para monitorizar impulso, esfuerzo y trabajo respiratorio. La literatura destaca que, aunque los conceptos de impulso, esfuerzo y trabajo respiratorio se perciben intuitivos, no existe una definición clara. Asimismo, destacados autores los definen como conceptos diferentes.


Technological advances in mechanical ventilation have been essential to increasing the survival rate in intensive care units. Usually, patients needing mechanical ventilation use controlled ventilation to override the patient's respiratory muscles and favor lung protection. Weaning from mechanical ventilation implies a transition towards spontaneous breathing, mainly using assisted mechanical ventilation. In this transition, the challenge for clinicians is to avoid under and over assistance and minimize excessive respiratory effort and iatrogenic diaphragmatic and lung damage. Esophageal balloon monitoring allows objective measurements of respiratory muscle activity in real time, but there are still limitations to its routine application in intensive care unit patients using mechanical ventilation. Like the esophageal balloon, respiratory muscle electromyography and diaphragmatic ultrasound are minimally invasive tools requiring specific training that monitor respiratory muscle activity. Particularly during the coronavirus disease pandemic, non invasive tools available on mechanical ventilators to monitor respiratory drive, inspiratory effort, and work of breathing have been extended to individualize mechanical ventilation based on patient's needs. This review aims to identify the conceptual definitions of respiratory drive, inspiratory effort, and work of breathing and to identify non invasive maneuvers available on intensive care ventilators to measure these parameters. The literature highlights that although respiratory drive, inspiratory effort, and work of breathing are intuitive concepts, even distinguished authors disagree on their definitions.


Subject(s)
Humans , Work of Breathing , Pandemics , Respiration, Artificial , Ventilators, Mechanical , Critical Care
2.
Univ. salud ; 24(1): 76-84, ene.-abr. 2022. tab
Article in Spanish | LILACS-Express | LILACS, COLNAL | ID: biblio-1361188

ABSTRACT

Introducción: La COVID-19 es una enfermedad que desencadena infecciones respiratorias graves como el síndrome respiratorio agudo severo, que puede requerir atención prolongada intra y extrahospitalaria. Objetivo: Brindar recomendaciones y pautas para una correcta evaluación y tratamiento del paciente con COVID-19 mediante la rehabilitación pulmonar. Materiales y métodos: Revisión de la literatura en las bases de datos MEDLINE, PEDRO, Scielo y en Google Scholar, a partir de las palabras clave: COVID-19, Síndrome de Dificultad Respiratoria del Adulto, Enfermedades pulmonares, Rehabilitación, pruebas de función respiratoria, Unidad de cuidado intensivo; seleccionando, aquellos artículos que presentaran información sobre rehabilitación en pacientes con COVID-19 y otras alteraciones con compromiso similar como el Síndrome Respiratorio Agudo y las Enfermedades Pulmonares Intersticiales Difusas. Resultados: Para realizar una intervención en paciente con COVID-19 u otra alteración respiratoria como Síndrome de Dificultad Respiratoria del Adulto y Enfermedad Pulmonar Intersticial Difusa, es necesario realizar un adecuado diagnóstico de la enfermedad, una minuciosa evaluación integral y una intervención basada en las necesidades de cada individuo. Conclusiones: El paciente intrahospitalario puede recibir intervención enfocada a evitar el deterioro funcional y una vez son dados de alta la rehabilitación pulmonar extrahospitalaria podría ser una alternativa eficaz en el tratamiento para los pacientes.


Introduction: COVID-19 is a disease that triggers serious respiratory infections such as severe acute respiratory syndrome, which requires treatment on an inpatient and outpatient basis. Objective: To provide recommendations and guidelines for the appropriate assessment and treatment of COVID-19 patients through pulmonary rehabilitation. Materials and methods: A literature review using MEDLINE, PEDRO, Scielo and Google Scholar databases and the keywords: COVID-19, Adult Respiratory Distress Syndrome, Pulmonary diseases, Rehabilitation, Respiratory function tests, Intensive Care Unit. Articles that described information regarding rehabilitation in COVID-19 patients and other similar dysfunctions such as Acute Respiratory Syndrome and Diffuse Interstitial Lung Diseases. Results: It is necessary to carry out an appropriate disease diagnosis, a detailed integral assessment, and an intervention based on the needs of each patient in order to intervene with either COVID-19 patients or cases with other respiratory dysfunctions such as Adult Respiratory Distress Syndrome and Diffuse Interstitial Lung Disease. Conclusions: Inpatients can be subjected to an intervention focused on avoiding functional failure. Once they are discharged, outpatient pulmonary rehabilitation could be an effective treatment alternative for these patients.


Subject(s)
Humans , Rehabilitation , Respiratory Tract Diseases , Respiratory Distress Syndrome, Newborn , Respiratory Function Tests , Respiratory Tract Infections , Lung Diseases, Interstitial , Critical Care , Lung Diseases
3.
Oncología (Ecuador) ; 32(1): 15-26, 30-04-2022.
Article in Spanish | LILACS | ID: biblio-1368925

ABSTRACT

Introducción: Los pacientes críticos con enfermedades oncológicas desarrollan una respuesta metabólica severa frente a la agresión con un alto grado de hipermetabolismo, lo que constituye un riesgo asociado e incide en la mortalidad de estos pacientes. El objetivo del presente estudio fue medir el estado nutricional de un grupo de pacientes oncológicos ingresados en terapia intensiva y establecer una asociación con la mortalidad. Metodología: El presente estudio observacional retrospectivo se realizó en la unidad de cuidados intensivos del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" - Guayaquil en el período septiembre - 2017 /agosto -2018. La muestra fue no probabilística, de pacientes con diagnóstico oncológico. Las variables fueron edad, sexo, mortalidad, NUTRIC score, condición de ingreso, tipo de tumores, escalas fisiológicas APACHE y SOFA, días de hospitalización y número de comorbilidades. Se utilizó análisis de curvas ROC, Rho de Spearman y Chi2 para establecer la asociación. Resultados: Se incluyeron 176 casos, con edad de 57 años (RI 43-67). 113/176 mujeres (64.2%). La media de puntuación de APACHE fue de 18 ±7.3 y la mediana de SOFA fue de 4.0 (RI 1.0 ­ 6.0). El tipo de cáncer más frecuente fue el ginecológico con un 25% (44/176) de los casos. La mortalidad fue del 19.9% (35/176). Los puntajes de NUTRIC fueron mayores en los pacientes fallecidos (Me 6.00 (RI 5-9) vs Me 3.00 (RI 1-4); P <0.0001). La presencia de puntaje NUTRIC >4 tiene una sensibilidad del 74.3% (IC 95% 56.7 ­ 87.5), especificidad del 80.9% (IC 95% 73.4 ­ 87.0), valor predictivo positivo del 49.1% (IC 95% 39.4 ­ 58.7) y un valor predictivo negativo 92.7% (IC 95% 87.8 ­ 95.7) para el desenlace de mortalidad. Conclusión: En este estudio las puntuaciones altas de NUTRIC score modificado se encuentran fuertemente asociadas a mortalidad en pacientes oncológicos críticos. Las puntuaciones altas del test NUTRIC score modificado se correlaciona con peor condición clínica al momento de la admisión y mayor estancia en la unidad de cuidados intensivos.


Introduction: Critically ill patients with oncological diseases develop a severe metabolic response to aggression with a high degree of hypermetabolism, which constitutes an associated risk and affects the mortality of these patients. The objective of the present study was to measure the nutrition-al status of a group of cancer patients admitted to intensive care and establish an association with mortality. Methodology: This retrospective observational study was conducted in the intensive care unit of the National Oncology Institute "Dr. Juan Tanca Marengo" - Guayaquil in September - 2017 / August -2018. The sample was nonprobabilistic of patients with a cancer diagnosis. The variables were age, sex, mortality, NUTRIC score, admission condition, type of tumor, APACHE and SOFA physiological scales, days of hospitalization, and some comorbidities. ROC curve, Spearman's Rho, and Chi2 analyses were used to establish the association. Results: A total of 176 cases were included, aged 57 years (IR 43-67). 113/176 women (64.2%). The mean APACHE score was 18 ±7.3, and the median SOFA score was 4.0 (IR 1.0 ­ 6.0). The most fre-quent type of cancer was gynecological, with 25% (44/176) of cases. Mortality was 19.9% (35/176). NUTRIC scores were higher in deceased patients (Me 6.00 (IR 5-9) vs Me 3.00 (IR 1-4); P<0.0001). The presence of a NUTRIC score >4 has a sensitivity of 74.3% (95% CI 56.7 ­ 87.5), a specificity of 80.9% (95% CI 73.4 ­ 87.0), a positive predictive value of 49.1% (95% CI 39.4 ­ 58.7) and a negative predic-tive value of 92.7% (95% CI 87.8 ­ 95.7) for the outcome of mortality. Conclusion: In this study, high modified NUTRIC score scores were strongly associated with mor-tality in critical cancer patients. High scores on the modified NUTRIC score test correlate with worse clinical condition at admission and more extended stay in the intensive care unit.


Subject(s)
Humans , Pregnancy , Malnutrition , Neoplasms , Health Status Indicators , Critical Care , Nutritional and Metabolic Diseases
4.
Invest. educ. enferm ; 40(1): 97-114, 01/03/2022. tab
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1370181

ABSTRACT

Objective. To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. Methods. Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. Results. Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. Conclusion. People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.


Objetivo. Describir las características clínicas, tratamiento, evolución y cuidados de enfermería de los pacientes adultos con síndrome de dificultad respiratoria aguda grave, positivos para SARS-CoV-2, hospitalizados en Unidades de Cuidados Intensivos (UCI) durante el primer pico de pandemia en Colombia en 2020. Métodos. Estudio descriptivo multicéntrico con la participación de cuatro hospitales de alto nivel de complejidad en Colombia, que incluyó 473 pacientes adultos, admitidos de forma consecutiva en unidades de cuidados intensivos -UCI-, con diagnóstico confirmado para SARS CoV-2. Se incluyó información sociodemográfica, clínica, comorbilidades, tratamiento y evolución, además de los cuidados de enfermería brindados. Resultados. Del total de pacientes incluidos fallecieron el 43.7%, presentaron neumonía el 88.8% y un 60.2% desarrollaron síndrome de dificultad respiratoria. Las personas que fallecieron en su mayoría fueron hombres, con una mediana de edad de 68.4 años, con mayor frecuencia de comorbilidades (hipertensión, enfermedad cardiovascular, enfermedad pulmonar obstructiva crónica y mayor índice de masa corporal); además ingresaron a UCI con mayor presencia de disnea, menor saturación de oxígeno, y con puntaje mayor de falla multiorgánica. Así mismo, requirieron con más frecuencia de ventilación mecánica, terapia de pronación, uso de vasopresores y terapia de reemplazo renal. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas. Conclusión. Las personas con síndrome de dificultad respiratoria aguda grave por COVID-19 que se hospitalizaron en UCI tuvieron un riesgo elevado de fallecer, especialmente los pacientes de mayor edad, sexo masculino y con comorbilidades cardiovasculares, respiratorias e hipertensión arterial, uso de ventilación mecánica y un puntaje puntaje de SOFA elevado. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas.


Objetivo. Descrever as características clínicas, tratamento, evolução e cuidados de enfermagem dos pacientes adultos com síndrome de dificuldade respiratória aguda grave, positivos para SARS-CoV-2, hospitalizados nas Unidades de tratamentos Intensivos (UTI) durante o primeiro pico de pandemia na Colômbia em 2020. Métodos. Estudo descritivo multicêntrico com a participação de quatro hospitais de alto nível de complexidade na Colômbia, que incluiu 473 pacientes adultos, admitidos de forma consecutiva nas unidades de tratamentos intensivos -UTI-, com diagnóstico confirmado para SARS CoV-2. Se incluiu informação sociodemográfica, clínica, comorbilidades, tratamento e evolução, além dos cuidados de enfermagens brindados. Resultados. Do total de pacientes incluídos faleceram 43.7%, apresentaram pneumonia 88.8% e um 60.2% desenvolveram síndrome de dificuldade respiratória. As pessoas que faleceram em sua maioria foram homens, com uma média de idade de 68.4 anos, com maior frequência de comorbilidades (hipertensão, doença cardiovascular, doença pulmonar obstrutiva crónica e maior índice de massa corporal); ademais ingressaram a UTI com maior presença de dispneia, menor saturação de oxigeno, e com pontuação maior de falha multiorgânica. Assim mesmo, requereram com mais frequência de ventilação mecânica, terapia de pronação, uso de vasopressores e terapia de substituição renal. Os cuidados de enfermagem destes pacientes em estado crítico se enfocaram ao cuidado respiratório e a prevenção de complicações associadas. Conclusão. As pessoas com síndrome de dificuldade respiratória aguda grave por COVID-19 que se hospitalizaram em UTI tinham um elevado risco de morte, especialmente os pacientes mais velhos; os homens; aqueles com comorbilidades cardiovasculares, respiratórias e hipertensão; aqueles que precisavam de ventilação mecânica; e aqueles com um escore SOFA elevado. Os cuidados de enfermagem destes pacientes criticamente doentes concentraram-se nos cuidados respiratórios e na prevenção de complicações associadas.


Subject(s)
Critical Care , COVID-19 , Nursing Care , Colombia
5.
Aquichan ; 22(1): e2216, ene. 26, 2022.
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1353836

ABSTRACT

Introduction: Surviving Intensive Care Unit (ICU) brings positive and negative feelings, depending on each person's experience. Likewise, some patients may present with negative mental and physical consequences after discharge, causing a very complex stay at home. Aim: To understand the experience of critical illness survivors after three months of ICU discharge. Methods: Hermeneutical phenomenological study using in-depth interviews with 15 adult participants after three months of ICU discharge. Data analysis was made considering Cohen, Kahn, and Steeves' procedures. Results: Phenomenological analysis revealed three existential themes: Changes in memory and mood, Changes in day-to-day life, and My body after ICU. Conclusion: Surviving ICU brings with it positive aspects such as winning a battle against death. However, psychological, emotional, and physical consequences after discharge turn it into an exhausting experience.


Introducción: sobrevivir a la Unidad de Cuidados Intensivos (UCI) trae sentimientos positivos y negativos, dependiendo de la experiencia de cada persona. Asimismo, algunos pacientes pueden presentar consecuencias físicas y mentales negativas tras el alta, lo que ocasiona una estadía en casa muy compleja. Objetivo: comprender la experiencia de los sobrevivientes de enfermedades críticas después de tres meses del alta de la UCI. Métodos: estudio fenomenológico hermenéutico mediante entrevistas a profundidad a 15 participantes adultos después de tres meses del alta de la UCI. El análisis de datos se realizó con base en los procedimientos de Cohen, Kahn y Steeves. Resultados: el análisis fenomenológico reveló tres temas existenciales: Cambios en la memoria y el estado de ánimo, Cambios en la vida cotidiana y Mi cuerpo después de la UCI. Conclusión: sobrevivir en la UCI trae consigo aspectos positivos como ganarle una batalla a la muerte; sin embargo, las consecuencias psicológicas, emocionales y físicas tras el alta convierten todo esto en una experiencia agotadora.


Introdução: sobreviver à Unidade de Tratamento Intensivo (UTI) traz sentimentos positivos e negativos, dependendo da experiência de cada um. Além disso, alguns pacientes podem apresentar consequências físicas e mentais negativas após a alta, o que ocasiona um período complexo de repouso domiciliar. Objetivo: compreender a experiência dos sobreviventes de doenças críticas depois de três meses da alta da UTI. Materiais e métodos: estudo fenomenológico hermenêutico mediante entrevistas a profundidade com 15 participantes adultos depois de três meses de receberem alta da UTI. A análise de dados foi realizada com base nos procedimentos de Cohen, Kahn e Steeves. Resultados: a análise fenomenológica revelou três temas existenciais: "mudanças na memória e no humor", "mudanças na vida cotidiana" e "meu corpo depois da UTI". Conclusões: sobreviver à UTI traz consigo aspectos positivos como o sentimento de ter ganhado uma batalha contra a morte; contudo, as consequências psicológicas, emocionais e físicas após receber a alta tornam tudo isso uma experiência exaustiva.


Subject(s)
Patients , Critical Illness , Survivors , Critical Care , Qualitative Research
6.
repert. med. cir ; 31(1): 3-10, 2022. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1363848

ABSTRACT

Introducción: la estadía en la unidad de cuidados intensivos genera cambios en la dinámica familiar causados por las alteraciones en las actividades diarias que obligan a utilizar estrategias que los mitiguen. Objetivo: describir las estrategias de afrontamiento de los familiares de pacientes críticos. Materiales y métodos: revisión integradora de literatura en las bases de datos y metabuscadores PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY, obteniendo 13 artículos: 7 estudios cuantitativos observacionales, 4 cualitativos fenomenológicos y 2 revisiones sistemáticas. Resultados: se determinó que las estrategias más utilizadas por los familiares de pacientes críticos son respuesta emocional, apoyo social, valores y creencias y crisis familiar. La más recurrente en los estudios revisados es la respuesta emocional debido a la implicación afectiva que tiene en los familiares la hospitalización de su ser querido. Conclusión: la respuesta emocional usada por los familiares como estrategia evidencia la necesidad de que los enfermeros garanticen espacios de acercamiento y expresión de sentimientos. Los servicios de salud deben priorizar el trato humanizado y una comunicación acorde con las necesidades de los familiares.


Introduction: the stay in the intensive care unit generates changes in the family dynamics caused by alterations in its daily activities that force the use of strategies that mitigate them. Objective: to describe the coping strategies for the relatives of critically ill patients. Materials and methods: integrative review of the literature in the PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY databases, obtaining 13 articles: 7 quantitative observational studies, 4 qualitative phenomenological studies and 2 systematic reviews. Results: it was determined that the most used strategies by relatives of critically ill patients are emotional response, social support, values and beliefs and family crisis. The most recurrent in the studies reviewed is the emotional response due to the emotional involvement of the family members in the hospitalization of their loved ones. Conclusion: the emotional response used by relatives as a strategy shows the need for nurses to guarantee spaces for approaching and expressing feelings. Health services should prioritize humanized treatment and communication according to the need of family members.


Subject(s)
Social Support , Adaptation, Psychological , Critical Care , Family , Self Efficacy , Intensive Care Units
8.
Rev. baiana enferm ; 36: e46565, 2022. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1376467

ABSTRACT

Objetivo: analisar ações e barreiras dos enfermeiros intensivistas para o exercício da advocacia do paciente. Método: estudo exploratório e descritivo de natureza qualitativa. Os dados foram coletados entre agosto 2018 e fevereiro de 2019, com 75 enfermeiros intensivistas brasileiros. Solicitou-se aos participantes que listassem três situações vivenciadas de necessidade de defesa do paciente cujo resultado foi positivo para o enfermeiro e três situações de necessidade de defesa do paciente cujo resultado foi negativo para o enfermeiro. Os dados foram organizados consoante a Análise de Conteúdo Temática. Resultados: emergiram 3 categorias e 10 subcategorias relacionadas às ações dos enfermeiros, além de 4 categorias e 13 subcategorias relacionadas às barreiras encontradas. Considerações finais: o estudo demonstrou as ações que visibilizaram a atuação autônoma dos enfermeiros intensivistas no exercício da advocacia do paciente e que o exercício de advogar deve buscar superar a imposição de barreiras diariamente encontradas, capazes de impactar na qualidade da assistência.


Objetivo: analizar las acciones y barreras de las enfermeras de cuidados intensivos para practicar la defensa del paciente. Método: estudio exploratorio y descriptivo de carácter cualitativo. Los datos fueron recolectados entre agosto de 2018 y febrero de 2019, con 75 enfermeras brasileñas de cuidados intensivos. Se pidió a los participantes que enumeraran tres situaciones experimentadas en necesidad de defensa del paciente cuyo resultado fue positivo para la enfermera y tres situaciones de necesidad de defensa del paciente cuyo resultado fue negativo para la enfermera. Los datos se organizaron de acuerdo con el análisis de contenido temático. Resultados: surgieron 3 categorías y 10 subcategorías relacionadas con las acciones de las enfermeras, además de 4 categorías y 13 subcategorías relacionadas con las barreras encontradas. Consideraciones finales: el estudio demostró las acciones que visualizaron el desempeño autónomo de las enfermeras de cuidados intensivos en la práctica de la abogacía del paciente y que la práctica de abogar debe buscar superar la imposición de barreras diarias encontradas, capaces de impactar en la calidad de la atención.


Objective: to analyze actions and barriers of intensive care nurses to practice the patient's advocacy. Method: exploratory and descriptive study of qualitative nature. Data were collected between August 2018 and February 2019, with 75 Brazilian intensive care nurses. Participants were asked to list three situations experienced in need of defense of the patient whose result was positive for the nurse and three situations of need for defense of the patient whose result was negative for the nurse. The data were organized according to thematic content analysis. Results: 3 categories and 10 subcategories related to the actions of nurses emerged, in addition to 4 categories and 13 subcategories related to the barriers found. Final considerations: the study demonstrated the actions that visualized the autonomous performance of intensive care nurses in the practice of the patient's advocacy and that the practice of advocating should seek to overcome the imposition of daily barriers found, capable of impacting on the quality of care.


Subject(s)
Humans , Patient Advocacy , Critical Care , Health Advocacy , Barriers to Access of Health Services , Intensive Care Units , Ethics, Nursing
9.
Acta Paul. Enferm. (Online) ; 35: eAPE0245345, 2022.
Article in Portuguese | LILACS, BDENF | ID: biblio-1374029

ABSTRACT

Resumo Objetivo Discutir as relações de poder entre profissionais de saúde em ambientes de cuidado intensivo e sua interferência no processo de construção do conhecimento. Métodos Neste artigo filosófico, exploramos a influência das relações de poder na construção do conhecimento, a partir das perspectivas foucaultiana e crítica de Gramsci e Freire em relação às práticas de enfermagem e cuidados de saúde. Resultados Há quatro fontes de poder organizacional (tomada de decisão, critério, controle de recursos e controle de conhecimento/rede) que atuam em diferentes níveis das organizações de saúde. As unidades de terapia intensiva são um importante segmento do ambiente de saúde, e a complexidade no cotidiano dos profissionais desse setor pode dificultar as relações de poder no processo de construção do conhecimento. Por exemplo, quando profissionais externos à equipe da UTI, que detêm conhecimentos específicos, precisam ser contatados para auxiliar em casos, como durante o processo de doação e transplante de órgãos. Nesta situação, é necessário desconstruir o poder competitivo para construir o poder colaborativo. Conclusão Usando as perspectivas de Freire e Gramsci, argumentamos que a falta de conhecimento contribui para o poder competitivo, que pode ser superado se os indivíduos envolvidos participarem no processo de aprendizagem em direção ao poder colaborativo. Portanto, as estratégias ou ações para lidar com os desequilíbrios de poder interprofissional podem contribuir para a transformação e mudança mútua.


Resumen Objetivo Discutir las relaciones de poder entre profesionales de salud en ambientes de cuidado intensivo y su interferencia en el proceso de construcción del conocimiento. Métodos En este artículo filosófico, exploramos la influencia de las relaciones de poder en la construcción del conocimiento a partir de las perspectivas foucaultianas y la crítica de Gramsci y de Freire en relación con las prácticas de enfermería y los cuidados de salud. Resultados Hay cuatro fuentes de poder organizativo (toma de decisión, criterio, control de recursos y control de conocimiento/red) que actúan en distintos niveles de las organizaciones de salud. Las unidades de cuidados intensivos son un importante sector del ambiente de la salud, y la complejidad en la labor cotidiana de los profesionales de ese sector puede dificultar las relaciones de poder en el proceso de construcción del conocimiento. Por ejemplo, cuando profesionales externos al equipo de la UCI, que tienen conocimientos específicos, tienen que ser contactados para auxiliar en algunos casos, como durante el proceso de donación y trasplante de órganos. En esta situación se hace necesario deconstruir el poder competitivo para construir el poder colaborativo. Conclusión Usando las perspectivas de Freire y de Gramsci, argumentamos que la falta de conocimiento contribuye para el poder competitivo, que se puede superar si los individuos involucrados participan en el proceso de aprendizaje en dirección al poder colaborativo. Por lo tanto, las estrategias o las acciones para hacer frente a los desequilibrios de poder interprofesional pueden contribuir con la transformación y el cambio mutuo.


Abstract Objective To discuss the power relations among health care professionals in acute care settings and its interference in the process of knowledge building. Methods In this philosophical paper, we explored the influence of power relations on knowledge building using a Foucauldian and critical perspective of Gramsci and Freire related to nursing and health care practices. Results There are four sources of organizational power (decision-making, discretion, control of resources, and control of knowledge/network) that act at different levels of healthcare organizations. Intensive care units are an important segment of healthcare setting, and the complexity involved in the daily activities of professionals in this sector can lead to difficult power relations in the process of knowledge building. For instance, when professionals external to the ICU team that hold specific knowledge need to be contacted to help in cases, such as during organ donation and transplantation process. In this situation it is necessary to deconstruct the competitive power in order to build the collaborative power. Conclusion Using Freire's and Gramsci's perspectives we argued that lack of knowledge contributes to competitive power which can be overcome if involved individuals engage in the learning process towards a collaborative power approach. Therefore, strategies or action to address interprofessional power imbalances can contribute mutual transformation and change.


Subject(s)
Humans , Tissue and Organ Procurement , Power, Psychological , Patient-Centered Care , Critical Care , Interprofessional Relations , Professional Autonomy , Health Facility Environment/organization & administration
10.
South. Afr. j. crit. care (Online) ; 38(1): 39-42, 2022. figures, tables
Article in English | AIM | ID: biblio-1371298

ABSTRACT

Background. Professional quality of life, measured as compassion satisfaction, is a prerequisite for nurses working in intensive care units where patients rely on their care. Nurses who experience compassion satisfaction, or good professional quality of life, engage enthusiastically with all work activities and render quality patient care. In contrast, compassion fatigue eventually leads to disengagement from work activities and unsatisfactory patient outcomes. In this study, we described the demographic factors influencing professional quality of life of intensive care nurses working in public hospitals in Gauteng, South Africa (SA), during the first wave of the COVID-19 pandemic. Objective. To describe the demographic factors associated with professional quality of life of critical care nurses working in Gauteng, SA. Methods. In this cross-sectional study, we used total population sampling and invited all nurses who had worked for at least 1 year in one of the critical care units of three selected public hospitals in Gauteng to participate. One-hundred and fifty-four nurses responded and completed the ProQol-5 tool during the first wave of the COVID-19 pandemic. Data were analysed using descriptive and inferential statistics. Results. The nurses' average age was 45 years, and 59.1% (n=91) had an additional qualification in critical care nursing. Most of the nurses had a diploma (51.3%; n=79), with a mean work experience of 12.56 years. The main demographic variables that influenced professional quality of life were years of work experience (p=0.047), nurses' education with specific reference to a bachelor's degree (p=0.006) and nurse-patient ratio (p<0.001). Conclusions. Nurses working in critical care units in public hospitals in Gauteng experienced low to moderate compassion satisfaction, moderate to high burnout and secondary traumatic stress, suggesting compassion fatigue. The high workload, which may have been associated with the COVID-19 pandemic, influenced nurses' professional quality of life.


Subject(s)
Quality of Life , Critical Care , Pandemics , Compassion Fatigue , COVID-19 , Nurses , Demography
11.
Chinese Journal of Surgery ; (12): 321-328, 2022.
Article in Chinese | WPRIM | ID: wpr-927613

ABSTRACT

Parenteral nutrition has become a routine clinical nutritional treatment. The guidelines at home and abroad unanimously recommend and standardize the application of "all in one" parenteral nutrition."Multi-chamber bag" parenteral nutrition encapsulates nutrients such as fat emulsion, amino acid and glucose in a non polyvinyl chloride soft bag composed of two or three cavities. When in use, the inner cavity separator is opened. The multi-chamber bag preparation has a variety of specifications and has the characteristics of reasonable prescription, strict quality standards, ready-to-use, and other characteristics, which can reduce prescription and configuration errors, reduce bloodstream infections, and meet the clinical nutritional needs of most patients. In view of the non-standard application of multi-chamber bag, the Chinese Society for Parenteral and Enteral Nutrition organized domestic experts in general surgery, critical care medicine, gastroenterology, geriatrics, nutrition, clinical pharmacy, and evidence-based medicine to write this expert consensus in accordance with the latest guidelines, expert consensus, and the latest clinical evidence. According to the improved Delphi method, 43 experts discussed and modified 23 recommendations one by one in the first round, and 219 experts voted and put forward modification suggestions in the second round. Each recommendation shall be established only when the approval rate of ≥ 90%. It is hoped that this consensus can promote the rational application of multi-chamber bag for parenteral nutrition.


Subject(s)
Consensus , Critical Care , Enteral Nutrition , Humans , Nutritional Status , Parenteral Nutrition
12.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1361338

ABSTRACT

Objetivo: classificar os pacientes segundo o risco de desenvolvimento de mediastinite no pós-operatório de cirurgia de revascularização do miocárdio. Método: estudo observacional, transversal, realizado na Unidade de Terapia Intensiva Pós-Operatória de um hospital universitário no interior paulista. Amostra consecutiva e não probabilística foi constituída por pacientes adultos, submetidos à revascularização do miocárdio. A coleta de dados foi realizada na alta da Terapia Intensiva, utilizando o Escore de Risco Multivariável para Mediastinite. Para a obtenção do escore foram realizadas análises estatística descritivas. Resultados: participaram do estudo 50 pacientes, 68% do sexo masculino, com média de idade de 62,7 anos. Nenhum paciente foi reoperado ou apresentava doença pulmonar obstrutiva crônica; 26,0% eram obesos; 12,0% apresentaram angina instável e 4,0% foram politransfundidos no pós-operatório. Segundo o escore, 58,0% apresentaram baixo e 42,0% médio risco de desenvolvimento de mediastinite. Conclusão: a maior parte dos pacientes apresentava baixo risco de desenvolvimento de mediastinite


Objective: to classify patients according to the risk of developing mediastinitis in the postoperative period of myocardial revascularization surgery. Method: observational, cross-sectional study, carried out in the Post-Operative Intensive Care Unit of a university hospital in the interior of São Paulo. Consecutive and non-probabilistic sample consisted of adult patients who underwent myocardial revascularization. Data collection was performed at discharge from the Intensive Care, using the Multivariable Risk Score for Mediastinitis. To obtain the score, descriptive statistical analyzes were performed. Results: the50 patients participated in the study, 68% were male, with a mean age of 62.7 years. No patient was reoperated or had chronic obstructive pulmonary disease; 26.0% were obese; 12.0% had unstable angina and 4.0% were transfused in the postoperative period. According to the score, 58.0% had a low and 42.0% medium risk of developing mediastinitis. Conclusion: most patients were at low risk of developing mediastinitis


Objetivo: clasificar a los pacientes según el riesgo de desarrollar mediastinitis en el postoperatorio de cirugía de revascularización miocárdica. Método: estudio observacional, transversal, realizado en la Unidad de Cuidados Intensivos Posoperatorios de un hospital universitario del interior de São Paulo. La muestra consecutiva y no probabilística estuvo constituida por pacientes adultos sometidos a revascularización miocárdica. La recolección de datos se realizó al alta de la Unidad de Cuidados Intensivos, utilizando el Multivariable Risk Score para Mediastinitis. Para obtener la puntuación se realizaron análisis estadísticos descriptivos. Resultados: participaron en el estudio 50 pacientes, el 68% eran varones, con una edad media de 62,7 años. Ningún paciente fue reintervenido ni presentó enfermedad pulmonar obstructiva crónica; El 26,0% eran obesos; El 12,0% presentó angina inestable y el 4,0% recibió transfusión en el postoperatorio. Según el puntaje, el 58.0% tenía un riesgo bajo y el 42.0% medio de desarrollar mediastinitis. Conclusión: la mayoría de los pacientes tenían un riesgo bajo de desarrollar mediastinitis


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Risk Factors , Mediastinitis , Myocardial Revascularization , Postoperative Period , Perioperative Nursing , Critical Care , Pulmonary Disease, Chronic Obstructive , Angina, Unstable
13.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1368446

ABSTRACT

A doença crítica promove um estado hipercatabólico associado a uma resposta inflamatória intensa. Admite-se que essas alterações contribuem para o aumento do gasto de energia e para a elevação do catabolismo proteico. Objetivo: analisar a adequação calórico-proteica da terapia de nutrição enteral e o seu impacto no desfecho clínico de pacientes críticos. Método: Trata-se de um estudo longitudinal prospectivo realizado com 36 pacientes internados em unidades de terapia intensiva. A adequação da oferta calórico-proteica foi obtida pela relação percentual a partir do quarto dia de implementação da terapia nutricional. Realizou-se o teste de Shapiro Wilk para averiguar a normalidade dos dados e a partir disso, foi aplicado o teste de Mann-Whitney ou de t-Student não pareado. Foi realizada a análise de regressão logística com estimativa de seu coeficiente. Para a regressão estimou-se o intervalo de confiança de 95% e nível de significância de 5%. Foi utilizado o software STATA® versão 14.0 nesta análise. Resultados: Ao avaliar 36 pacientes verificou-se que a sobrevida foi menor entre os indivíduos que apresentaram o menor percentual de adequação calórica (p=0,010) e proteica (p=<0,001). Observou-se que oferta proteica impactou mais expressivamente os desfechos clínicos, ao aumento de 1% na média de adequação proteica as chances de óbito diminuíram 21%. Conclusão: O menor percentual de adequação calórico-proteica foi associado a menor sobrevida de pacientes críticos. Ainda, observou-se que o percentual de adequação proteica se associou mais expressivamente aos desfechos clínicos nessa amostra


The critical illness promotes a hypercatabolic state associated with an intense inflammatory response. It is recognized that those changes contribute to the rise of consumption of energy expenditure and to protein metabolism rise. Objective: to analyze the adequacy caloric-protein of enteral nutrition therapy and its impact on the clinical outcome of critical patients. Method: This is a prospective longitudinal study conducted with 36 hospitalized patients in intensive care units. The caloric-protein adequacy was acquired by percent ratio from the fourth day of nutritional therapy implementation. The Shapiro Wilk test was performed to check the data normality and based on that the Mann-Whitney test or unpaired Student t test was applied. The logistic regression analysis was performed with an estimate of its coefficient. For regression, it was estimated the confidence interval of 95% and significance level of 5%. In this analysis was utilized the STATA® software version 14.0. Results: In the evaluation of 36 patients, it was found that survival was lower among the individuals who had the lower percentage of caloric adequacy (p=0,010) and protein (p=<0,001). It was observed that the protein supply impacted expressively the clinical outcome with an increase of 1% in the average protein adequacy, the chances of death decreased by 21%. Conclusion: The lower percentage of caloric-protein adequacy was associated with lower mortality of critical patients. In addition, in this sampling, it was observed that the protein adequacy percentual joined expressively in the clinical outcome


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Enteral Nutrition , Protein-Energy Malnutrition/therapy , Critical Care , Nutrition Therapy , Longitudinal Studies , Sepsis/therapy , COVID-19/therapy , Inpatients
14.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1379114

ABSTRACT

A terapia nutricional é uma das intervenções terapêuticas mais utilizadas em cuidados intensivos, quando aplicada de forma correta auxilia na diminuição de complicações metabólicas, no equilíbrio imunológico, além de amenizar a perda de massa corporal do paciente gravemente enfermo. Objetivo: avaliar a associação dos indicadores antropométricos e o consumo proteico com o desfecho clínico de pacientes críticos em uso de terapia nutricional enteral (TNE) exclusiva. Materiais e Métodos: Trata-se de um estudo prospectivo de caráter observacional analítico, com a utilização de dados de pacientes adultos e idosos em uso exclusivo de TNE desenvolvido em uma Unidade de Terapia Intensiva (UTI). Realizado por meio da coleta de dados secundários registrados nos prontuários de pacientes ≥ 18 anos, que receberam terapia nutricional enteral exclusiva por pelo menos 72 horas. Utilizou-se os indicadores antropométricos índice de massa corporal (IMC) e circunferência do braço. Para a estimativa das necessidades proteicas, considerou-se a recomendação da American Society for Parenteral and Enteral Nutrition. A adequação nutricional foi realizada por meio da coleta diária do volume da formula enteral prescrita e administrada. Nas análises utilizaram-se testes paramétricos e não paramétricos e foi considerado significante p < 0,05. Resultado: Participaram do estudo 52 pacientes que estiveram em uso de nutrição enteral exclusiva internados na UTI no hospital por pelo menos de 72 horas durante a etapa de coleta de dados. Desses pacientes a maioria era do sexo masculino (76,9%), com idade média de 45,7 anos (DP=15,0, mínimo 20 e máximo 71). O tempo de internação médio foi de 12 dias. Os diagnósticos de AIDS (síndrome da imunodeficiência adquirida) (46,1%) e COVID-19 (13,4%) foram os mais prevalentes. Foram identificados que quase 60% da amostra não tinham comorbidades e o desfecho clínico mais frequente foi a alta hospitalar. Conclusão: Neste estudo não foi verificado associações entre os desfechos clínicos avaliados (alta ou óbito) com o aporte proteico ofertado e os indicadores antropométricos, assim também como não tiveram entre as variáveis demográficas e clínicas investigadas


Nutritional therapy is one of the most used therapeutic interventions in intensive care, when correctly applied, it helps to reduce metabolic complications, immune balance, in addition to mitigating the loss of body mass in seriously ill patients. Objective: to evaluate the association of anthropometric indicators and protein consumption with the clinical outcome of critically ill patients using exclusive enteral nutritional therapy (EN). Materials and Methods: This is a prospective, observational, analytical study, using data from adult and elderly patients exclusively using EN developed in an Intensive Care Unit (ICU). Performed by collecting secondary data recorded in the medical records of patients ≥ 18 years old, who received exclusive enteral nutritional therapy for at least 72 hours. Anthropometric indicators body mass index (BMI) and arm circumference were used. For the estimation of protein requirements, the recommendation of the American Society for Parenteral and Enteral Nutrition was considered. Nutritional adequacy was performed through the daily collection of the volume of the prescribed and administered enteral formula. Parametric and non-parametric tests were used in the analyses, and p < 0.05 was considered significant. Result: The study included 52 patients who had been using exclusive enteral nutrition and were hospitalized in the ICU for at least 72 hours during the data collection stage. Of these patients, the majority were male (76.9%), with a mean age of 45.7 years (SD=15.0, minimum 20 and maximum 71). The mean hospital stay was 12 days. The diagnoses of AIDS (acquired immunodeficiency syndrome) (46.1%) and COVID-19 (13.4%) were the most prevalent. It was identified that almost 60% of the sample had no comorbidities and the most frequent clinical outcome was hospital discharge. Conclusion: In this study, there were no associations between the evaluated clinical outcomes (discharge or death) with the protein intake offered and the anthropometric indicators, as well as they did not have between the demographic and clinical variables investigated


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Enteral Nutrition , Critical Care , Nutrition Therapy , Protein Deficiency , Communicable Diseases
15.
Cambios rev. méd ; 20(2): 19-24, 30 Diciembre 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1368220

ABSTRACT

INTRODUCCION. El paciente crítico presenta mayor riesgo de lesiones por presión, su incidencia en cuidados intensivos continúa elevada y variable, a pesar de su prevención. En Ecuador se desconoce la realidad de esta complicación. OBJETIVO. Realizar una caracterización demográfica y epidemiológica a los pacientes críticos con lesiones por presión. MATERIALES Y MÉTODOS. Estudio descriptivo, retrospectivo. De una población de 2 087 ingresados en la Unidad de Adultos Área de Cuidados Intensivos del Hospital de Especialidades Carlos Andrade Marín, se recolectaron datos demográficos y epidemiológicos de 147 registros de historias clínicas físicas y electrónicas de pacientes que presentaron lesiones por presión, en el periodo 01 de enero al 31 diciembre 2018. Los datos fueron analizados en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 22. RESULTADOS. La mediana de edad fue 66 años; sexo hombre 63,3%, pre obesidad 40,8%, hipertensos 37,6% y diabéticos 23,8%. Más del 60,0% recibieron ventilación mecánica invasiva, sedantes y drogas vasoactivas, la mediana del Acute Physiology and Chronic Health disease Classification System II fue 20 (IQ 14-27), mortalidad 34,0%. La prevalencia de lesiones por presión fue 7,0% y la incidencia 3,49%. En la localización de las lesiones por presión: en región sacra 62,6%, talón 24,0% y cara 7,5%; 59,2% estadío 2 y 5,4% estadío 3. Al comparar los grupos de lesiones por presión no adquiridas versus adquiridas hubo diferencia estadísticamente significativa en duración de hospitalización previa a la detección de lesiones por presión (p<0,001), duración de hospitalización (p=0,003), localización de lesiones por presión en sacro (p=0,02), cara (p=0,02) y estadío 3 de lesiones por presión (p=0,03), en el resto de variables no se encontró diferencias. CONCLUSIÓN. La prevalencia de lesiones por presión está en los estándares aceptados a nivel internacional, su frecuencia y estadíos son similares a otros reportes, gracias a las medidas de prevención y control adoptadas por la Unidad.


INTRODUCTION. A patient at a critical situation has a higher risk of pressure injuries, and their incidence in intensive care continues being high and variable, despite its prevention. In Ecuador the reality of this complication is unknown. OBJECTIVE. To perform a demographic and epidemiological characterization of critically ill patients with pressure injuries. MATERIALS AND METHODS. Descriptive, retrospective study. From a population of 2 087 admitted to the Adult Unit Intensive Care Area of the Carlos Andrade Marín Specialties Hospital, demographic and epidemiological data were collected from 147 records of physical and electronic Medical Records of patients who pressure injuries, in the period January 1 to December 31, 2018. The data were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 22. RESULTS. Median age was 66 years; male sex 63,3%, pre-obese 40,8%, hypertensive 37,6% and diabetic 23,8%. More than 60,0% received invasive mechanical ventilation, sedatives and vasoactive drugs, the median of the Acute Physiology and Chronic Health disease Classification System II was 20 (IQ 14-27), mortality 34,0%. The prevalence of pressure injuries was 7,0% and incidence 3,49%. The location of pressure injuries were: the sacral region 62,6%, heel 24,0% and face 7,5%; 59,2% stage 2 and 5,4% stage 3. When comparing the groups of non-acquired versus acquired pressure lesions, there was a statistically significant difference in hospital-stay lengths prior to the detection of pressure lesions (p<0,001), hospital-stay lengths (p=0,003), location of pressure lesions in sacrum (p=0,02), face (p=0,02) and stage 3 of pressure lesions (p=0,03); no differences were found in the rest of the variables. CONCLUSION. The prevalence of pressure injuries remains within international accepted standards, their frequency and stages are similar to other reports.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Skin , Ulcer , Critical Illness , Skin Care , Pressure Ulcer , Intensive Care Units , Respiration, Artificial , Sacrococcygeal Region , Wounds and Injuries , Heel , Comorbidity , Demography , Critical Care , Ecuador , Face , Critical Care Nursing , Analgesia
16.
Cambios rev. méd ; 20(2): 74-79, 30 Diciembre 2021. ilus, tabs.
Article in Spanish | LILACS | ID: biblio-1368362

ABSTRACT

INTRODUCCIÓN. El posicionamiento prono es una de las estrategias ventilatorias más estudiadas y difundidas de la medicina intensiva, forma parte del manejo de ventilación protectiva con impacto en disminución de la mortalidad en pacientes con síndrome de dificultad respiratoria aguda. OBJETIVO. Revisar la evidencia disponible acerca de ventilación en posición prona en pacientes con síndrome de dificultad respiratoria aguda, enfocada en el análisis fisiopatológico y clínico. MATERIALES Y MÉTODOS. Se realizó una revisión bibliográfica en la base de datos de buscadores académicos como PubMed, Google Scholar y Elsevier, en los idiomas español e inglés, en el período comprendido entre los años 1970-2020; se seleccionaron 16 publicaciones en texto completo: 3 metaanálisis, 10 estudios randomizado, 3 revisiones sistemáticas. CONCLUSIÓN. En base a la evidencia y percepción recopilada de la experiencia de los autores, la ventilación en posición prona es una estrategia de manejo de primera línea, fiable, que no requiere para su empleo equipamiento costoso ni complejo y ha demostrado mejoría en desenlaces relevantes en el tratamiento del paciente crítico respiratorio como disminución en la mortalidad y optimización de los parámetros ventilatorios y de oxigenación.


INTRODUCTION. Prone positioning is one of the most studied and widespread ventilatory strategies in intensive medicine, it is part of protective ventilation management with an impact on mortality reduction in patients with acute respiratory distress syndrome. OBJECTIVE. To review the available evidence about ventilation in the prone position in patients with acute respiratory distress syndrome, focused on the pathophysiological and clinical analysis. MATERIALS AND METHODS. A bibliographic review was carried out in the databases of academic search engines such as PubMed, Google Scholar and Elsevier, in the Spanish and English languages, in the period between the years 1970-2020, 16 full text publications were selected: 3 meta-analyses, 10 randomized studies, 3 systematic reviews. CONCLUSION. Based on the evidence and perception gathered from the authors' experience, prone ventilation is a reliable first-line management strategy that does not require costly or complex equipment for its use and has demonstrated improvements in relevant outcomes in the treatment of the critically ill respiratory patient, such as decreased mortality and optimization of ventilatory and oxygenation parameters.


Subject(s)
Humans , Male , Female , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Ventilators, Mechanical , Mortality , Prone Position , Critical Care , Oxygenation , Severe Acute Respiratory Syndrome , Alveolar Process , Interactive Ventilatory Support , COVID-19 , Intensive Care Units
17.
Rev. colomb. anestesiol ; 49(4): e303, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341242

ABSTRACT

Abstract Life support withdrawal can be a challenging decision, but it should be considered as an option when death is inevitable or recovery to an acceptable quality of life is not possible. The process is beset by obstacles that must be overcome to finally offer patients comfort and a peaceful death. In this article, we offer a series of tools that seek to solve the challenges of palliative extubation, as well as a protocol that could facilitate the decision to withdraw life support, making palliative extubation an alternative to consider instead of artificially prolonging life at the expense of unacceptable human and economic costs.


Resumen La interrupción de la asistencia vital puede ser una decisión complicada, aun cuando se debe considerar como una opción cuando la muerte es inevitable o la recuperación a una calidad de vida aceptable no es posible. A lo largo del proceso se encuentran obstáculos que se deben sortear para finalmente ofrecer a los pacientes una muerte tranquila y confortable. En este artículo ofrecemos una serie de herramientas que buscan solucionar los desafíos de la extubación paliativa y presentamos una guía de extubación que podría facilitar la decisión de retiro del soporte vital, haciendo de la extubación paliativa una alternativa por considerar en lugar de prolongar la vida de manera artificial a expensas de un costo humano y económico inaceptable.


Subject(s)
Humans , Palliative Care , Right to Die , Airway Extubation , Life Support Care , Quality of Life , Critical Care , Guidelines as Topic/prevention & control
18.
Rev. argent. cir ; 113(4): 453-459, dic. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1356954

ABSTRACT

RESUMEN El control de daños es un procedimiento en tres etapas en pacientes con riesgo vital. Primera etapa: laparotomía abreviada para el control de sangrados y contaminación. Segunda etapa: en cuidados críticos para corregir alteraciones fisiológicas y tercera etapa: con resolución definitiva de las lesiones. Se describió el empaquetamiento (packing) torácico como adaptación del empaquetamiento abdominal como procedimiento contemporizador y hemostático. El objetivo fue presentar nuestra experiencia con la cirugía de empaquetamiento torácico y mostrar su utilidad en la cirugía de control de daños en tórax. Las lesiones traumáticas de tórax pueden ir desde lesiones de leve entidad hasta lesiones graves que amenacen la vida del paciente. La decisión de empaquetar el tórax se adopta al tomar contacto con un paciente "in extremis". En conclusión, el empaquetamiento torácico se muestra eficaz para el control del sangrado en pacientes que no admiten medidas definitivas para él.


ABSTRACT Damage control is defined as an approach with 3 stages in patients with life-threatening injuries. Stage I: abbreviated laparotomy for hemorrhage and contamination control. Stage II: intensive care management to correct physiologic abnormalities; and stage III: definitive repair of injuries. Thoracic packing, an adaptation of abdominal packing, was described as a temporary procedure for hemostatic control. The aim of this study is to report our experience with thoracic packing and show its usefulness in thoracic damage control surgery. Traumatic chest injuries vary from minor trauma to life-threatening injuries. The decision to perform thoracic packing is made during the contact with a critically ill patient. In conclusion, packing is effective for bleeding control in critically ill patients who are not suitable for definitive treatment.


Subject(s)
Shock, Hemorrhagic , Thoracic Surgery , Emergencies , Emergency Medicine , Wounds and Injuries , Critical Illness , Critical Care , Adaptation to Disasters , Environmental Pollution , Surgical Wound
19.
Biomédica (Bogotá) ; 41(4): 803-809, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1355751

ABSTRACT

Resumen | El monitoreo electroencefalográfico no invasivo continuo es una técnica indispensable en los pacientes neurológicos críticos, ya que muestra de forma directa e indirecta su actividad cerebral y permite relacionar los hallazgos con su estado clínico. Es muy sensible, aunque su especificidad es menor, por lo que puede demostrar la alteración del estado de conciencia sin aclarar su etiología. El uso del registro electroencefalográfico continuo en pacientes con alteraciones del estado de conciencia, convulsiones, o estado epiléptico convulsivo y no convulsivo, se ha incrementado en los últimos años porque permite obtener información en tiempo real de la función cerebral y de los cambios en el tiempo; además, facilita la detección de crisis epilépticas subclínicas y electrográficas, estas últimas de gran importancia, ya que no presentan correlación clínica. Los hallazgos del monitoreo permiten modificar el tratamiento farmacológico y anticonvulsivo, y constituyen una gran ventaja para el médico tratante en la toma de decisiones oportunas que redunden en la mejoría del pronóstico del paciente.


Abstract | Continuous non-invasive electroencephalographic monitoring is an essential technique for critical care patients as it shows directly and indirectly the patient's brain activity and makes it possible to relate it with findings in the clinical status. It is highly sensitive, although its specificity is lower, so they can show alterations of the state of consciousness without clarifying the etiology. Continuous electroencephalographic recording in patients with altered levels of consciousness, seizures, and convulsive and non-convulsive status epilepticus has been increasing in recent years as real-time feedback of the cerebral function shows evolution changes and allows for the identification of electric and subclinical epileptic seizures that are highly important since they do not have clinical correlations. These findings in electroencephalographic monitoring also help to modify pharmacological and antiseizure treatments. For practitioners, they are advantageous when making timely decisions that impact the prognosis of the patient.


Subject(s)
Critical Care , Environmental Monitoring , Electroencephalography , Spectrum Analysis , Oximetry
20.
Enferm. foco (Brasília) ; 12(3): 560-566, dez. 2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1352857

ABSTRACT

Objetivo: compreender o conhecimento de enfermeiras sobre a sucção não nutritiva no manejo da dor do recém-nascido. Métodos: pesquisa qualitativa. Participaram 31 enfermeiras, a partir de entrevistas, seguindo um roteiro semiestruturado, cujos dados foram submetidos à análise temática. Resultados: dos dados emergiram duas categorias temáticas: conhecimento sobre a sucção não nutritiva com glicose a 25% para o manejo da dor do recém-nascido; conhecimento sobre a técnica da sucção não nutritiva com glicose a 25%. Conclusão: a sucção não nutritiva, associada à glicose a 25% como método de analgesia não farmacológica para o manejo da dor em recém-nascidos, foi a mais indicada pelas enfermeiras. Todavia, sua aplicabilidade na prática clínica neonatal, ainda é um desafio no que tange à padronização desta medida quanto à dose, o tempo e o tipo de sucção. (AU)


Objective: To understand the nurses' knowledge about non-nutritive sucking in the newborn's pain management. Methods: Qualitative research. Were included 31 interviews from nurses, following a semi-structured script and the data were submitted to thematic analysis. Results: From the data resulted two thematic categories: knowledge about non-nutritive sucking with 25% glucose in the newborn's pain management; knowledge about non-nutritive tecnic of sucking with 25% glucose. Conclusion: The non-nutritive sucking, associated to 25% glucoses as a method of non-pharmacological analgesia in the newborn's pain management, were the most indicated from the nurses. However, the applicability in the clinical neonatal practice is still a challenge regarging the standardization of this tecnic in terms of dose, time, and type of suctions. (AU)


Objetivo: Comprender los conocimientos de las enfermeras sobre la succión no nutritiva en el manejo del dolor neonatal. Métodos: Investigación cualitativa. Participaron 31 enfermeros, a partir de entrevistas, siguiendo un guión semiestructurado, cuyos datos fueron sometidos a análisis temático. Resultados: De los datos surgieron dos categorías temáticas: conocimientos sobre la succión no nutritiva con glucosa al 25% para el manejo del dolor neonatal; Conocimientos sobre la técnica de succión no nutritiva con glucosa al 25%. Conclusión: La succión no nutritiva, asociada a glucosa al 25% como método de analgesia no farmacológica para el manejo del dolor en recién nacidos, fue la más indicada por las enfermeras. Sin embargo, su aplicabilidad en la práctica clínica neonatal sigue siendo un desafío en cuanto a la estandarización de esta medida en cuanto a dosis, tiempo y tipo de succión. (AU)


Subject(s)
Nursing , Pain , Infant, Newborn , Critical Care
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