ABSTRACT
Background: In refractory respiratory failure (RF), extracorporeal membrane oxygenation (ECMO) is a salvage therapy that seeks to reduce lung injury induced by mechanical ventilation. The parameters of optimal mechanical ventilation in children during ECMO are not known. Pulmonary ventilatory management during this therapy may impact mortality. The objective of this study was to evaluate the association between ventilatory parameters in children during ECMO therapy and in-hospital mortality. Methods: A systematic search of PubMed/MEDLINE, Embase, Cochrane, and Google Scholar from January 2013 until May 2022 (PROSPERO 450744), including studies in children with ECMO-supported RF assessing mechanical ventilation parameters, was conducted. Risk of bias was assessed using the Newcastle-Ottawa scale; heterogeneity, with absence <25% and high >75%, was assessed using I2. Sensitivity and subgroup analyses using the Mantel-Haenszel random-effects model were performed to explore the impact of methodological quality on effect size. Results: Six studies were included. The median age was 3.4 years (IQR: 3.2-4.2). Survival in the 28-day studies was 69%. Mechanical ventilation parameters associated with higher mortality were a very low tidal volume ventilation (<4â ml/kg; OR: 4.70; 95% CI: 2.91-7.59; p < 0.01; I2: 38%), high plateau pressure (mean Dif: -0.70 95% CI: -0.18, -0.22; p < 0.01), and high driving pressure (mean Dif: -0.96 95% CI: -1.83, -0.09: p = 0.03). The inspired fraction of oxygen (p = 0.09) and end-expiratory pressure (p = 0.69) were not associated with higher mortality. Patients who survived had less multiple organ failure (p < 0.01). Conclusion: The mechanical ventilation variables associated with higher mortality in children with ECMO-supported respiratory failure are high plateau pressures, high driving pressure and very low tidal volume ventilation. No association between mortality and other parameters of the mechanical ventilator, such as the inspired fraction of oxygen or end-expiratory pressure, was found. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450744, PROSPERO 2023 (CRD42023450744).
ABSTRACT
BACKGROUND: A growing body of literature has showed the need to minimize the impact of rotating shiftwork (RS) on health of shift-healthcare workers (HCWs). OBJECTIVE: The aims of the study were: 1) assessing the occupational risk associated with RS program in HCWs employed in 24 hours hospital wards 2) testing the feasibility of the questionnaire used. METHODS: The Rotating Shiftwork Questionnaire (RSQ) was implemented to assess the RS risk (RSR); the analysis was addressed to: 1) Sentinel events (SE) and 2) Risk factors (RF). The RSQ was administered to the specialist nursing coordinators in eighteen hospitals in Italy with the aim to evaluate the RSR index among nurses in 24 hours hospital wards. RESULTS: Eighteen structures participated in the multicenter study, of which 12 (66.7%) were public. Concerning the Rotating Shiftwork Risk index, there are the 78.8% of observations in the intermediate zone, with RSR scores ranging from 14.1 and 16 and in the high score area (RSRâ>â26) in which there are 4 observations equal to the 21.2% of the total. The multivariate analysis showed that the only significant variable associated with RF score was the macro-area (for Northern regionsbetaâ=â-0.651; pâ=â0.008). CONCLUSIONS: RSQ has been shown a feasible and applicable tool to analyze the RSR in healthcare sector through the detection of quantitative data involving indicators of the risk. The questionnaire allowed to identify improvement actions targeted at minimizing specific critical issues through strategic interventions focused on organizational environment.
Subject(s)
Shift Work Schedule , Health Personnel , Hospitals , Humans , Risk Factors , Shift Work Schedule/adverse effects , Surveys and Questionnaires , Work Schedule ToleranceABSTRACT
Resumen Introducción. El masaje es una estrategia terapéutica estudiada por diferentes profesionales de la salud y de la cual la literatura reporta efectos que redundan en el bienestar físico y emocional del niño. Objetivo. Describir el estado del arte en relación con los efectos que genera la aplicación de masaje terapéutico sobre la ansiedad y el estrés en población pediátrica a partir de la evidencia disponible. Materiales y métodos. Revisión sistematizada que incluyó artículos de naturaleza experimental, en su mayoría ensayos clínicos aleatorizados evaluados mediante la escala PEDro. Las bases de datos consultadas fueron EBSCO, Embase, ScienceDirect, PubMed, BVS y PEDro. Resultados. En total, se seleccionaron 7 artículos, incluyendo 4 ensayos clínicos aleatorizados y 3 cuasi experimentales. Conclusiones. La literatura reporta efectos beneficiosos del masaje terapéutico aplicado en población pediátrica; entre ellos, disminución de los niveles de cortisol, mejor adaptación de respuestas fisiológicas frente a estresores, ganancia de peso y mejor organización comportamental y del sueño. Dichos efectos se potencializan al aplicar presión moderada, en comparación con técnicas de masaje realizadas con presión ligera.
Abstract Introduction: Massages are a therapeutic strategy studied by different health professionals. Literature has reported positive effects on the physical and the emotional well-being of children. Objective: To describe the state of the art regarding the effects of therapeutic massages on anxiety and stress relief in the pediatric population based on the available evidence. Materials and methods: Systematic review including experimental articles, mostly randomized clinical trials, evaluated using the PEDro scale. The databases consulted were EBSCO, Embase, ScienceDirect, PubMed, VHL and PEDro. Results: Seven articles were selected, including 4 randomized and 3 quasi-experimental clinical trials. Conclusions: The literature reports beneficial effects of therapeutic massages on the pediatric population, including decreased cortisol levels, better adaptation of physiological responses to stressors, weight gain and better behavioral and sleep patterns. These effects are potentiated by moderate pressure, compared to massage techniques performed with light pressure.
