Interrupções e distrações durante a preparação e administração de medicamentos de alto risco: Estudo transversal / Interruptions and distractions during the preparation and administration of high-risk medications: A cross-sectional study / Distracciones e interrupciones durante la preparación y administración de medicamentos de alto riesgo: Estudio transversal

Resumo Enquadramento: Estudos indicam que as interrupções contribuem para erros clínicos e falhas em procedimentos. Objetivo: Analisar as interrupções vivenciadas pelos enfermeiros durante a preparação e administração de medicamentos de alto risco. Metodologia: Foi realizado um estudo transversal numa unidade de cuidados intensivos e numa unidade de internamento. As interrupções vivenciadas pelos enfermeiros durante o processo de medicação foram observadas com a ajuda de duas checklists. A amostra foi selecionada por conveniência em abril e maio de 2019. Os dados quantitativos foram analisados através de estatística descritiva no programa IBM SPSS Statistics, versão 24.0, enquanto os dados qualitativos foram tratados por meio da análise de conteúdo. Resultados: Observaram-se 137 interrupções em 193 processos de medicação. A maioria das interrupções foi iniciada por outros membros da equipa de cuidados de saúde por meio de conversas. Estas interrupções foram maioritariamente prejudiciais e ocorreram durante a fase de preparação. A estratégia multitarefa foi utilizada para as gerir. Conclusão: As interrupções ocorridas durante o processo de medicação eram maioritariamente associadas com comunicações profissionais e sociais. A sua relevância diferiu consoante a fase do processo.

Abstract Background: Interruptions have been reported to contribute to clinical errors and procedural failures. Objective: To analyze the interruptions experienced by nurses during the preparation and administration of high-risk medications. Methodology: A cross-sectional study was conducted in an intensive care and inpatient unit. The interruptions experienced by nurses during the medication process were observed through two checklists. The sample was selected by convenience in April-May 2019. Descriptive statistics was used to analyze quantitative data in IBM SPSS Statistics software, version 24.0, while content analysis was used to analyze qualitative data. Results: In 193 medication processes, there were 137 interruptions. Other members of the healthcare team initiated most interruptions through conversations. These interruptions were mostly negative and occurred during the preparation phase. The multitasking strategy was used to manage them. Conclusion: Interruptions during the medication process were primarily associated with professional and social communications. The impact of these interruptions varied depending on the phase of the process.

Resumen Marco contextual: Se ha reportado la participación de distracciones en errores clínicos y fallos de procedimiento. Objetivo: Analizar las distracciones del personal de enfermería durante la preparación y administración de fármacos de alto riesgo. Metodología: Estudio transversal desarrollado en una unidad de cuidados intensivos y una unidad de hospitalización. Se observaron distracciones del personal de enfermería durante el proceso de medicación a través de dos listas de control. La muestra fue seleccionada por conveniencia (abril-mayo 2019). Los datos cuantitativos se analizaron mediante estadística descriptiva (IBM SPSS Statistics, versión 24.0). Los datos cualitativos se analizaron mediante análisis de contenido. Resultados: Hubo 137 distracciones en 193 procesos de medicación. La mayoría de las distracciones fueron iniciadas por otros miembros del equipo sanitario a través de conversaciones. La mayoría se produjeron en la fase de preparación y fueron negativas y se gestionaron mediante la estrategia multitarea. Conclusión: Las distracciones durante el proceso de medicación se referían principalmente a las comunicaciones profesionales y sociales. La importancia de esas distracciones variaba en función de la fase del proceso.

[Postpartum progression of anxiety and depression levels in mothers of premature newborns]. / Progresión posparto de los niveles de ansiedad y depresión en madres de recién nacidos prematuros.

OBJECTIVE: The postpartum period represents a vulnerable time for women's mental health, especially for those with complications and prematurity. This study aims to explore the evolution of depression and anxiety levels during the 12 weeks postpartum in mothers of premature babies. DESIGN: Prospective study of two parallel cohorts. SETTING: Hospital Clínic of Barcelona. PARTICIPANTS: Women with obstetric complications [premature rupture of membranes or preeclampsia] requiring hospitalization and preterm delivery (< 37 weeks of gestation); 2) Women without complications with term delivery. MAIN MEASURES: Validated questionnaires were administered to measure anxiety (State-Trait Anxiety Inventory, STAI) and depression (Edinburgh Postnatal Depression Scale, EPDS) during the first week, and at 6 and 12 weeks postpartum. RESULTS: 182 women were analyzed: 90 with uncomplicated pregnancies and term deliveries, and 92 with complications requiring preterm delivery. During the follow-up, women with premature newborns showed a significantly unfavorable progression in depression (p <0.001) and anxiety (p <0.001) scores, as well as a higher proportion of abnormal scores on both scales (p <0.001 and p=0.004, respectively) CONCLUSIONS: Women with preterm delivery show higher anxiety and depression levels than those with term delivery during the 12 weeks postpartum. It is essential to ensure a seamless transition between care levels to effectively address postpartum mental health.

Patient safety in the intensive care department.

Patient safety is a priority for all healthcare systems. Despite this, too many patients still suffer harm as a consequence of healthcare. Furthermore, it has a significant impact on family members, professionals and healthcare institutions, resulting in considerable economic costs. The critically ill patient is particularly vulnerable to adverse events. Numerous safe practices have been implemented, acknowledging the influence of human factors on safety and the significance of the well-being of professionals, as well as the impact of critical episodes at hospital discharge on patients and their families. Training and engagement of professionals, patients and families are of paramount importance. Recently, artificial intelligence has demonstrated its ability to enhance clinical safety. This update on "Patient Safety" reviews all these aspects related to one of the most pivotal dimensions of healthcare quality.

Blood-sparing techniques prevalence in adult intensive care units: A multicentre survey study.

INTRODUCTION: Anaemia is a common condition in patients admitted to intensive care units (ICUs). It is also well known that a significant amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing, and the manufacture, storage, and distribution of blood components. To mitigate this, prevention strategies such as blood-sparing techniques are available. There is a lack of knowledge regarding the use of such techniques in ICUs in Spain and Latin America, healthcare systems with very different health expenditures per capita. The aim is to assess the degree of implementation of blood-sparing techniques in these regions. METHODS: Cross-sectional online multicentre survey. 251 ICUs in Spain and 53 in Latin America (20 in Argentina, 20 in Colombia, 13 in Ecuador) participated. A 20-item survey on the use of point-of-care, small-volume tubes (SVT), and closed-blood sampling devices (CBSD) was validated. Effect sizes were calculated using Phi (φ) or Cramer's V (V). RESULTS: A response rate of 77% was obtained for Spain and 96% for Latin America. In Spain, the majority of ICUs were affiliated with public hospitals (88.1%, 171/194) while in Latin America, most were associated with private hospitals (56.9%, 29/51). Regarding the use of point-of-care testing, 67.5% of Spanish ICUs, compared to 35.3% of Latin Americans, reported frequent use (V=0.343). In 91.7% of Spanish ICUs and 58.9% of Latin Americans, SVTs were rarely or never used (V=0.380). The use of CBSD was significantly lower in Spain for both arterial and central venous catheters (V=0.336). Private hospitals used more CBSD in arterial catheter than public ones (27% vs 8.3%, V=0.278). CONCLUSION: Point-of-care testing can be improved in Latin America, while the use of CBSD and small-volume tubes can be enhanced in Spain. Private hospitals tend to implement blood-sparing techniques more effectively than public hospitals.

Bronchodilator administration by pressurized inhaler during invasive mechanical ventilation in adults: A scoping review. / [Artículo traducido] Administración de broncodilatadores mediante inhalador de dosis medida durante la ventilación mecánica invasiva: una revisión sistemática exploratoria.

OBJECTIVE: To identify the administration characteristics and connection methods of bronchodilators by pressurized inhalers to the ventilatory circuit of patients under invasive mechanical ventilation. METHODS: A scope review was conducted following the PRISMA for Scoping Review, using the PubMed, Embase Elsevier, Cochrane Library, and Lilacs databases without language restrictions, up to July 2023. Eligible sources included reviews and consensuses (based on clinical studies), experimental and observational studies involving adult patients admitted to the Intensive Care Unit and undergoing invasive mechanical ventilation, regardless of the underlying condition, who used bronchodilator drugs contained in pressurized inhalers. Information regarding inhalation technique, pressurized inhalers connection mode to the circuit, and patient care were collected by two researchers independently, with discrepancies resolved by a third reviewer. Studies involving bronchodilators combined with other pharmacological classes in the same device, as well as reviews containing preclinical studies, were excluded. RESULTS: In total, 23 publications were included, comprising 19 clinical trials and 4 non-randomized experimental studies. Salbutamol (albuterol) was the bronchodilator of study in the majority of the articles (n=18), and the spacer device was the most commonly used to connect the pressurized inhaler to the circuit (n=15), followed by an in-line adapter (n=3) and a direct-acting device without chamber (n=3). Concerning the pressurized inhaler placement in the circuit, 18 studies positioned it in the inspiratory limb, and 19 studies synchronized the jet actuation with the start of the inspiratory phase. Agitation of the pressurized inhaler before each actuation, waiting time between actuations, airway suction before administration, and semi-recumbent patient positioning were the most commonly described measures across the studies. CONCLUSIONS: This review provided insights into the aspects related to inhalation technique in mechanically ventilated patients, as well as the most prevalent findings and the existing gaps in knowledge regarding bronchodilator administration in this context. The evidence indicates the need for further research on this subject.

Analysis of medication errors in Neonatal Intensive Care: A systematic review.

Medication errors, potentially causing harm and causing harm, increase significantly in newborns cared for in intensive care settings. In this sense, this work carries out a systematic review to analyze the most current evidence in relation to medication errors in neonatal intensive care, discussing the topics that refer to health technology from smart pumps, cost-effectiveness of medications, the practice of nursing professionals on the medication administration process and quality improvement models. In this way, it could be considered a useful tool to promote quality and safety in neonatal intensive care.

Towards better mortality prediction in cancer patients in the ICU: a comparative analysis of prognostic scales: systematic literature review.

OBJECTIVE: To evaluate the predictive ability of mortality prediction scales in cancer patients admitted to intensive care units (ICUs). DESIGN: A systematic review of the literature was conducted using a search algorithm in October 2022. The following databases were searched: PubMed, Scopus, Virtual Health Library (BVS), and Medrxiv. The risk of bias was assessed using the QUADAS-2 scale. SETTING: ICUs admitting cancer patients. PARTICIPANTS: Studies that included adult patients with an active cancer diagnosis who were admitted to the ICU. INTERVENTIONS: Integrative study without interventions. MAIN VARIABLES OF INTEREST: Mortality prediction, standardized mortality, discrimination, and calibration. RESULTS: Seven mortality risk prediction models were analyzed in cancer patients in the ICU. Most models (APACHE II, APACHE IV, SOFA, SAPS-II, SAPS-III, and MPM II) underestimated mortality, while the ICMM overestimated it. The APACHE II had the SMR (Standardized Mortality Ratio) value closest to 1, suggesting a better prognostic ability compared to the other models. CONCLUSIONS: Predicting mortality in ICU cancer patients remains an intricate challenge due to the lack of a definitive superior model and the inherent limitations of available prediction tools. For evidence-based informed clinical decision-making, it is crucial to consider the healthcare team's familiarity with each tool and its inherent limitations. Developing novel instruments or conducting large-scale validation studies is essential to enhance prediction accuracy and optimize patient care in this population.

Humanização na perspectiva dos profissionais da saúde atuantes em unidades de terapia intensiva: revisão integrativa / Humanization from the perspective of health professionals workingin Intensive Care Units: integrative review / La humanización desde la perspectiva de los profesionales de la salud que trabajan en Unidades de Cuidados Intensivos: revisión integrativa

Introdução:Esteartigo apresenta uma revisão integrativa da literatura em relação à compreensãodos profissionais sobre humanização na Unidade de Terapia Intensiva. Objetivo: Analisar os estudos científicos que abordem a percepção sobre humanização entre profissionais da saúde atuantes em Unidades de Terapia Intensiva.Metodologia:Revisão integrativa da literatura. Nas bases de dados e biblioteca virtual selecionadas, utilizou-se os descritores em ciências da saúde: percepção, humanização da assistência e unidades de terapia intensiva, combinados com o operador booleano "AND".As etapas de seleção dos artigos,compreenderam: identificação do tema e seleção da pergunta norteadora; estabelecimento dos critérios de inclusão e exclusão; identificação dos estudos selecionados e pré-selecionados; categorização dos estudos selecionados; análise e interpretação dos resultados; apresentação dos achados da revisão com a síntese do conhecimento.Os critérios de inclusão abrangeram:publicações dos últimos 10 anos (2013-2023), que atendessem ao objetivo do estudo, artigos disponíveis na íntegra nas bases de dados selecionadas, nos idiomas inglês, português e espanhol. Foram excluídos estudos duplicados, trabalhos de conclusão de curso, teses, dissertações, editoriais, cartas, resumos de anais, livros, estudo de caso e relatos de experiência. Resultados:Foram incluídos 16 artigos, revelandotrês categorias temáticas: compreensão dos profissionais sobre a humanização, fatores facilitadores e dificultadores para consolidar a humanização e os benefícios da prática humanizada.Considerações finais:Verificou-se a dificuldade em definir um conceito de humanização pelos profissionais da saúde. Foram destacados os elementos facilitadores da prática humanizada, incluindo empatia, respeito, acolhimento e comunicação adequada. Além disso, foi possível observar os obstáculos, como a falta de materiais, dimensionamento inadequado, ambiente inadequado, sobrecarga de trabalho, rotatividade da equipe e estresse. Adicionalmente, foi possível observar a percepção dos profissionais quanto aos benefícios da prática humanizada na Unidade de Terapia Intensiva (AU).

Introduction:This article presents an integrative literature revision of the understanding ofprofessionals about humanization in the Intensive Care Unit. Objective:Analyze scientific studies that address the perception of humanization among health professionals working in Intensive Care Units. Methodology:Literature integrative revision. In thedatabases and virtual library selected, we used the descriptors in health sciences: perception, humanization of assistance and intensive care units, combined with the Boolean operator "AND". The article selection steps included: identification of the topic and selection of the guiding question; establishment of inclusion and exclusion criteria; identification of the selected and pre-selected studies; categorization of the selected studies; analysis and interpretation of the results; presentation of the results of the revision and the synthesis of knowledge. The inclusion criteria were: publications from the last 10 years (2013-2023), which met the study's objective, articles available in full in the selected databases, in English, Portuguese and Spanish. Duplicate studies, term papers, theses, dissertations, editorials, letters, abstracts from proceedings, books, case studies and experience reports were excluded. Results:Sixteen articles were included, disclosing three thematic categories: professionals' understanding of humanization, factors that facilitate and hinder the consolidation of humanization, and the benefits of humanized practice. Final considerations:Health professionals had difficulty defining a concept of humanization. The elements that facilitate humanized practice were highlighted, including empathy, respect, hospitality and proper communication. In addition, there were obstacles including a shortage of materials, inadequate dimensioning, an unsuitable environment, work overload, staff turnover and stress. In addition, it was possible to observe the professionals' perception of the benefits of humanized practice in the Intensive Care Unit (AU).

Introducción:Este artículo presenta una revisión integradora de la literatura en relación a la comprensión de los profesionales sobre humanización en la Unidad de Cuidados Intensivos. Objetivo:Analizar los estúdios científicos que aborden la percepciónsobre humanización entre profesionales de la salud actuantes en Unidades de Cuidados Intensivos. Metodología:Revisión integrativa de la literatura. En las bases de datos y biblioteca virtual seleccionadas, se utilizó los descriptores en ciencias de la salud: percepción, humanizaciónde la asistencia y unidades de cuidados intensivos.Las etapasde selección de los artículos fueron las siguientes: identificación del tema y selección de la pregunta orientadora; establecimiento de los criterios de inclusión y exclusión;identificación de los estúdios seleccionados y preseleccionados; categorización de los estudios seleccionados; análisis e interpretación de los resultados; presentación de los hallazgos de la revisióncon la síntesis delconocimiento. Los criterios de inclusión abarcaron: publicaciones de los últimos diez años (2013-2023),que atendieran al objetivo del estudio, artículos disponibles íntegramente en las bases de datos seleccionadas, en los idiomas inglés, portugués y español. Se excluyeron estudios duplicados, trabajos de fin de grado, tesis, disertaciones, editoriales, cartas, resúmenes de anales, libros, estudio de caso y relatos de experiencia. Resultados:Fueron incluidos 16 artículos, revelando tres categorías temáticas: comprensión de los profesionales sobre la humanización, factores facilitadores y dificultadores para consolidar la humanización y los beneficios de la práctica humanizada. Consideraciones finales:Se verificó la dificultad para definir un concepto de humanización por los profesionales de la salud. Se destacaron los elementos facilitadores de la práctica humanizada, incluyendo empatía, respeto, acogimiento y comunicación adecuada. Además de eso, fue posible observar los obstáculos, como la falta de materiales, dimensionamiento inadecuado, ambiente inadecuado, sobrecarga de trabajo, rotación del equipo y estrés. Adicionalmente, fue posible observar la percepción de los profesionales en cuanto a los beneficios de la práctica humanizada en la Unidad de Cuidados Intensivos (AU).

Perception of novice nurses in an emergency box: A qualitative approach to their experiences and needs.

BACKGROUND: Nurses play an essential role in the care of emergency hospital patients, being the ones who have the most contact with the patient and the first to be able to detect their imminent deterioration. However, the literature shows the impact that this can have in terms of stress and insecurity among new nurses, with the consequent risk of resignation in the institution and in their learning process. AIMS: To explore the process of incorporation of new nurses in the emergency room, as well as to identify and understand their emotions, difficulties, needs and proposals for improvement. METHODS: Qualitative research aimed at emergency room nurses in a tertiary level university hospital in Catalonia, between April 2022 and March 2023. Twelve semi-structured interviews were conducted with content analysis. RESULTS: Four categories emerged: identification of deficiencies, emotional dimension, competencies of the expert nursing professional, and needs and proposals for improvement, as main themes. CONCLUSIONS: Insufficient training and deficit of interdisciplinary communication skills appear as main stressors. The analysis of the results suggests the need to create an intervention program that protects the mental and emotional health of new nurses and ensures the integrity of their patients. Innovative and multimodal training adapted to generational change is called for, with virtual, immersive, and contextualized simulation scenarios, together with the implementation of tools such as debriefing and nursing clinical sessions.

Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study.

OBJECTIVE: To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients. DESIGN: Retrospective observational study. SETTING: Sixty-seven ICU from Spain, Andorra, Ireland. PATIENTS: 5399 patients March 2020 to April 2022. MAIN VARIABLES OF INTEREST: Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO). RESULTS: Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001). CONCLUSIONS: Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.

The roles and responsibilities of advanced practice nurses in intensive care units: A scoping review.

INTRODUCTION: Since the intensive care units are one of the most sensitive hospital settings and critically ill patients undergo various stressful factors that put their lives in danger, a more advanced level of nursing practice is imperative to accommodate these issues and provide optimal care of patients. OBJECTIVES: To review the literature describing the roles and activities performed by advanced practice nurses in intensive care units. REVIEW METHODS: We conducted a scoping review to search published articles using Scopus, PubMed, CINAHL (EBSCOhost), Science Direct, MEDLINE (EBSCOhost) and Cochrane Library during a 10-year period from 2013 to 2023. RESULTS: We identified 729 records, from which eleven articles were included in the review. We included six reviews and five original articles or research papers. With regard to the target area of our review, we used the information provided by these studies and categorized the contents related to the roles of advanced practice nurses in intensive care units into five sections, including direct practice, education and counseling, research, collaboration, and leadership. CONCLUSION: Advanced practice nurses are essential members of critical care team by playing various roles in practice, education, research, collaboration, and leadership, and therefore, they can increase patients' access to critical care and improve healthcare outcomes. The advancement of technology and complexity of care in intensive care units have led to the role expansion of these nurses which results in task-shifting between doctors and nurses. Therefore, it is considered essential for nursing and medical professionals to reach an agreement to establish standardized roles for advanced practice nurses.

Dysphagia management by nurses in Spanish intensive care units.

INTRODUCTION/PURPOSE: Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses. METHOD: Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis. OUTCOMES: 43 nurses were recruited. Dysphagia is considered an important problem (90,7%) but in 50,3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32,6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = ,029). The most common treatment is modification of food consistency (86,0%). CONCLUSION: The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.

Adverse events with arterial catheters in intensive care units: a scoping review.

INTRODUCTION: The installation of an arterial line is one of the invasive procedures performed for hemodynamic monitoring and, even with its clear importance in intensive care, it is still an invasive procedure and liable to cause harms to the patients. OBJECTIVE: To identify the adverse events associated with the use of arterial catheters in critically-ill patients in the world scientific production. METHODOLOGY: The present scoping review was conducted according to the JBI methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used for reporting. The research question was "Which adverse events related to the use of arterial catheters in patients admitted to intensive care are more evident in the literature?". Data collection took place in the following databases: LILACS; MEDLINE; EMBASE; CINAHL, EBSCOhost; and WEB OF SCIENCE. RESULTS: Through the search strategies, 491 articles were found in the databases. After exclusion of duplicates, peer analysis of titles and abstracts, full reading and screening of lists of references, the final sample of studies included was 38 articles. The main harms cited by the publications were as follows: limb ischemia, thrombosis, hemorrhage, accidental removal, inadvertent connection of inadequate infusion solution, pseudoaneurysm and bloodstream infection. CONCLUSIONS: It was evidenced that patients are subjected to risks of adverse events from the insertion moment to removal of the arterial catheter, focusing on the infusion solution used to fill the circuit, the type of securement and dressings chosen, as well as the Nursing care measures for the prevention of bloodstream infection.

Sublingual and buccal drug administration in medical emergencies. / Administración sublingual y bucal de fármacos en situaciones de urgencia y emergencia vital.

Drug administration is crucial to achieve effective therapeutic drug outcomes. In medical emergencies, it is particularly convenient to use drugs that could be administered as an alternative to traditional routes (as oral or intravenous routes), that are not always suitable in these situations. Thus, sublingual and buccal routes offer an alternative to traditional routes, when a rapid onset of action is required. The main objective of this narrative review is to summarize the evidence for the use of sublingual and buccal drug administration in medical emergencies. The evidence obtained has been divided into four common scenarios found in the emergency department and intensive care units: cardiovascular emergencies, acute pain, agitation, and epileptic status. Moreover, the main advantages and disadvantages of sublingual and buccal routes are presented, as the future perspectives in the drug delivery field to overcome the limitations of these routes.

Development of burnout and moral distress in intensive care nurses: An integrative literature review.

AIMS: To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress. METHODS: An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality. RESULTS: Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress. CONCLUSIONS: This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses' job satisfaction and retention while improving nurses' quality of care.

Prediction of adverse drug reactions in geriatric patients admitted to intensive care units. / [Artículo traducido] Predicción de reacciones adversas a medicamentos en pacientes geriátricos ingresados en unidades de cuidados intensivos.

INTRODUCTION: Intensive Care Units (ICUs) pose challenges in managing critically-ill patients with polypharmacy, potentially leading to Adverse Drug Reactions (ADRs), particularly in the elderly. OBJECTIVE: To evaluate whether the severity and clinical prognosis scores used in ICUs correlate with the prediction of ADRs in aged patients admitted to an ICU. METHODS: A cohort study was conducted in a Brazilian University Hospital ICU. APACHE II and SAPS 3 assessed clinical prognosis, while GerontoNet ADR Risk Score and BADRI evaluated ADR risk at ICU admission. Severity of the patients' clinical conditions was evaluated daily based on the SOFA score. Adverse Drug Reaction (ADR) screening was performed daily through the identification of ADR triggers. RESULTS: 1295 triggers were identified (median 30 per patient, IQR = 28), with 15 suspected ADRs. No correlation was observed between patient severity and ADRs at admission (p=0.26), during hospitalization (p=0.91), or at follow-up (p=0.77). There was also no association between death and ADRs (p=0.28) or worse prognosis and ADRs (p>0.05). Higher BADRI scores correlated with more ADRs (p=0.001). CONCLUSIONS: The data suggest that employing the severity and clinical prognosis scores used in Intensive Care Units is not sufficient to direct active pharmacovigilance efforts, which are therefore indicated for critically ill patients.

Pharmacotherapy assessment and adverse drug reactions in older patients admitted to intensive care.

INTRODUCTION: Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems. OBJECTIVE: To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU). METHOD: A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs. RESULTS: The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy. CONCLUSIONS: Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.

Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19.

OBJECTIVE: We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events. DESIGN: Single center prospective observational longitudinal cohort study (February-November 2021). SETTING: Patients admitted to the ICU of a University Hospital. PARTICIPANTS: Patients with severe COVID-19 pneumoniae. INTERVENTIONS: Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol. MAIN VARIABLES OF INTEREST: Target: thomboembolic events. PREDICTORS: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results. Logistic regression was used to identify independent risk factors for thomboembolic events. RESULTS: Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19. CONCLUSIONS: Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.

Enfermagem em UTI: cuidados essenciais na assistência direta ao paciente / ICU nursing: essential care in direct patient care

Objetivo: O objetivo deste estudo foi identificar e descrever os cuidados essenciais que os enfermeiros devem ter ao atuar em uma Unidade de Terapia Intensiva (UTI). Métodos: Realizou-se uma revisão bibliográfica da literatura, com uma abordagem qualitativa, descritiva e exploratória. As buscas foram realizadas PubMed, SciELO, LILACS e BIREME. Resultados: Os cuidados de enfermagem desempenham um papel crucial na recuperação e bem-estar dos pacientes em estado crítico na UTI. As intervenções dos enfermeiros devem ser embasadas em conhecimento científico, empatia e habilidades técnicas avançadas. Discute-se a importância da monitorização rigorosa, controle de infecções, prevenção de complicações da imobilidade, abordagem holística ao paciente e comunicação efetiva na UTI. Conclusão: Conclui-se que os enfermeiros devem basear suas intervenções em conhecimento científico, empatia e habilidades técnicas avançadas, destacando-se a importância da monitorização, controle de infecções, prevenção de complicações da imobilidade, abordagem holística ao paciente e comunicação efetiva na UTI.(AU)

Objectives: The objective of this study was to identify and describe the essential care that nurses must take when working in an Intensive Care Unit (ICU). Methods: A bibliographical review of the literature was carried out, with a qualitative, descriptive and exploratory approach. The searches were carried out in PubMed, SciELO, LILACS and BIREME. Results: Nursing care plays a crucial role in the recovery and well-being of critically ill patients in the ICU. Nurses' interventions must be based on scientifi c knowledge, empathy and advanced technical skills. The importance of rigorous monitoring, infection control, prevention of immobility complications, a holistic approach to the patient and effective communication in the ICU are discussed. Conclusion: It is concluded that nurses must base their interventions on scientifi c knowledge, empathy and advanced technical skills, highlighting the importance of monitoring, infection control, prevention of immobility complications, a holistic approach to the patient and effective communication in the ICU.(AU)

Objetivos: El objetivo de este estudio fue identifi car y describir los cuidados esenciales que deben tener las enfermeras cuando trabajan en una Unidad de Cuidados Intensivos (UCI). Métodos: Se realizó una revisión bibliográfi ca de la literatura, con un enfoque cualitativo, descriptivo y exploratorio. Las búsquedas se realizaron en PubMed, SciELO, LILACS y BIREME. Resultados: Los cuidados de enfermería juegan un papel crucial en la recuperación y el bienestar de los pacientes críticos en la UCI. Las intervenciones de las enfermeras deben basarse en el conocimiento científi co, la empatía y las habilidades técnicas avanzadas. Se discute la importancia de un seguimiento riguroso, el control de infecciones, la prevención de complicaciones de la inmovilidad, un enfoque holístico del paciente y una comunicación efi caz en la UCI. Conclusión: Se concluye que los enfermeros deben basar sus intervenciones en el conocimiento científi co, la empatía y las habilidades técnicas avanzadas, resaltando la importancia del seguimiento, control de infecciones, prevención de complicaciones de la inmovilidad, abordaje holístico del paciente y comunicación efectiva en la UCI.(AU)

Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness.

Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.

Clinically significant depressive and post-traumatic stress disorder symptoms in survivors of COVID-19 critical illness, especially in patients who had undergone invasive mechanical ventilation, were highly frequent, occurred soon after discharge, and persisted over the long term.