Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses.

Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.

The comfort perception in the critically ill patient from the Kolcaba theoretical model.

BACKGROUND: The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ). OBJECTIVES: To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors. METHODS: Cross-sectional descriptive observational prospective study. POPULATION: 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16. RESULTS: The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0-4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2-7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184-8,707], mild pain (p = 0,000) OR 4,007 CI [2,068-7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328-5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316-0,705]. CONCLUSIONS: The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.

Pediatric nephrologist-intensivist interaction in acute kidney injury / Interação nefro-intensivista pediátrica na lesão renal aguda

ABSTRACT Introduction: Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist's participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods. Methods: Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016). Parameters studied: frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05. Results: 53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development. Conclusion: Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.

RESUMO Introdução: Os conceitos sobre diagnóstico e conduta da Lesão Renal Aguda (LRA) na Unidade de Terapia Intensiva (UTI) tem como ponto primordial a avaliação do balanço hídrico. Em nossa UTI, de 2004 a 2012, a participação do nefrologista era sob demanda. A partir de 2013, a participação passou a ser contínua em reunião de discussão de casos. O objetivo deste estudo foi determinar como a maior interação nefrologista/intensivista influenciou a frequência de indicação de diálise, no balanço hídrico e na classificação pRIFLE durante esses dois períodos de observação. Método: Estudo retrospectivo, avaliação longitudinal de todas as crianças com LRA em diálise (2004 a 2016). Parâmetros estudados: frequência de indicação, tempo de duração e volume de infusão nas 24 horas precedendo a diálise; diurese e balanço hídrico a cada 8 horas. Estatística não paramétrica, p ≤ 0,05. Resultado: 53 pacientes (47 antes e 6 após 2013). Sem diferença significativa no número de internações e nem de cirurgias cardíacas entre os períodos. Após 2013, houve diminuição significativa no número de indicação de diálise/ano (5,85 vs. 1,5; p = 0,000); no volume de infusão (p = 0,02), aumento do tempo de duração da diálise (p = 0,002) e melhora da discriminação do componente diurese do pRIFLE na indicação de LRA. Conclusão: Integração entre equipes de UTI e nefrologia pediátrica na discussão rotineira de casos, abordando criticamente o balanço hídrico, foi determinante para a melhora na conduta da LRA na UTI.

Should videolaryngoscopy be routinely used for airway management? An approach from different scenarios in medical practice

During the past two decades, the videolaryngoscope (VDL) has become a valuable and effective tool for the management of the airway, not just in the realm of anesthesiology, but also in other medical specialties in clinical scenarios requiring tracheal intubation. In countries such as the United States, this represents over 15 million cases in the operating room and 650,000 outside the OR. The overall accumulated incidence of difficult airway is 6.8% events in routine practice and between 0.1 and 0.3 % of failed intubations, both associated with complications such as desaturation, airway injury, hemodynamic instability and death. Notwithstanding the fact that the VDL has proven advantages such as improved visualization of the glottis, higher first attempt success rates, and a shortened learning curve, most of the time its use is limited to rescue attempts or as a secondary option. The aim of this article is to comment the advantages and limitations of the VDL vs. the direct laryngoscope in a wide range of clinical settings, including the operating room, intensive care units, emergency departments, pediatrics, obstetrics, and Covid-19 to consider its routine use.

En las últimas dos décadas, el videolaringoscopio (VDL) se ha convertido en una herramienta valiosa y eficaz para el manejo de la vía aérea no solo en el ámbito de anestesiología, sino en otras especialidades médicas durante escenarios clínicos que requieren la intubación traqueal y las cuales, en países como Estados Unidos corresponden anualmente a más de 15 millones dentro de salas de cirugía y 650.000 fuera de ella. Aproximadamente, hay una incidencia global acumulada de 6,8 % de eventos de vía aérea difícil en la práctica rutinaria y 0,1 al 0,3 % de intubaciones fallidas, ambas asociadas a complicaciones como desaturación, daño en la vía aérea, inestabilidad hemodinámica y muerte. Pese a que el VDL ha demostrado ventajas como mejoría de la visualización de la glotis, aumento de tasa de éxito al primer intento y menor curva de aprendizaje, su uso en la mayoría de las veces se ve limitado como dispositivo de rescate o de manera secundaria. El propósito de este artículo es comentar acerca de las ventajas y limitaciones del VDL vs. el laringoscopio directo en un variado número de escenarios clínicos, como salas de cirugía, unidades de cuidado intensivo, emergenciología, pediatría, obstetricia y covid-19, con el fin de considerar si su uso debiera hacerse de manera rutinaria.

Seguimiento Funcional hasta Seis Meses después de Sobrevivir a Cuidados Intensivos: Lecciones aprendidas de un Estudio Chileno Multicéntrico / Functional follow-up six months after surviving intensive care: lessons learned from a Chilean multicenter study

Introducción. Las tasas de retención en los estudios de seguimiento oscilan entre el 32 y 100%, demostrando el desafío que implica realizar estudios longitudinales de sobrevivientes de la unidad de cuidados intensivos (UCI). Objetivo. Identificar las estrategias implementadas y lecciones aprendidas en un estudio prospectivo multicéntrico de seguimiento de sobrevivientes de la UCI durante la pandemia. Métodos. Estudio post-hoc de las lecciones aprendidas mediante encuestas y entrevistas dirigidas a explorar la experiencia de los investigadores y coordinadores del estudio IMPACCT COVID-19, realizado en siete centros chilenos entre octubre 2020 y abril 2021 evaluando el síndrome post-cuidados intensivos de sobrevivientes hasta seis meses después. Resultados. Identificamos ocho lecciones: 1) selección de instrumentos de medición, 2) identificación de centros participantes, 3) aprobación del estudio, 4) financiamiento, 5) capacitación de evaluadores, 6) coordinación/aseguramiento de calidad, 7) reclutamiento y 8) seguimiento de pacientes. Incluso durante el primer año de pandemia, reclutamos 252 pacientes a una tasa de 1,4 pacientes/día con una retención del 48% a los 6 meses de seguimiento. El uso de redes académicas existentes y las estrategias de comunicación entre investigadores, coordinadores y evaluadores fueron aspectos positivos; mientras que la fidelización con evaluadores al egreso de la UCI y con pacientes durante el seguimiento son aspectos que deberían considerarse en futuros estudios. Conclusiones. Se evaluaron más de 250 pacientes en seis meses durante la pandemia, con tasas de retención post UCI acorde a la literatura. Futuros estudios debiesen optimizar los procesos de medición y de seguimiento para minimizar la pérdida de pacientes.

Background. Retention rates of follow-up studies range from 32 to 100%, demonstrating the challenge to conduct longitudinal studies of intensive care unit (ICU) survivors. Objective. To identify the strategies implemented and lessons learned in a multicenter prospective follow-up study of ICU survivors during pandemic times. Methods. Post-hoc study of lessons learned through surveys and interviews aimed at exploring the experience of the researchers and coordinators of the IMPACCT COVID-19 study. The original study was performed in seven Chilean sites between October 2020 and April 2021 evaluating the post-intensive care syndrome of survivors up to six-month follow-up. Results. We identified eight lessons: 1) selection of measurement instruments, 2) identification of participating sites, 3) Study approval, 4) funding, 5) evaluators training, 6) coordination/quality assurance, 7) recruitment, and 8) patient follow-up. Even during the first year of the pandemic, we recruited 252 patients at a rate of 1.4 patients/day with a retention rate of 48% at 6 months of follow-up. The use of existing academic networks and communication strategies between researchers, coordinators and evaluators were positive aspects; while evaluators fidelity at ICU discharge and patient engagement during follow-up are aspects should be considered. Conclusions. More than 250 patients were evaluated in six months during the pandemic, with post-ICU retention rates consistent with the literature. Future studies should optimize measurement and monitoring processes to minimize patient atrition.

Estado actual y tendencias en el proceso de formación de enfermeras(os) de cuidados críticos / Current status and trends in the training process of critical care nurses

Introducción: Las Organizaciones Internacionales reconocen que, para las profesiones de la salud, es trascendental el desarrollo de sus especialidades dado que les permite profundizar conocimientos y habilidades para una práctica profesional más cualificada que permita mejorar la calidad de atención.Objetivo: Explorar el estado del arte, aplicación de modelos y teorías de enfermería en unidades de cuidado intensivo y las tendencias en la formación en la formación del especialista en enfermería del paciente en estado crítico. Método: Investigación documental cuyo objeto de estudio fueron 17 artículos de investigaciones relacionadas con el tema, los artículos fueron capturados en bases de datos internacionales Scielo, Elsevier, ScienceDirect, publicados entre los años 2011-2021. Se utilizó como instrumentos de recolección de información una matriz para la selección de investigaciones y la Ficha Analítica de Investigación. El análisis se orientó con base a la evolución del proceso formativo, enfoques teóricos-disciplinares y tendencias y retos de la formación. Resultados: Se encontró artículos provenientes de revisiones documentales y en menor proporción de estudios de investigación cualitativa o cuantitativa. Conclusiones: El estudio permitió reconocer los avances del proceso formativo y la evolución de estrategias de enseñanza aprendizaje propias de modelos educativos tradicionales a otras que estimulan el pensamiento reflexivo y crítico. Es escasa la literatura que da cuenta de la aplicación de modelos y teorías de enfermería en las unidades de cuidado crítico, se encontró perspectivas novedosas relacionadas con la formación en enfermería para el cuidado crítico (AU)

Introduction: International Organizations recognize that, for the health professions, the development of their specialties is transcendental since it allows them to deepen knowledge and skills for a more qualified professional practice that allows improving the quality of care. Objective: To explore the state of the art, application of nursing models and theories in intensive care units and trends in the training of nursing specialists for critically ill patients.Method: Documentary research whose object of study were 17 research articles related to the subject, the articles were captured in international databases Scielo, Elsevier, ScienceDirect, published between 2011-2021. A matrix for the selection of investigations and the Investigation Analytical Sheet were used as information collection instruments. The analysis was oriented based on the evolution of the training process, theoretical-disciplinary approaches and training trends and challenges Results: Articles from documentary reviews were found and, to a lesser extent, from qualitative or quantitative research studies. Conclusions: The study allowed us to recognize the progress of the training process and the evolution of teaching-learning strategies typical of traditional educational models to others that stimulate reflective and critical thinking. The literature that accounts for the application of nursing models and theories in critical care units is scarce; novel perspectives related to nursing training for critical care were found (AU)

Encuesta a los estudiantes tras diez años de enseñanza semipresencial continua de ecocardiografía / Student survey after ten years of continuous blended teaching of echocardiocraphy

Objetivo: Analizar el impacto durante 10 años de nuestro programa de enseñanza semipresencial en ecocardiografía. Métodos y resultados: Se envió una encuesta retrospectiva a todos los médicos especialistas que se graduaron en el programa, desarrollado en la Universidad de Chile, con un equipo docente de Chile y España. Un total de 140 de entre 210 estudiantes, graduados en nuestro programa de 2011 a 2020, respondieron voluntariamente a la encuesta. Entre quienes respondieron, el 53,57% fueron anestesiólogos y el 26,42% intensivistas. Más del 85% de los respondedores indicó que el periodo de enseñanza online cumplió sus expectativas, y el 70,2% indicó que la experiencia práctica cumplió sus objetivos. En un análisis retrospectivo utilizando datos autorreportados, se observaron incrementos significativos en cuanto a frecuencia del uso de ecocardiografía transtorácica y transesofágica del 24,29% al 40,71% y del 13,57% al 27,86%, respectivamente, tras el programa, en comparación con el periodo anterior al mismo. Se usó la ecocardiografía principalmente en el periodo perioperatorio (56,7%) y en cuidados intensivos (32,3%), mientras que solo el 11% de los respondedores la utilizó en unidades de urgencia. Además, el 92,4% de los respondedores reveló que la información aprendida durante el programa había sido muy útil para su práctica posterior. Conclusiones: A lo largo de una década de uso, el programa de aprendizaje semipresencial de ecocardiografía fue evaluado satisfactoriamente por los especialistas que se graduaron en el programa, siendo asociado a un incremento significativo del uso de ecocardiografía en el periodo perioperatorio y en cuidados intensivos. El principal desafío es establecer un periodo más prolongado de práctica, y lograr un mayor alcance en la medicina de urgencias.(AU)

Objective:To analyse the impact of 10 years of blended echocardiography teaching. Methods and results: A questionnaire was emailed to all medical doctors who graduated from the blended learning diploma in echocardiography developed by the University of Chile and taught by a team from Chile and Spain. One hundred and forty of the 210 students who graduated from the program between 2011 and 2020 completed the questionnaire: 53.57% were anaesthesiologists, and 26.42% were intensivists. More than 85% of respondents indicated that the online teaching met their expectations, and 70.2% indicated that the hands-on practice fulfilled the stated objectives. In a retrospective analysis using self-reported data, graduates reported that their use of transthoracic and transoesophageal echocardiography has increased from 24.29% to 40.71% and from 13.57% to 27.86%, repectively, after the programme compared to before the programme. They used echocardiography mainly in the perioperative period (56.7%) and during intensive care (32.3%), while only 11% of respondents used it in emergency care units. Nearly all (92.4%) respondents reported that the skills learned was very useful in their professional practice. Conclusions: Ten years after its launch, the blended learning diploma in echocardiography was well rated by graduate specialists, and is associated with a significant increase in the use of echocardiography in the perioperative period and during intensive care. The main challenges are to establish a longer period of practice and achieve greater implantation in emergency medicine.(AU)

Student survey after ten years of continuous blended teaching of echocardiography.

OBJECTIVE: To analyse the impact of 10 years of blended echocardiography teaching. METHODS AND RESULTS: A questionnaire was emailed to all medical doctors who graduated from the blended learning diploma in echocardiography developed by the University of Chile and taught by a team from Chile and Spain. One hundred and forty of the 210 students who graduated from the program between 2011 and 2020 completed the questionnaire: 53.57% were anaesthesiologists, and 26.42% were intensivists. More than 85% of respondents indicated that the online teaching met their expectations, and 70.2% indicated that the hands-on practice fulfilled the stated objectives. In a retrospective analysis using self-reported data, graduates reported that their use of transthoracic and transoesophageal echocardiography has increased from 24.29% to 40.71% and from 13.57% to 27.86%, repectively, after the programme compared to before the programme. They used echocardiography mainly in the perioperative period (56.7%) and during intensive care (32.3%), while only 11% of respondents used it in emergency care units. Nearly all (92.4%) respondents reported that the skills learned was very useful in their professional practice. CONCLUSIONS: Ten years after its launch, the blended learning diploma in echocardiography was well rated by graduate specialists, and is associated with a significant increase in the use of echocardiography in the perioperative period and during intensive care. The main challenges are to establish a longer period of practice and achieve greater implantation in emergency medicine.

Repercussions of the Emergency neurological life support on scientific literature: a bibliometric study / Repercussões do Emergency neurological life support na literatura científica: um estudo bibliométrico

Abstract Background In 2012, the Neurocritical Care Society launched a compilation of protocols regarding the core issues that should be addressed within the first hours of neurological emergencies - the Emergency neurological life support (ENLS). Objective We aim to evaluate this repercussion through a bibliometric analysis. Methods We searched Scopus on October 2022 for articles mentioning ENLS. The following variables were obtained: number of citations; number of citations per year; number of publications per year; year of publication; research type; research subtype; country of corresponding author and its income category and world region; journal of publication and its 5-year impact factor (IF); and section where ENLS appeared. Results After applying eligibility criteria, we retrieved 421 articles, published from 2012 to 2022. The mean number of citations per article was 17.46 (95% Confidence Interval (CI) = 8.20-26.72), while the mean number of citations per year per article was 4.05 (95% CI = 2.50-5.61). The mean destiny journal 5-year IF was 5.141 (95% CI = 4.189-6.093). The majority of articles were secondary research (57.48%; n= 242/421) of which most were narrative reviews (71.90%; n= 174/242). High-Income countries were the most prominent (80.05%; n= 337/421 articles). There were no papers from low-income countries. There were no trials or systematic reviews from middle-income countries. Conclusion Although still low, the number of publications mentioning ENLS is increasing. Articles were mainly published in journals of intensive care medicine, neurology, neurosurgery, and emergency medicine. Most articles were published by authors from high-income countries. The majority of papers were secondary research, with narrative review as the most frequent subtype.

Resumo Antecedentes Em 2012, a Neurocritical Care Society lançou uma compilação de protocolos sobre as questões centrais que devem ser abordadas nas primeiras horas de emergências neurológicas - Emergency neurological life support (ENLS). Objetivo Avaliar a repercussão do ENLS por meio de uma análise bibliométrica. Métodos A base de dados Scopus foi utilizada em outubro de 2022 para a busca por artigos mencionando o ENLS. As seguintes variáveis foram obtidas: número de citações; número de citações por ano; número de publicações por ano; ano de publicação; tipo de pesquisa; país do autor correspondente e sua categoria de renda; revista de publicação e seu fator de impacto de 5 anos (IF); e seção onde o ENLS apareceu. Resultados Os 421 artigos incluídos foram publicados de 2012 a 2022. A média de citações por artigo foi de 17.46 (intervalo de confiança (IC) 95% = 8.20-26.72), enquanto a de citações por ano por artigo foi de 4.05 (IC95% = 2.50-5.61). O IF médio por revista foi de 5.14 (IC95% = 4.19-6.09). A maioria dos artigos era de pesquisa secundária (57.48%; n= 242/421), dos quais a maioria eram revisões narrativas (71.90%; n= 174/242). Os países de alta renda foram os mais prolíficos (80.05%; n= 337/421 artigos). Não houve publicações de países de baixa ou média renda. Conclusão Embora ainda baixo, o número de publicações mencionando o ENLS vem aumentando recentemente. A maioria dos artigos foram publicados em revistas de medicina intensiva, neurologia, neurocirurgia e medicina de emergência. Artigos de pesquisa secundária foram os mais comuns, com revisões narrativas sendo o subtipo mais frequente.

Vaccination status and outcomes in critical COVID-19 patients / Situação vacinal e desfechos em pacientes com COVID-19 em estado crítico

ABSTRACT Objective: To analyze the clinical characteristics and outcomes of patients with COVID-19-related acute respiratory failure on the basis of their vaccination status at the time of ICU admission. Methods: We conducted a retrospective observational study using a prospective database of patients admitted to the ICU of a university hospital in the city of Murcia, in Spain, between January 1, 2021 and September 1, 2022. Clinical, analytical, and sociodemographic data were collected and analyzed on the basis of patient vaccination status. We adjusted for confounding variables using propensity score matching and calculated adjusted ORs and 95% CIs. Results: A total of 276 patients were included in the study. Of those, 8.3% were fully vaccinated, 12% were partially vaccinated, and 79.7% were unvaccinated. Although fully vaccinated patients had more comorbidities, partially vaccinated patients had higher disease severity. The proportion of patients with severe acute respiratory failure was higher in the unvaccinated group, followed by the partially vaccinated group. No significant differences were found among the different groups regarding complications, duration of ventilatory support, or length of ICU/hospital stay. In the sample selected by propensity score matching, the number of patients with severe complications and the in-hospital mortality rate were higher in unvaccinated patients, but the differences were not significant. Conclusions: This study failed to show a significant improvement in outcomes in critically ill COVID-19 patients vaccinated against SARS-CoV-2. However, the CIs were wide and the mortality point estimates favored patients who received at least one dose of COVID-19 vaccine.

RESUMO Objetivo: Analisar as características clínicas e desfechos de pacientes com insuficiência respiratória aguda por COVID-19 com base na situação vacinal no momento da admissão na UTI. Métodos: Estudo observacional retrospectivo com um banco de dados prospectivo de pacientes admitidos na UTI de um hospital universitário em Múrcia, na Espanha, entre 1º de janeiro de 2021 e 1º de setembro de 2022. Dados clínicos, analíticos e sociodemográficos foram coletados e analisados com base na situação vacinal dos pacientes. Por meio de pareamento por escore de propensão, foram realizados ajustes de modo a levar em conta as variáveis de confusão. Além disso, foram calculadas as OR ajustadas e IC95%. Resultados: Foram incluídos no estudo 276 pacientes. Destes, 8,3% apresentavam vacinação completa, 12% apresentavam vacinação incompleta e 79,7% não haviam sido vacinados. Embora os pacientes com vacinação completa apresentassem mais comorbidades, os com vacinação incompleta apresentavam doença mais grave. A proporção de pacientes com insuficiência respiratória aguda grave foi maior nos não vacinados, seguidos daqueles com vacinação incompleta. Não foram observadas diferenças significativas entre os diferentes grupos quanto a complicações, tempo de suporte ventilatório ou tempo de internação na UTI/hospital. Na amostra selecionada pelo pareamento por escore de propensão, o número de pacientes com complicações graves e a taxa de mortalidade hospitalar foram maiores em pacientes não vacinados, mas as diferenças não foram significativas. Conclusões: Este estudo não conseguiu demonstrar uma melhoria significativa dos desfechos em pacientes com COVID-19 em estado crítico e vacinados contra o SARS-CoV-2. No entanto, os IC foram amplos e as estimativas pontuais de mortalidade favoreceram os pacientes que receberam pelo menos uma dose de vacina contra a COVID-19.

High-flow nasal cannula and non-invasive mechanical ventilation in pediatric asthma exacerbation: two-year prospective observational study in intensive care.

BACKGROUND: Asthma is a common cause of admission to the pediatric intensive care unit (PICU). We described and analyzed the therapies applied to children admitted to a tertiary PICU because of asthma. Later, we evaluated high-flow nasal cannula (HFNC) use in these patients and compared their evolution and complications with those who received non-invasive ventilation. METHODS: We conducted a prospective observational study (October 2017-October 2019). Collected data: epidemiological, clinical, respiratory support therapy needed, complementary tests, and PICU and hospital stay. Patients were divided into three groups: (1) only HFNC; (2) HFNC and non-invasive mechanical ventilation (NIMV); and (3) only NIMV. RESULTS: Seventy-six patients were included (39 female). The median age was 2 years and 1 month. The median pulmonary score was 5. The median PICU stay was 3 days, and the hospital stay was 6 days. Children with HNFC only (56/76) had fewer PICU days (p = 0.025) and did not require NIMV (6/76). Children with HFNC had a higher oxygen saturation/fraction of inspired oxygen ratio ratio (p = 0.025) and lower PCO2 (p = 0.032). In the group receiving both therapies (14/76), NIMV was used first in all cases. No epidemiologic or clinical differences were found among groups. CONCLUSION: HFNC was a safe approach that did not increase the number of PICU or hospital days. On admission, normal initial blood gases and the absence of high oxygen requirements were useful in selecting responders to HFNC. Further randomized and multicenter clinical trials are needed to verify these data.

INTRODUCCIÓN: El asma es una causa frecuente de ingreso en la unidad de cuidados intensivos pediátricos (UCIP). En este, cuadro el uso de cánula nasal de alto flujo (CNAF) se ha visto extendido. En este trabajo se describe el tratamiento global en la UCIP ante el ingreso por asma en un hospital monográfico pediátrico y se evalúa la respuesta al uso de la CNAF, comparando la evolución de los pacientes con aquellos que recibieron ventilación no invasiva (VNI). MÉTODOS: Se llevó a cabo un estudio observacional prospectivo (de octubre del 2017 a octubre del 2019). Se describieron epidemiología, clínica, tratamiento y soporte respiratorio. Para la comparación se crearon tres grupos de pacientes: 1) solo CNAF; 2) CNAF y VNI; y 3) solo VNI. RESULTADOS: Se incluyeron 76 pacientes. La mediana de edad fue de dos años y un mes; la mediana de índice pulmonar fue 5. La mediana de ingreso en UCIP fue de tres días y de ingreso hospitalario, seis días. Los niños con solo CNAF (56/76) mostraron menos días de UCIP (p = 0.025) y no requirieron VNI (6/76). También mostraron mayor SatO2/FiO2 (saturación de oxígeno/fracción de oxígeno inspirado) (p = 0.025) y menor nivel de PCO2 (presión parcial de CO2) (p = 0.032). La VNI se utilizó primero siempre en el grupo que recibió ambas modalidades (14/76). No se encontraron diferencias epidemiológicas o clínicas entre grupos. CONCLUSIONES: En nuestra serie, el uso de CNAF no aumentó los días de ingreso en la UCIP ni de hospital. Tampoco requirió cambio a VNI. Al ingreso, una gasometría normal y bajo requerimiento de oxígeno permitieron seleccionar a los pacientes respondedores. Se necesitan más ensayos multicéntricos clínicos aleatorizados para verificar estos datos.

Perspectiva parental del cuidado humanizado de la Unidad de Cuidados Intensivos Pediátricos / Parental perspective of humanized care at the Paediatric Intensive Care Unit

Objetivo: describir el cuidado humanizado en Enfermería desde la perspectiva parental en la Unidad de Cuidados Intensivos Pediátricos (UCIP).Método: orientación fenomenológica de Husserl. Los participantes han sido progenitores de población infantil de entre 3 a 6 años ingresados en la UCIP en la Comunidad de Madrid. Se ha realizado un muestreo por conveniencia y bola de nieve con nueve participantes. La recopilación de datos ha sido mediante entrevistas semiestructuradas a partir de preguntas abiertas sobre temas de interés con una duración entre 40 y 50 minutos. El análisis de contenido se realizó siguiendo el método de Strauss y Corbin en tres fases.Resultados: se identificaron tres categorías: Disrupción del ingreso en la UCIP, Tiempo y espacio en la UCI Pediátricos y Atención enfermera en la UCIP. Los progenitores manifestaron un gran desconocimiento acerca de los cuidados y las labores realizadas en las unidades de cuidados intensivos antes del ingreso de sus hijos e hijas. En todos los casos sintieron miedo e incertidumbre. Los progenitores valoraron la constancia, el seguimiento exhaustivo y el apoyo emocional como una parte fundamental de los cuidados del personal de Enfermería en estas unidades.Conclusiones: todavía existe un desafío en la inclusión efectiva de los padres y hay una percepción insuficiente del apoyo del equipo de Enfermería hacia ellos y ellas. Se debe considerar incluir a las familias en los cuidados de sus hijos e hijas en una UCIP para disminuir el estrés y mejorar la percepción de la atención enfermera. (AU)

Objective: to describe the humanized Nursing care from the parental perspective at the Paediatric Intensive Care Unit (PICU).Method: husserlian-oriented descriptive phenomenological methodology. The participants were parents of the paediatric population (3-to-6 years old) admitted at the PICU in the Community of Madrid. Convenience and snowball sampling were conducted with nine participants. There was data collection through semistructured interviews based on open questions about topics of interest, with a duration between 40 and 50 minutes. Content analysis was conducted following the method in three stages by Strauss and Corbin.Results: three categories were identified: Disruption of admission at the PICU, Time and space at the Pediatric ICU, and Nursing care at the PICU. Parents showed a major lack of knowledge about the care and tasks conducted at the Intensive Care Units before their children were admitted. In all cases, they felt fear and uncertainty. Parents valued consistency, thorough follow-up and emotional support as an essential part of Nursing care in these units.Conclusions: the effective inclusion of parents still represents a challenge, and there is an insufficient perception of the support by the Nursing team towards them. It must be considered to include families in the care of their children at the PICU, in order to reduce stress and improve the perception of Nursing care. (AU)

Conocimiento del Equipo de Enfermería sobre Prevención de Lesiones por Presión en un hospital de Barranquilla, Colombia / Knowledge by the Nursing Team about Prevention of Pressure Ulcers at a hospital in Barranquilla, Colombia

Objetivo: determinar el nivel de conocimiento sobre prevención de lesiones por presión (LPP) en el equipo de Enfermería (enfermeros/as y auxiliares de Enfermería) en un hospital de cuarto nivel en Barranquilla, Colombia.Material y método: estudio descriptivo transversal realizado en los servicios de Medicina Interna y Cuidados Intensivos (N= 77). Se midieron la edad, el tiempo de formación, el tiempo de experiencia y el nivel de conocimientos sobre LPP mediante el porcentaje de aciertos en el Cuestionario Pieper y Mott Pressure Ulcer Knowledge de 41 ítems, traducido ad hoc, para los apartados de evaluación y clasificación y prevención. Se efectuó estadística descriptiva y bivariante.Resultados: participaron 77 personas. El porcentaje promedio de aciertos en la prueba de conocimiento fue de un 62% (DE= 27) en el apartado de evaluación y clasificación de las LPP (auxiliares de Enfermería [x–= 61%; DE= 26]; enfermeros/as [x–= 64%; DE= 30]; valor p= 0,663) y de un 72% (DE= 17) en el apartado de prevención (auxiliares de Enfermería [x–= 72%; DE= 16]; enfermeros/as [x–= 71%; DE= 22]; valor p= 0,663). En total, diez de los ítems superaron un 90% de aciertos en el caso de las/os enfermeras/os y uno en el caso de las/os auxiliares.Conclusiones: las/os enfermeras/os y auxiliares de Enfermería presentaron un conocimiento aceptable en prevención de LPP. Es necesario implementar estrategias exitosas para mejorar la prevención e incentivar la actualización de conocimientos. (AU)

Objective: to determine the level of knowledge about prevention of pressure ulcers (PU) by the Nursing Team (nurses and nursing assistants) at a fourth level hospital in Barranquilla, Colombia.Material and method: a descriptive, cross-sectional study conducted at the Internal Medicine and Intensive Care Units (N= 77). Their age, time of training, time of experience, and level of knowledge about PU prevention were measured through the percentage of right answers at the 41-item Pressure Ulcer Knowledge Questionnaire by Pieper and Mott, translated ad hoc, for the sections of evaluation and classification and prevention. Descriptive and bivariate statistics were conducted.Results: the study included 77 persons. The average proportion of right answers at the knowledge test was of 62% (SD= 27) in the section of evaluation and classification of PU prevention (nursing assistants [x–= 61%; SD= 26]; nurses [x–= 64%; SD= 30]; p value= 0.663) and 72% (SD= 17) in the prevention section (nursing assistants [x–= 72; SD= 16]; nurses [x–= 71%; SD= 22]; p value= 0.663). In total, ten of the items exceeded 90% of right answers in the case of nurses, and one in the case of assistants.Conclusions: nurses and Nursing assistants presented an acceptable knowledge regarding PU prevention. It is necessary to implement successful strategies in order to improve prevention and encourage the updating of knowledge. (AU)

Ultrasonography and procedures in intensive care medicine / Ecografía y procedimientos en Medicina Intensiva

The use of point-of-care ultrasonography (POCUS) is not limited to the diagnosis and/or monitoring of critically ill patients. Further, ultrasound guidance is of paramount relevance to aid in successfully and safely performing several procedures in the intensive care unit (ICU). In this article, we review the role of POCUS as a procedural guidance in the ICU. Core procedures include, but are not limited to, vascular cannulation, pericardiocentesis, thoracentesis, paracentesis, aspiration of soft-tissue collections/arthrocentesis and lumbar puncture. With time, the procedures performed by intensivists may extend beyond the core competencies depicted in this review. Ultrasound guidance should be part of the intensivist’s competencies, for which appropriate training should be achieved. (AU)

El uso de la ecografía no se limita al diagnóstico y/o monitorización del paciente crítico. Además, la guía ecográfica es de gran importancia para la ejecución exitosa y segura de diversos procedimientos en la Unidad de Cuidados Intensivos (UCI). En este artículo, revisamos el papel de la ecografía como guía intervencionista en la UCI. Los procedimientos ecodirigidos claves son, aunque no se limitan a estos, la canulación vascular, pericardiocentesis, toracocentesis, paracentesis, aspiración de colecciones de partes blandas/artrocentesis y la punción lumbar. Con el tiempo, los procedimientos realizados por los intensivistas se extenderán más allá de los descriptos en esta revisión. La guía ecográfica debe formar parte de las competencias del intensivista, para lo cual se requiere un entrenamiento adecuado. (AU)

El cuidado desde la visión sensible en la unidad de choque / Cuidados com a visão sensível na unidade de choque / Care from the sensitive vision in the shock unit

Objective: To understand the perception of the nurses who work in the Shock Unit about care during fibrinolytic therapy. Method: Qualitative study, Ethnographic approach, according to ethno-nursing, of Leininger's theory. Thirty-four nurse practitioners participated in a shock unit for adults of a Mexican general hospital. The data were obtained through a semi-structured interview, participant observation, it opted for the content analysis that allowed the elaboration of the categories that facilitated the understanding the data. Results: The analysis revealed the themes: An experience in the time of the other, the scientific and humanistic with a light on the paradigmatic path; opportunity from the nature of life and care from the sensitive vision of my human side. Conclusion: human care is perceptible by belief, motivated from the experiences lived in intensive care units, in this scenario it is necessary to promote hospital cross-cultural studies, due to the scientific wealth of nursing interventions in the shock unit, that strengthens cares like a light on the road.(AU)

Objetivo: comprender la percepción de las enfermeras que actúan en la Unidad de choque en relación a cuidado durante la terapia fibrinolítica. Método: Estudio cualitativo, de aproximación Etnográfico, según la etnoenfermería, de la teoría de Leininger. Participaron 34 enfermeras actoras en una unidad de Choque para adulto de un hospital general mexicano. Los datos se consiguieron a través de entrevista semi-estructurada, observación participante, se optó por el análisis de contenido que permitió la elaboración de las categorías que facilitaran la comprensión de los datos. Resultados: El análisis reveló los temas: Una experiencia en el tiempo del otro, lo científico y humanístico con una luz en el camino paradigmático; oportunidad desde la naturaleza de la vida y el cuidado desde la visión sensible mi lado humano. Conclusión: es perceptible el cuidado humano por la creencia, motivada desde las experiencias vividas en las unidades de terapia intensiva, en este escenario se requiere impulsar estudios transculturales hospitalarios, por la riqueza científica de las intervenciones de enfermería en la unidad de choque, eso fortalece los cuidados como una luz en el camino.(AU)

Objetivo: compreender a percepção dos enfermeiros que atuam na Unidade de Choque em relação aos cuidados durante a terapia fibrinolítica. Método: estudo qualitativo, abordagem etnográfica, segundo aetnoenfermagem, da teoria de Leininger. 34 enfermeiras atores participaram de uma unidade de choque para adultos de um hospital geral mexicano. Os dados foram obtidos por meio de entrevista semiestruturada, observação participante, optou-se pela análise de conteúdo que permitiua elaboração das categorias que facilitaram a compreensão dos dados. Resultados: A análise revelou os temas: Uma experiência no tempo do outro, o científico e o humanístico com uma luz no caminho paradigmático; oportunidade da natureza da vida e cuidado da visão sensível do meu lado humano. Conclusão: o cuidado humano é perceptível pela crença, motivado a partir das experiências vividas em unidades de terapia intensiva, neste cenário é necessário promover estudos transculturais hospitalares, devido à riqueza científica das intervenções de enfermagem na unidade de choque, o que fortalece se preocupa como uma luz na estrada.(AU)

Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2 / Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19

La aparición de úlceras por presión (UPP) es una de las complicaciones frecuentes del decúbito prono (DP), debido a la presión prolongada y las fuerzas de cizallamiento. Objetivos: Comparar la incidencia de UPP secundarias a la posición del decúbito prono y describir su localización entre 4 unidades de cuidados intensivos (UCI) de hospitales públicos. Metodología: Estudio observacional descriptivo retrospectivo multicéntrico. La población estuvo formada por pacientes ingresados en la UCI entre febrero de 2020 y mayo 2021, diagnosticados de COVID-19 que precisaron decúbito prono. Las variables estudiadas fueron sociodemográficas, días de ingreso en la UCI, horas totales en DP, prevención de UPP, localización, estadio, frecuencia de cambios posturales, nutrición y aporte de proteínas. La recogida de datos se realizó a través de la historia clínica de las diferentes bases de datos informatizadas de cada hospital. Se realizó análisis descriptivo y asociación entre las variables, utilizando el programa SPSS vs.20.0.Resultados: Ingresaron 574 pacientes por COVID-19, el 43,03% fueron pronados. El 69,6% fueron hombres, la mediana de edad fue 66 (RIC: 55-74) y el IMC de 30,7 (RIC: 27-34,2). La mediana de estancia en la UCI fue de 28 días (RIC: 17-44,2) y la mediana de horas en DP por paciente 48h (RIC: 24-96). La incidencia de aparición de UPP fue del 56,3% y el 76,2% de los pacientes la presentaron; la localización más frecuente fue la frente (74,9%). Existen diferencias significativas entre hospitales en cuanto a la incidencia de UPP (p<0,001), su localización (p=0,000) y la duración media de horas por cada episodio de DP (p=0,001). Conclusiones: La incidencia de UPP secundarias al DP fue muy elevada. Existe gran variabilidad en cuanto a incidencia de UPP entre hospitales, la localización y la duración media de horas por cada episodio de DP.(AU)

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p=0.002), location (p<0.001) and median duration of hours per PD episode (p=0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.(AU)

Lesiones cutáneas relacionadas con la dependencia en el paciente crítico pronado. Estudio de incidencia / Dependency-related skin lesions in the prone critical patient. Incidence study

Objetivo: Determinar la incidencia de las lesiones cutáneas relacionadas con la dependencia (LCRD) en los pacientes en decúbito prono (DP) e identificar los factores predisponentes. Método: Estudio descriptivo-longitudinal en 2 unidades de cuidados intensivos (UCI) polivalentes. Se incluyeron pacientes con ventilación mecánica invasiva y DP, sin lesiones al ingreso. Se registraron 3 tipos de LCRD: (lesiones por presión [LPP], lesiones cutáneas asociadas a la humedad [LESCAH] y lesiones por fricción [LF]), variables demográficas, diagnóstico, estancia, episodios en DP, cambios posturales, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbúmina al ingreso, índice de masa corporal (IMC), diabetes, hipertensión arterial, tabaquismo, enfermedad vascular periférica (EVP), fármacos vasoactivos, escala de Braden y mortalidad. Análisis bivariante: prueba de χ2, t-Student o U de Mann-Whitney. Multivariante: regresión logística. Resultados: Se incluyeron 49 pacientes. Se realizaron 170 DP. Aparecieron 41 LCRD en 22 pacientes con una incidencia acumulada del 44,9% (IC 95%: 31,6-58,7). El 63,4% LPP (73,1% faciales; 76,9% categoría II), el 12,2% LESCAH (60% inguinales; 60% categoría II) y el 24,4% LF (50% torácicas; 70% categoría III). La mediana de edad del grupo con lesiones (GCL) fue de 66,5 (61,8-71,3) frente al 64 (43-71) años del grupo sin lesiones (GSL); p=0,04. El 80% del GCL tenía EVP frente al 20% del GSL; p=0,03. La mediana de horas totales en DP del GCL fue de 96,9 (56,1-149,4) frente a 38,2 (18,8-57) del GSL; p<0,001. El análisis multivariante seleccionó horas totales DP (OR: 1,03; IC 95%: 1,01-1,05) y la EVP (OR: 8,9; IC 95%: 1,3-58,9) como factores predisponentes para desarrollar LCRD. Conclusiones: Existe una elevada incidencia de LCRD en DP, mayoritariamente lesiones por presión, aunque de baja severidad. Las horas acumuladas en DP y la enfermedad vascular periférica favorecen su desarrollo.(AU)

Objective: To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. Method: Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL:(pressure ulcers (PU), moisture-associated skin damage (MASD) and friction injuries (FI)), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: Chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. Results: Forty nine patients were included and 170 PP were performed. Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95% CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 (61.8-71.3) vs 64 (43-71) years old in the non-lesion group (NLG), P=.04. Eighty percent of the LG had PVD vs 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 (56.1-149.4) vs 38.2 (18.8-57) of the NIG, P<.001. Multivariate analysis selected total PP hours (OR: 1.03; 95% CI: 1.01-1.05) and PVD (OR: 8.9; 95% CI: 1.3-58.9) as predisposing factors for developing DRSL. Conclusions: There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity. The accumulated hours in probe position and peripheral vascular disease favor their development.(AU)

Uso de la ultrasonografía en la evaluación de la retención urinaria en pacientes críticos / Use of ultrasonography in the evaluation of urinary retention in critically ill patients / Utilização da ultrassonografia na avaliação de retenção urinária em pacientes críticos

Objetivo: medir el volumen urinario por medio de la ecografía vesical, realizado por una enfermera en pacientes críticos, después de la retirada de la sonda urinaria permanente y verificar los factores relacionados en la retención urinaria. Método: estudio cuantitativo, observacional y transversal, realizado con 37 pacientes críticos de ambos sexos, mayores de 18 años, con retiro de catéter vesical permanente en las últimas 48 horas. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Los datos fueron presentados a través de distribución de frecuencias, medidas de centralidad y variabilidad, asociación mediante la prueba exacta de Fisher y, para el análisis, regresión logística binomial múltiple. Resultados: de los 37 pacientes, en su mayoría fue de sexo masculino, con una edad média de 54,9 años. La medición del volumen urinario por ecografía osciló entre 332,3 y 950 ml, y el 40,54% de los pacientes presentó retención urinaria. La retención urinaria se asoció significativamente a la aparición de infección urinaria, estreñimiento intestinal y diuresis por rebosamiento espontáneo. Los pacientes con infección del tracto urinario tenían 7,4 veces más probabilidades de tener retención urinaria. Conclusión: la ecografía vesical fue eficaz para medir el volumen urinario después de retirar el catéter urinario permanente y puede contribuir a la detección de retención urinaria.

Objective: to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention. Method: quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis. Results: the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention. Conclusion: bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention.

Objetivo: mensurar o volume urinário por meio da ultrassonografia de bexiga, realizada por enfermeiro em pacientes críticos, após a remoção do cateter vesical de demora, e verificar os fatores relacionados na retenção urinária. Método: estudo quantitativo, observacional e transversal, realizado com 37 pacientes críticos de ambos os sexos, idade superior a 18 anos, com retirada de cateter vesical de demora nas últimas 48 horas. Foram utilizados um questionário contendo as variáveis sociodemográficas e clinicas e o exame de ultrassonografia. Os dados foram apresentados por meio da distribuição de frequência, medidas de centralidade e de variabilidade, associação pelo teste exato de Fisher e, para análise a regressão logística binomial múltipla. Resultados: dos 37 pacientes, a maioria era do sexo masculino, com média de idade de 54,9 anos. A mensuração do volume urinário pela ultrassonografia variou de 332,3 a 950 ml, sendo que 40,54% dos pacientes apresentaram retenção urinária. A retenção urinaria apresentou associação significativa para a ocorrência de infecção do trato urinário, constipação intestinal e diurese espontânea por transbordamento. Pacientes com infecção urinária tiveram 7,4 vezes mais chance de apresentar retenção urinária. Conclusão: ultrassonografia de bexiga foi eficaz para mensurar o volume urinário após a remoção do cateter vesical de demora e poderá contribuir na detecção da retenção urinária.

Perspectivas para a Prática Avançada de Enfermagem em Unidades de Terapia Intensiva: uma reflexão / Perspectives for Advanced Practice Nursing in Intensive Care Units: a reflection

OBJETIVO: Refletir sobre as ações de práticas avançadas de enfermagem no contexto das Unidades de Terapia Intensiva. MÉTODO: Trata-se de um estudo teórico-reflexivo embasado em literatura internacional, cujos artigos apontem ações do enfermeiro de prática avançada no ambiente de terapia intensiva, além do guideline de Prática Avançada de Enfermagem do International Council of Nurses. RESULTADOS: A união de informações acerca das ações de práticas avançadas de enfermagem no ambiente de terapia intensiva permitiu a reflexão que gerou nove categorias de ações: educação continuada, educação em saúde, ser referência especializada em terapia intensiva, atividade de pesquisa, gerenciamento do cuidado, liderança de equipe, cuidado com a família, atuação em equipe multidisciplinar e assistência direta ao paciente. CONCLUSÃO: A reflexão evidenciou que educação, gestão e assistência são eixos de competências encontradas nas práticas avançadas de enfermagem na terapia intensiva.

OBJECTIVE: To reflect on the actions of advanced practice nursing in the context of intensive care units. METHOD: This is a theoretical-reflective study based on international literature whose articles refer to the actions of advanced practice nurses in the intensive care environment. It is also based on the International Council of Nurses' Advanced Practice Nursing Guideline. RESULTS: The union of information about the actions of advanced practice nursing in the intensive care environment allowed a reflection that generated nine categories of actions: continuing education, patient education, being a specialized reference in intensive care, research activity, care management, team leadership, family care, multidisciplinary teamwork, and direct patient care. CONCLUSION: The reflection showed that education, management, and care are the axes of competencies in advanced practice nursing in intensive care.