Characteristics and risk factors associated with mortality during the first cycle of prone secondary to ARDS due to SARS-CoV-2 pneumonia / Características y factores de riesgo asociados a mortalidad durante el primer ciclo de prono por SDRA secundario a neumonía por SARS-CoV-2

Objective To analyze characteristics, changes in oxygenation, and pulmonary mechanics, in mechanically ventilated patients with ARDS due to SARS-CoV-2 treated with prone position and evaluate the response to this maneuver.Design Cohort study including patients with PaO2/FiO2 <150mmHg requiring prone position over 18 months. We classified patients according to PaO2/FiO2 changes from basal to 24h after the first prone cycle as: 1) no increase 2) increase <25%, 3) 25%–50% increase 4) increase >50%. Setting 33-bed medical-surgical Intensive Care Unit (ICU) in Argentina. Patients 273 patients. Interventions None. Main variables of interest Epidemiological characteristics, respiratory mechanics and oxygenation were compared between survivors and non-survivors. Independent factors associated with in-hospital mortality were identified. Results Baseline PaO2/FiO2 was 116 [97–135]mmHg (115 [94–136] in survivors vs. 117 [98–134] in non-survivors; p=0.50). After prone positioning, 22 patients (8%) had similar PaO2/FiO2 values; 46(16%) increased PaO2/FiO2 ≤25%; 55 (21%) increased it 25%–50%; and 150 (55%), >50%. Mortality was 86%, 87%, 72% and 50% respectively (p<0.001). Baseline PaO2/FiO2, <100mmHg did not imply that patients were refractory to prone position. Factors independently associated with mortality were age, percentage increase in PaO2/FiO2 after 24h being in prone, and number of prone cycles. Conclusions Older patients unable to improve PaO2/FiO2 after 24h in prone position and who require >1 cycle might early receive additional treatments for refractory hypoxemia. After the first 24h in the prone position, a low percentage of PaO2/FiO2 increase over baseline, beyond the initial value, was independently associated with higher mortality. (AU)

Objetivo Analizar las características, cambios en la oxigenación y mecánica pulmonar, en pacientes ventilados mecánicamente con SDRA por SARS-CoV-2 tratados con posición prona, y evaluar la respuesta a esta maniobra. Diseño Estudio de cohorte que incluyó pacientes con PaO2/FiO2 <150mmHg que requirieron posición prona durante 18 meses. Se clasificaron los pacientes según los cambios de PaO2/FiO2 desde el basal y 24horas después del primer ciclo prono como: 1) Sin aumento 2) Aumento <25%, 3) 25–50% de aumento 4) Aumento >50%. Ambito Unidad de Cuidados Intensivos (UCI) médico-quirúrgica de 33 camas en Argentina. Pacientes 273 pacientes. Intervenciones Ninguna. Principales variables de interés Se compararon características epidemiológicas, mecánica respiratoria y oxigenación entre sobrevivientes y no sobrevivientes. Se identificaron factores independientes asociados a la mortalidad hospitalaria. Resultados La PaO2/FiO2 basal fue de 116 [97–135]mmHg (115 [94–136] en sobrevivientes vs. 117 [98–134] en no sobrevivientes; p=0,50). Después de la posición prona, 22 pacientes (8%) tenían valores similares de PaO2/FiO2; 46 (16%) aumentaron PaO2/FiO2 ≤25%; 55 (21%) lo aumentaron 25%–50%; y 150 (55%), >50%. La mortalidad fue de 86%, 87%, 72% y 50% respectivamente (p<0,001). La PaO2/FiO2 basal, <100mmHg no implicó que los pacientes fueran refractarios a la posición prona. Los factores asociados independientemente con la mortalidad fueron la edad, el aumento porcentual de PaO2/FiO2 después de 24horas en prona, y el número de ciclos prono. Conclusiones Los pacientes mayores que no pueden mejorar PaO2/FiO2 después de 24 horas en posición prona y que requieren más de 1 ciclo podrían recibir tratamientos adicionales para la hipoxemia refractaria. Después de las primeras 24horas en decúbito prono, un bajo porcentaje de aumento de PaO2/FiO2 sobre el valor basal, más allá del valor inicial, se asoció de forma independiente con una mayor mortalidad. (AU)

Characteristics and risk factors associated with mortality during the first cycle of prone secondary to ARDS due to SARS-CoV-2 pneumonia.

OBJECTIVE: To analyze characteristics, changes in oxygenation, and pulmonary mechanics, in mechanically ventilated patients with ARDS due to SARS-CoV-2 treated with prone position and evaluate the response to this maneuver. DESIGN: Cohort study including patients with PaO2/FiO2 <150mmHg requiring prone position over 18 months. We classified patients according to PaO2/FiO2 changes from basal to 24h after the first prone cycle as: 1) no increase 2) increase <25%, 3) 25%-50% increase 4) increase >50%. SETTING: 33-bed medical-surgical Intensive Care Unit (ICU) in Argentina. PATIENTS: 273 patients. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Epidemiological characteristics, respiratory mechanics and oxygenation were compared between survivors and non-survivors. Independent factors associated with in-hospital mortality were identified. RESULTS: Baseline PaO2/FiO2 was 116 [97-135]mmHg (115 [94-136] in survivors vs. 117 [98-134] in non-survivors; p=0.50). After prone positioning, 22 patients (8%) had similar PaO2/FiO2 values; 46(16%) increased PaO2/FiO2 ≤25%; 55 (21%) increased it 25%-50%; and 150 (55%), >50%. Mortality was 86%, 87%, 72% and 50% respectively (p<0.001). Baseline PaO2/FiO2, <100mmHg did not imply that patients were refractory to prone position. Factors independently associated with mortality were age, percentage increase in PaO2/FiO2 after 24h being in prone, and number of prone cycles. CONCLUSIONS: Older patients unable to improve PaO2/FiO2 after 24h in prone position and who require >1 cycle might early receive additional treatments for refractory hypoxemia. After the first 24h in the prone position, a low percentage of PaO2/FiO2 increase over baseline, beyond the initial value, was independently associated with higher mortality.

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)

Tratamientos coadyuvantes a la ventilación mecánica invasiva en el manejo del síndrome de distrés respiratorio agudo secundario a covid-19 / Adjuvant treatments to invasive mechanical ventilation in the management of acute respiratory distress syndrome secondary to COVID-19

Introducción: La presente revisión bibliográfica está realizada con el fin de obtener respuestas acerca de aspectos relacionados con las técnicas y tratamientos, así como cuidados asociados al paciente crítico diagnosticado con covid-19. Objetivo: Analizar la evidencia científica disponible sobre la efectividad de la utilización de la ventilación mecánica invasiva junto con otras técnicas coadyuvantes, en la reducción de la tasa de mortalidad en pacientes con síndrome de distrés respiratorio agudo y juicio clínico de covid-19 atendidos en unidades de cuidados intensivos. Metodología: Se realizó una revisión bibliográfica sistematizada en las bases de datos PubMed, CUIDEN, LILACS, Medline, CINAHL y Google Scholar, utilizando términos MeSH (adult respiratory distress syndrome, mechanical ventilation, prone position, nitric oxide, extracorporeal membrane oxygenation, nursing care) y los operadores booleanos correspondientes. Los estudios seleccionados se sometieron a una lectura crítica realizada entre el 6 de diciembre de 2020 y el 27 de marzo de 2021 utilizando la herramienta Critical Appraisal Skills Programme en español y un instrumento de evaluación de estudios epidemiológicos transversales. Resultados: Se seleccionaron un total de 85 artículos. Tras realizar la lectura crítica se incluyeron en la revisión un total de 7 artículos, consistiendo en 6 estudios descriptivos y un estudio de cohortes. Tras el análisis de dichos estudios, se desprende que la técnica que mejor resultados ha obtenido es la oxigenación por membrana extracorpórea, siendo importantes los cuidados proporcionados por el personal de enfermería cualificado y capacitado. Conclusión: La mortalidad por covid-19 aumenta en pacientes tratados con ventilación mecánica invasiva respecto a los pacientes tratados con oxigenación por membrana extracorpórea. Los cuidados de enfermería y la especialización pueden repercutir en una mejora de los resultados en los pacientes.(AU)

Introduction: This bibliographic review is carried out in order to obtain answers about aspects related to techniques and treatments, as well as care associated with the critically ill patient diagnosed with COVID-19. Objective: To analyze the available scientific evidence on the effectiveness of the use of invasive mechanical ventilation together with other adjuvant techniques, in reducing the mortality rate in patients with acute respiratory distress syndrome and clinical trial of COVID-19 treated in intensive care units. Methodology: A systematized bibliographic review was carried out in the PubMed, CUIDEN, LILACS, Medline, CINAHL and Google Scholar databases, using MeSH terms (adult respiratory distress syndrome, mechanical ventilation, prone position, nitric oxide, extracorporeal membrane oxygenation, nursing care) and the corresponding Boolean operators. The selected studies underwent a critical reading carried out between December 6, 2020 and March 27, 2021 using the Critical Appraisal Skills Program tool in Spanish and a cross-sectional epidemiological studies evaluation instrument. Results: A total of 85 articles were selected. After performing the critical reading, a total of 7 articles were included in the review, 6 being descriptive studies and one a cohort study. After analyzing these studies, it appears that the technique that has obtained the best results is extracorporeal membrane oxygenation, with the care provided by qualified and trained nursing staff being very important. Conclusion: Mortality from COVID-19 increases in patients treated with invasive mechanical ventilation compared to patients treated with extracorporeal membrane oxygenation. Nursing care and specialization can have an impact on improving patient outcomes.(AU)

Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19.

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 48 h (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 = .002), location (P = .000) and median duration of hours per PD episode (P = .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.

Adjuvant treatments to invasive mechanical ventilation in the management of acute respiratory distress syndrome secondary to COVID-19.

INTRODUCTION: This bibliographic review is carried out in order to obtain answers about aspects related to techniques and treatments, as well as care associated with the critically ill patient diagnosed with Covid-19. OBJECTIVE: To analyze the available scientific evidence on the effectiveness of the use of invasive mechanical ventilation together with other adjuvant techniques, in reducing the mortality rate in patients with Acute Respiratory Distress Syndrome and clinical trial of Covid-19 treated in intensive care units. METHODOLOGY: A systematized bibliographic review was carried out in the Pubmed, Cuiden, Lilacs, Medline, Cinahl and Google Scholar databases, using MeSH terms (Adult Respiratory Distress Syndrome, Mechanical Ventilation, Prone Position, Nitric Oxide, Extracorporeal Membrane Oxygenation, Nursing Care) and the corresponding Boolean operators. The selected studies underwent a critical reading carried out between December 6, 2020 and March 27, 2021 using the Critical Appraisal Skills Program tool in Spanish and a cross-sectional epidemiological studies evaluation instrument. RESULTS: A total of 85 articles were selected. After performing the critical reading, a total of 7 articles were included in the review, 6 being descriptive studies and 1 cohort study. After analyzing these studies, it appears that the technique that has obtained the best results is ECMO, with the care provided by qualified and trained nursing staff being very important. CONCLUSION: Mortality from Covid-19 increases in patients treated with invasive mechanical ventilation compared to patients treated with extracorporeal membrane oxygenation. Nursing care and specialization can have an impact on improving patient outcomes.

Algoritmos para prevenir lesão por pressão em paciente com COVID-19 em prona / Algoritmos para prevenir la úlcera por presión en pacientes con COVID-19 en prona / Algorithms to prevent pressure injury in COVID-19 patients in prone position

Resumo Objetivo Elaborar e validar o conteúdo de dois algoritmos para orientar profissionais da linha de frente na prevenção e no tratamento da lesão por pressão em paciente com COVID-19 em posição prona. Métodos Estudo realizado entre setembro e novembro de 2021. Para a construção dos algoritmos, realizou-se revisão da literatura junto às bases de dados MEDLINE®, SciELO e Lilacs. Foram pesquisados artigos publicados entre 2011 e 2021. A validação dos algoritmos foi feita por 59 profissionais da saúde (enfermeiros, fisioterapeutas e médicos), que trabalhavam na linha de frente da COVID-19, utilizando-se a técnica Delphi. Para a análise de dados, foi adotado o Índice de Validade de Conteúdo e o coeficiente alfa de Cronbach. Resultados No primeiro ciclo de avaliação, os itens dos algoritmos foram considerados pelos juízes como "parcialmente adequados a totalmente adequados", e o Índice de Validade de Conteúdo variou entre 0,87 e 0,92. O coeficiente alfa de Cronbach variou entre 0,95 e 0,96, indicando excelente consistência interna do questionário de avaliação utilizado pelos juízes. Após implementados os ajustes sugeridos pelos juízes, os algoritmos foram reenviados para o segundo ciclo de avaliação, no qual todos os itens foram julgados como "adequado" e "totalmente adequado", resultando em um Índice de Validade do Conteúdo de 1,0. Conclusão Os algoritmos para orientar profissionais da saúde na prevenção e no tratamento da lesão por pressão em pacientes com COVID-19 em posição prona foram avaliados por enfermeiros, fisioterapeutas e médicos que estavam na linha de frente de combate à COVID-19, que chegaram a um consenso quanto ao conteúdo no segundo ciclo de avaliação.

Resumen Objetivo Elaborar y validar el contenido de dos algoritmos para orientar profesionales de la línea de frente sobre la prevención y tratamiento de la úlcera por presión en pacientes con COVID-19 en posición prona. Métodos Estudio realizado entre septiembre y noviembre de 2021. Para la elaboración de los algoritmos, se realizó revisión de la literatura en las bases de datos MEDLINE®, SciELO y Lilacs. Se buscaron artículos publicados entre 2011 y 2021. La validación de los algoritmos fue realizada por 59 profesionales de la salud (enfermeros, fisioterapeutas y médicos), que trabajaban en la línea de frente del COVID-19, utilizando el método Delphi. Para el análisis de datos se adoptó el Índice de Validez de Contenido y el coeficiente alfa de Cronbach. Resultados En el primer ciclo de evaluación, los ítems de los algoritmos fueron considerados por los jueces como "parcialmente adecuados a totalmente adecuados", y el Índice de Validez de Contenido varió entre 0,87 y 0,92. El coeficiente alfa de Cronbach varió entre 0,95 y 0,96, lo que indica una excelente consistencia interna del cuestionario de evaluación utilizado por los jueces. Después de implementar las mejoras sugeridas por los jueces, se reenviaron los algoritmos para el segundo ciclo de evaluación, en el cual todos los ítems fueron calificados como "adecuado" y "totalmente adecuado", con un resultado del Índice de Validez de Contenido de 1,0. Conclusión Los algoritmos para orientar profesionales de la salud sobre la prevención y el tratamiento de la úlcera por presión en pacientes con COVID-19 en posición prona fueron evaluados por enfermeros, fisioterapeutas y médicos que estaban en la línea de frente de combate al COVID-19 y llegaron a un consenso respecto al contenido en el segundo ciclo de evaluación.

Abstract Objective To develop and validate the content of two algorithms to guide frontline professionals in the prevention and treatment of pressure injuries in COVID-19 patients in prone position. Methods Study conducted between September and November 2021. A literature review was performed in MEDLINE®, SciELO and Lilacs databases to build the algorithms. Articles published between 2011 and 2021 were searched. The validation of algorithms was performed by 59 health professionals (nurses, physical therapists and physicians) who worked on the frontline of COVID-19. The Delphi technique was used, and Content Validity Index and Cronbach's alpha coefficient were adopted for data analysis. Results In the first evaluation cycle, the items of algorithms were considered as "partially adequate to totally adequate" by the judges, and the Content Validity Index ranged between 0.87 and 0.92. Cronbach's alpha coefficient ranged between 0.95 and 0.96, indicating excellent internal consistency of the evaluation questionnaire used by the judges. After implementing the adjustments suggested by judges, the algorithms were sent to a second evaluation cycle, in which all items were judged as "adequate" and "totally adequate", resulting in a Content Validity Index of 1.0. Conclusion Algorithms to guide healthcare professionals in the prevention and treatment of pressure injury in COVID-19 patients in prone position were evaluated by nurses, physical therapists and physicians working on the frontline of COVID-19. They achieved consensus on content in the second evaluation cycle.

Investigating acetazolamide effectiveness on CSF leak in adul patients after spinal surgery / Investigación de la eficacia de la acetazolamida en la fuga de LCR en pacientes adultos después de una cirugía de column

Introduction and objectives Despite the use of acetazolamide in the management of CSF leak in most patients after CNS surgeries, there is scant evidence in the literature about the efficacy of this established protocol among adult patients in post-spinal surgery observations. We investigated the potential positive effect of acetazolamide in reducing CSF leak after spine surgery. Materials and methods We conducted a single-center, double-blind, randomized-controlled trial comparing Oral Acetazolamide plus Corrected body (prone) position (CP+A) versus Corrected body (prone) position alone(CP−A) from January 2014 to September 2015 in the Neurosurgery ward of Shariati Teaching Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seventy-two Patients divided into two groups [CP−A group (n=36, 50%) and CP+A group (n=36, 50%)] were randomly assigned to this Clinical Trial study. CP+A group (maintained the 3/4 lateral position+dose of acetazolamide 20mg/kg/day in 3–4 divided doses for 7 days), and CP−A group (Control group) (maintained the 3/4 lateral position for 7 days with no acetazolamide). Results Baseline characteristics between the two groups showed no significant differences: Sex (P<0.637), Age (P<0.988) and previous CNS operation at other location besides the spine (P<0.496). Although we reported post-surgical CSF leak in 2/36 (5.55%) of CP+A group and 4/36(11.11%) of CP−A (control) group, there was no significant difference observed between the two groups (95%CI, 0.081–2.748; OR=0.471; P<0.402; Adjusted P<0.247). Additionally, no significant differences were observed when we examined surgical characteristics, such as the size of the dural opening (P<0.489) and type of operation (P<0.465). Conclusion Acetazolamide has no positive effect in controlling CSF leak after dural ... (AU)

Introducción y objetivos A pesar del uso de acetazolamida en el manejo de la fuga de LCR en la mayoría de los pacientes después de cirugías del SNC, existe escasa evidencia en la literatura sobre la eficacia de este protocolo establecido entre pacientes adultos en observaciones poscirugía de columna. Investigamos el posible efecto positivo de la acetazolamida en la reducción de la fuga de LCR después de la cirugía de columna. Materiales y métodos Realizamos un ensayo controlado aleatorio, doble ciego, de un solo centro comparando acetazolamida oral más posición corporal (prona) corregida (CP + A) versus posición corporal (prona) corregida sola (CP-A) desde enero de 2014 hasta septiembre de 2015 en la sala de neurocirugía del Hospital Docente Shariati, Universidad de Ciencias Médicas de Teherán, Teherán, Irán. Setenta y dos pacientes divididos en dos grupos [grupo CP-A (n = 36, 50%) y grupo CP + A (n = 36, 50%)] fueron asignados aleatoriamente a este ensayo clínico. Grupo CP + A (mantuvo la posición lateral 3/4 + dosis de acetazolamida 20mg/kg/día en 3-4 dosis divididas durante 7 días) y grupo CP-A (grupo Control) (mantuvo la posición lateral 3/4 durante 7 días). 7 días sin acetazolamida). Resultados Las características basales entre los dos grupos no mostraron diferencias significativas: sexo (P <0,637), edad (P <0,988) y operación previa del SNC en otra ubicación además de la columna (P <0,496). Aunque informamos fuga de LCR posquirúrgica en 2/36 (5,55%) del grupo CP + A y 4/36 (11,11%) del grupo CP-A (control), no se observaron diferencias significativas entre los dos grupos (95% IC, 0,081-2,748; OR = 0,471; P <0,402; P ajustado <0,247). Además, no se observaron diferencias significativas cuando examinamos las características quirúrgicas, como el tamaño de la abertura dural (P <0,489) y el tipo de operación (P <0,465). Conclusión La acetazolamida no tiene un efecto positivo... (AU)

Cuidados de enfermería durante la ventilación decúbito prono de pacientes con COVID-19 / Nursing care during prone position ventilation of patients with COVID-19

Introducción: Una de las estrategias no convencionales para el cuidado del paciente con COVID-19 con síndrome de distress respiratorio agudo es la técnica de pronación. La responsabilidad de este cambio de posición recae en el equipo de enfermería y no se dispone de una sistematización de este conocimiento Objetivo: Sintetizar los cuidados de enfermería en el paciente con COVID-19, síndrome de distress respiratorio agudo y ventilación mecánica en decúbito prono versus otros decúbitos, para mejorar la oxigenación y disminuir el riesgo de complicaciones. Métodos: Revisión sistemática realizada entre noviembre del 2021 y enero del 2022. Se realizó búsqueda en las bases de datos Pupmed, Google académico, Elsevier y Research Gate. Se elaboró la pregunta guía a través del acrónimo PICO. La estrategia de búsqueda se realizó mediante los descriptores en Ciencias de Salud y Medical Subject Headings "Posición prona", "Ventilación mecánica", Síndrome de distress respiratorio agudo", "COVID-19", "Cuidados de enfermería" con los operadores booleanos AND y OR. Se utilizó el diagrama de flujo PRISMA. Tras aplicar los criterios de inclusión y exclusión, resultó una muestra de 18 artículos para ser discutidos. Conclusiones: La revisión realizada posibilitó destacar la importancia de los cuidados de enfermería antes, durante y después de aplicada la técnica de pronación para disminuir la incidencia de complicaciones, el análisis de los valores hemogasométricos permite establecer comparaciones que verifiquen la efectividad de la técnica(AU)

Introduction: One of the unconventional strategies for the care of the COVID-19 patient with acute respiratory distress syndrome is the pronation technique. The responsibility for this change in position falls on the Nursing team and there is no systematization of this knowledge Objective: integrate the results of studies regarding nursing care during ventilation in the prone position of patients with COVID-19 Methods: systematic review carried out between November 2021 and January 2022. A search was made in the Pupmed, Google academic, Elsevier, ResearchGate databases. The guiding question was elaborated through the acronym PICO. The search strategy was carried out using the descriptors in Health Sciences and Medical Subject Headings "prone position", "mechanical ventilation", Acute Respiratory Distress Syndrome", "COVID-19", "Nursing care" with Boolean AND operators and OR. The flow chart (PRISMA) was used. After applying the inclusion and exclusion criteria, a sample of 18 resulted to be discussed. Conclusions: the review carried out made it possible to highlight the importance of Nursing care before, during and after to reduce the incidence of complications, the analysis of hemogasometric values allows comparisons to be made that verify the effectiveness of the technique(AU)

Considerations of invasive mechanical ventilation in prone position. A narrative review / Consideraciones de la ventilación mecánica invasiva en posición prona. Revisión narrativa

Abstract The evidence regarding logistic considerations and safety events associated with prone position ventilation (PPV) is summarized and a flow diagrama for safe provision of mechanical ventilation in the setting of the COVID-19 pandemic is proposed. A review of the literature was conducted in the Medline via Pubmed, Embase, and Lilacs databases, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database, and Google scholar. Overall, 31 articles were selected for the analysis. The incidence of PPV-related safety events varies between 1% and 11.9% and the most frequent complications are pressure ulcers and airway complications. Early initiation of enteral nutrition is recommended, and transfers are possible in patients on PPV. There is controversy regarding contraindications and recommendations for PPV. Recommendations for its safe provision are based on expert opinions and the establishment of protocols for healthcare staff training. Clinical studies are required to determine which are the recommendations that should be considered for safe and reproducible PPV use during this pandemic.

Resumen Sintetizamos la evidencia con respecto a las consideraciones logísticas y los eventos de seguridad asociados a la ventilación mecánica en posición prona (VMPP) y proponemos un flujograma para realizarla de manera segura en el escenario de la pandemia por COVID-19. Para ello, realizamos una búsqueda de la literatura en las bases de datos Medline vía PubMed, Embase, Lilacs, Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database y Google académico. Se incluyeron 31 artículos para ser analizados. La incidencia de eventos de seguridad relacionados a la VMPP varía entre 1 % a 11.9 %, las complicaciones más frecuentes son las úlceras por presión y de la vía aérea. Se recomienda iniciar nutrición enteral temprana y es posible realizar traslado de pacientes con VMPP. Existe controversia acerca de las contraindicaciones y recomendaciones de la VMPP. Las recomendaciones para realizarla de forma segura se basan en opiniones de expertos y en la instauración de protocolos para el entrenamiento del personal de salud. Se requieren estudios clínicos para determinar cuáles recomendaciones son necesarias para que la VMPP se realice de forma segura y reproducible durante esta pandemia.

Perception of health professionals on the prone position as a therapeutic strategy for patients with COVID-19 / Percepção de profissionais de saúde sobre a posição prona como estratégia terapêutica para pacientes com covid-19 / Percepción de los profesionales de la salud sobre la posición prono como estrategia terapéutica para pacientes con Covid-19

ABSTRACT The COVID-19 pandemic has led to a great number of hospitalizations. A considerable number of cases progress to the severe form of the infection and death. Prone positioning is a therapeutic strategy with strong evidence of reduced mortality in patients with acute respiratory distress syndrome (ARDS). This study aims to assess if the prone positioning strategy is used by health professionals in hospitals to treat patients with COVID-19 on invasive mechanical ventilation and the professionals' perception of its effect on the mortality rate. This is a cross-sectional study, with a convenience sample composed of health professionals of both sexes working in hospitals throughout Brazil. Participants answered an online questionnaire composed of 16 questions using Google Forms, from July 2020 to September 2020. A total of 455 questionnaires were answered. Prone positioning is routinely performed in hospitals where 386 (95%) of the responding professionals work. Among them, 374 (96.9%) consider that the prone position strategy reduces hypoxemia and 289 (74.9%) consider that it reduces mortality in patients with COVID-19 and ARDS on invasive mechanical ventilation. Finally, most health professionals working in Brazilian hospitals perform and believe that prone positioning reduces hypoxemia and mortality in patients with COVID-19 on invasive mechanical ventilation.

RESUMO A pandemia de covid-19 gerou um grande número de internações hospitalares e uma quantidade considerável de casos evolui para a forma grave da doença e óbito. A manobra de posição prona é uma estratégia terapêutica com forte evidência de redução da mortalidade em pacientes com síndrome do desconforto respiratório agudo (SDRA). Este estudo teve como objetivo verificar se a manobra de decúbito ventral é realizada como estratégia de tratamento de pacientes com covid-19 em ventilação mecânica invasiva por profissionais de saúde que atuam em ambiente hospitalar e a percepção sobre seu impacto na mortalidade. Trata-se de um estudo transversal, com amostra de conveniência composta por profissionais de saúde que atuam em hospitais de todo o Brasil, de ambos os sexos. Os participantes responderam a um questionário online, composto por 16 questões, elaborado no Google Forms, de julho a setembro de 2020. Quatrocentos e cinquenta e cinco questionários foram respondidos. A manobra da posição prona é realizada rotineiramente em hospitais onde atuam 386 profissionais (95%). Desses, 374 (96,9%) têm a percepção de que a manobra de decúbito ventral reduz a hipoxemia e 289 (74,9%) percebe que ela reduz a mortalidade de pacientes com covid-19 e SDRA em ventilação mecânica invasiva. Em conclusão, a maioria dos profissionais de saúde que atuam em hospitais brasileiros realiza e acredita que a manobra de decúbito ventral reduz a hipoxemia e a mortalidade em pacientes com covid-19 em ventilação mecânica invasiva.

RESUMEN La pandemia del Covid-19 ha generado un incremento de las hospitalizaciones y un gran número de casos de esta enfermedad ha evolucionado a su forma grave y la muerte. El manejo de la posición de decúbito prono es una estrategia terapéutica con sólida evidencia de reducción de la mortalidad en pacientes con síndrome de dificultad respiratoria aguda (SDRA). Este estudio tuvo como objetivo comprobar si la posición de decúbito prono es realizada por los profesionales de la salud que trabajan en un hospital como estrategia para el tratamiento de pacientes con el Covid-19 en ventilación mecánica invasiva y la percepción de estos profesionales sobre el impacto de tal práctica en la mortalidad. Se trata de un estudio transversal, con una muestra de conveniencia compuesta por profesionales de la salud que actúan en hospitales de todo Brasil, de ambos sexos. Los participantes respondieron un cuestionario en línea, con 16 preguntas en Google Forms, en el periodo de julio a septiembre de 2020. Se respondieron 455 cuestionarios. El manejo de la posición de decúbito prono se realiza de forma rutinaria en los hospitales donde trabajan 386 profesionales (95%). De estos, 374 (96,9%) tienen la percepción de que el manejo de la posición de decúbito prono reduce la hipoxemia y 289 (74,9%) perciben que esta práctica reduce la mortalidad de los pacientes con Covid-19 y SDRA en ventilación mecánica invasiva. Se concluye que la mayoría de los profesionales de la salud que actúan en los hospitales brasileños realizan y creen que la posición de decúbito prono reduce la hipoxemia y la mortalidad en pacientes con Covid-19 en ventilación mecánica invasiva.

Clinical characteristics of pediatric patients with acute respiratory distress syndrome due to COVID-19.

BACKGROUND: There are only a few reports of acute respiratory distress syndrome (ARDS) in patients with SARS-CoV-2 in pediatrics. This study aimed to describe the characteristics of critically ill pediatric patients with COVID-19, the frequency of ARDS, ventilatory mechanics and results of prone position. METHODS: We conducted a retrospective, observational study of patients admitted to the pediatric intensive care unit (PICU) between April 1 to September 30, 2020. RESULTS: Thirty-four patients were admitted to pediatric intensive care unit, 31.7% were SARS-CoV-2 positive. 13 presented ARDS, 11 required invasive mechanical ventilation, and seven were pronated as an oxygenation strategy. All patients classified as severe ARDS were pronated. Obesity was the most important comorbidity. The complications associated with ARDS were multisystemic inflammatory syndrome (8 vs. 4; p < 0.05) and acute kidney injury (8 vs. 3; p < 0.05). Procalcitonin was higher in patients with ARDS, as were the days of stay in PICU (p < 0.05). The success of the pronation maneuver was achieved 8 hours later , with the following results: arterial oxygen partial pressure to fractional inspired oxygen ratio 128 vs. 204, oxygenation index 8.9 vs. 5.9, static lung compliance 0.54 vs. 0.70 ml/cmH2O/kg, plateau pressure 24 vs. 19 cmH2O (p < 0.05). The use of narcotics was higher in the group with ARDS plus pronation 124 vs. 27 hours in the non-pronated (p < 0.01). Mortality associated with SARS-CoV-2 was 5.8%. CONCLUSIONS: ARDS was presented in 38.2% of the children admitted to PICU and was more frequent in obese patients. Pronation, performed in severe cases, improved oxygenation and lung mechanics indexes. No patient died of ARDS.

INTRODUCCIÓN: Existen pocos reportes de síndrome de dificultad respiratoria aguda (SDRA) con COVID-19 en pacientes pediátricos. El objetivo de este estudio fue describir las características de los pacientes pediátricos críticamente enfermos con COVID-19, la frecuencia del SDRA, la mecánica ventilatoria y los resultados de la posición prona. MÉTODOS: Se llevó a cabo un estudio retrospectivo y observacional de los pacientes ingresados del 1 de abril al 30 de septiembre de 2020. RESULTADOS: Ingresaron 34 pacientes a la unidad de terapia intensiva pediátrica (UTIP) con prueba positiva para SARS-CoV-2. De ellos, 13 presentaron SDRA, 11 requirieron ventilación mecánica invasiva y siete fueron pronados como estrategia de oxigenación. Todos los pacientes clasificados como SDRA graves fueron pronados. La obesidad fue la comorbilidad más importante. Las complicaciones asociadas con SDRA fueron el síndrome inflamatorio multisistémico (p < 0.05) y la lesión renal aguda (p < 0.05). La procalcitonina fue mayor en los pacientes con SDRA, al igual que los días de estancia en la UTIP (p < 0.05). El éxito de la maniobra de pronación se alcanzó 8 horas después.Los resultados observados fueron los siguientes relación presión arterial de oxígeno/fracción inspirada de oxígeno 128 vs. 204, índice de oxigenación 8.9 vs. 5.9, distensibilidad pulmonar estática 0.54 vs. 0.70 ml/cmH2O/kg, y presión meseta 24 vs. 19 cmH2O (p < 0.05). El uso de narcóticos fue mayor en el grupo de SDRA más pronación que en los no pronados (124 vs. 27 h; p < 0.01). La mortalidad asociada con SARS-CoV-2 fue del 5.8%. CONCLUSIONES: El SDRA se presentó en el 38.2% de los niños admitidos a UTIP, y con mayor frecuencia en los pacientes con obesidad. La maniobra de pronación aplicada en los casos severos, mejoró la oxigenación de la mécanica pulmonar. Ninguno de los pacientes falleció por SDRA.

Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery.

INTRODUCTION AND OBJECTIVES: Despite the use of acetazolamide in the management of CSF leak in most patients after CNS surgeries, there is scant evidence in the literature about the efficacy of this established protocol among adult patients in post-spinal surgery observations. We investigated the potential positive effect of acetazolamide in reducing CSF leak after spine surgery. MATERIALS AND METHODS: We conducted a single-center, double-blind, randomized -controlled trial comparing Oral Acetazolamide plus Corrected body (prone) position (CP+A) versus Corrected body (prone) position alone (CP-A) from January 2014 to September 2015 in the Neurosurgery ward of Shariati Teaching Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seventy-two Patients divided into two groups [CP-A group (n = 36, 50%) and CP+A group (n = 36, 50%)] were randomly assigned to this Clinical Trial study. CP+A group (maintained the 3/4 lateral position + dose of acetazolamide 20 mg/kg/day in 3-4 divided doses for 7 days), and CP-A group (Control group) (maintained the 3/4 lateral position for 7 days with no acetazolamide). RESULTS: Baseline characteristics between the two groups showed no significant differences: Sex (P < .637), Age (P < .988) and previous CNS operation at other location besides the spine (P < .496). Although we reported post-surgical CSF leak in 2/36 (5.55%) of CP+A group and 4/36 (11.11%) of CP-A (control) group, there was no significant difference observed between the two groups (95%CI, 0.081-2.748; OR = 0.471; P < .402; Adjusted P < .247). Additionally, no significant differences were observed when we examined surgical characteristics, such as the size of the dural opening (P < .489) and type of operation (P < .465). CONCLUSION: Acetazolamide has no positive effect in controlling CSF leak after dural opening/dural tear in adult patients who undergo spinal surgery, when we considered alongside the one-week prone position. Therefore, acetazolamide administration may not be essential for postoperative spinal surgery for dural tear. Prospective studies involving a larger sample size may be needed to track long-term acetazolamide complications on patients with CSF leak.

Características clínicas de pacientes pediátricos con síndrome de dificultad respiratoria aguda asociado con COVID-19 / Clinical characteristics of pediatric patients with acute respiratory distress syndrome due to COVID-19

Resumen Introducción: Existen pocos reportes de síndrome de dificultad respiratoria aguda (SDRA) con COVID-19 en pacientes pediátricos. El objetivo de este estudio fue describir las características de los pacientes pediátricos críticamente enfermos con COVID-19, la frecuencia del SDRA, la mecánica ventilatoria y los resultados de la posición prona. Métodos: Se llevó a cabo un estudio retrospectivo y observacional de los pacientes ingresados del 1 de abril al 30 de septiembre de 2020. Resultados: Ingresaron 34 pacientes a la unidad de terapia intensiva pediátrica (UTIP) con prueba positiva para SARS-CoV-2. De ellos, 13 presentaron SDRA, 11 requirieron ventilación mecánica invasiva y siete fueron pronados como estrategia de oxigenación. Todos los pacientes clasificados como SDRA graves fueron pronados. La obesidad fue la comorbilidad más importante. Las complicaciones asociadas con SDRA fueron el síndrome inflamatorio multisistémico (p < 0.05) y la lesión renal aguda (p < 0.05). La procalcitonina fue mayor en los pacientes con SDRA, al igual que los días de estancia en la UTIP (p < 0.05). El éxito de la maniobra de pronación se alcanzó 8 horas después.Los resultados observados fueron los siguientes relación presión arterial de oxígeno/fracción inspirada de oxígeno 128 vs. 204, índice de oxigenación 8.9 vs. 5.9, distensibilidad pulmonar estática 0.54 vs. 0.70 ml/cmH2O/kg, y presión meseta 24 vs. 19 cmH2O (p < 0.05). El uso de narcóticos fue mayor en el grupo de SDRA más pronación que en los no pronados (124 vs. 27 h; p < 0.01). La mortalidad asociada con SARS-CoV-2 fue del 5.8%. Conclusiones: El SDRA se presentó en el 38.2% de los niños admitidos a UTIP, y con mayor frecuencia en los pacientes con obesidad. La maniobra de pronación aplicada en los casos severos, mejoró la oxigenación de la mécanica pulmonar. Ninguno de los pacientes falleció por SDRA.

Abstract Background: There are only a few reports of acute respiratory distress syndrome (ARDS) in patients with SARS-CoV-2 in pediatrics. This study aimed to describe the characteristics of critically ill pediatric patients with COVID-19, the frequency of ARDS, ventilatory mechanics and results of prone position. Methods: We conducted a retrospective, observational study of patients admitted to the pediatric intensive care unit (PICU) between April 1 to September 30, 2020. Results: Thirty-four patients were admitted to pediatric intensive care unit, 31.7% were SARS-CoV-2 positive. 13 presented ARDS, 11 required invasive mechanical ventilation, and seven were pronated as an oxygenation strategy. All patients classified as severe ARDS were pronated. Obesity was the most important comorbidity. The complications associated with ARDS were multisystemic inflammatory syndrome (8 vs. 4; p < 0.05) and acute kidney injury (8 vs. 3; p < 0.05). Procalcitonin was higher in patients with ARDS, as were the days of stay in PICU (p < 0.05). The success of the pronation maneuver was achieved 8 hours later , with the following results: arterial oxygen partial pressure to fractional inspired oxygen ratio 128 vs. 204, oxygenation index 8.9 vs. 5.9, static lung compliance 0.54 vs. 0.70 ml/cmH2O/kg, plateau pressure 24 vs. 19 cmH2O (p < 0.05). The use of narcotics was higher in the group with ARDS plus pronation 124 vs. 27 hours in the non-pronated (p < 0.01). Mortality associated with SARS-CoV-2 was 5.8%. Conclusions: ARDS was presented in 38.2% of the children admitted to PICU and was more frequent in obese patients. Pronation, performed in severe cases, improved oxygenation and lung mechanics indexes. No patient died of ARDS.

Paciente con neumonía por COVID 19 ingresado en cuidados intensivos: a propósito de un caso / Patient with Covid 19 pneumonia admitted to intensive care: a case report

Los datos publicados actualmente sobre los efectos de la pandemia originada por COVID 19 son devastadores, por lo que han sido necesarios la elaboración de guías y protocolos con el fin de conseguir una evolución óptima y unos niveles adecuados de control y prevención de la infección. Se presenta un caso clínico de un varón de 50 años diagnosticado de Neumonía por COVID 19, ingresado en cuidados intensivos, sedoanalgesiado y relajado y colocado en decúbito prono.Por ello, procede establecer un plan de cuidados para resolver las necesidades de salud identificadas y actuar específicamente en la resolución de las mismas en un paciente diagnosticado de Neumonía por COVID 19 en una unidad de Cuidados Intensivos Generales; apoyándonos en las taxonomías NANDA I, Nursing Outcomes Classification y Nursing Interventions Classification, para concretar criterios de resultados e intervenciones enfermeras.Las taxonomías organizan y priorizan las intervenciones, asegurando unos cuidados basados en la evidencia científica y facilitando el trabajo diario en el ámbito asistencial y de la investigación.La pandemia ha evolucionado muy rápido al igual que los conocimientos que se tienen sobre el virus y gracias al trabajo realizado por la comunidad científica, ha sido posible disponer de herramientas que ayuden a los sanitarios en la batalla contra el virus. (AU)

The data currently published on the effects of the pandemic caused by COVID 19 are devastating, for this reason, it has been necessary to develop guides and protocols in order to achieve optimal evolution and adequate levels of infection control and prevention. We present a clinical case of a 50-year-old man diagnosed with Pneumonia due to COVID 19, admitted to intensive care, sedated and relaxed and placed in the prone position.Thus, it is appropiated to establish a care plan to solve the identified health needs and act specifically to solve them in a patient diagnosed with Pneumonia due to COVID 19 in a General Intensive Care unit; relying on the taxonomies NANDA I, North American Nursing Diagnosis Association, Nursing Outcomes Classification and Nursing Interventions Classification to specify outcome criterias and nursing interventions.Taxonomies organize and prioritize interventions, ensuring care based on scientific evidence and facilitating daily work in healthcare and research.The pandemic has evolved very quickly as well as the knowledge that is had about the virus and thanks to the work carried out by the scientific community it has been possible to have tools that help health personnel in the battle against the virus. (AU)

Posición prono en embarazada con neumonía grave por COVID-19 / Prone position in pregnant woman with severe COVID-19 pneumonia

Resumen Se han comunicado buenos resultados clínicos al poner en posición prono a pacientes con Síndrome de Distrés Respiratorio Agudo por COVID-19. Objetivo: Describir la maniobra prono, sus resultados clínicos y cuidados asociados, en una mujer de 34 años de edad con 26 semanas de embarazo, que estaba en ventilación mecánica, por un cuadro clínico de neumonía multifocal por COVID-19. Se realizó maniobra prono lateralizada hacia izquierda, en tres etapas, preparación, ejecución y evaluación. Luego de 62 h de prono, se observó una recuperación favorable de la gestante: la relación PaO2/FiO2 aumentó de 151 a 368 mmHg, y disminuyó el compromiso radiológico pulmonar, sin que se detectaran complicaciones fetales. Conclusiones: Esta maniobra que puede beneficiar a pacientes con insuficiencia respiratoria grave, en embarazadas debe ser una técnica protocolizada, con equipos de trabajo experimentados e implementación adecuada.

Good clinical results have been reported when placing patients with acute respiratory distress syndrome due to COVID-19 in a prone position. Objective: To describe the prone maneuver, its clinical results and associated care in a 34-year-old woman with 26 weeks of pregnancy, who was on mechanical ventilation, due to a clinical picture of COVID-19 multifocal pneumonia. Lateralized prone maneuver was carried out to the left, in three stages, preparation, execution and evaluation. After 62 hours of prone, a favorable recovery of the pregnant woman was observed: PaO2/FiO2 ratio increased from 151 to 368 mmHg, and the pulmonary radiological compromise decreased, without fetal complications being detected. Conclusions: This maneuver that might benefit patients with severe respiratory failure, in pregnant women should be a protocolized technique, with experienced work teams and adequate implementation.

Cuidados de enfermagem e posição prona: revisão integrativa / Atención de enfermería y decúbito prono: revisión integradora / Nursing care and prone position: Integrative review

Objetivo: explorar, na literatura científica, práticas atuais de cuidado de enfermagem ou intervenções para pacientes com síndrome respiratório agudo grave (SRAG) submetidos à posição prona. Síntese do conteúdo: revisão integrativa, na qual foram realizadas buscas nas bases de dados PubMed, CINAHL, Scopus, Web of Science e LILACS em setembro de 2020 e janeiro de 2022, sem recorte temporal, por meio da questão deste estudo: "Quais são os cuidados de enfermagem para pacientes com SRAG submetidos à posição prona?". Foram selecionados 15 artigos, a partir da busca nas bases de dados. Após a leitura, os cuidados encontrados foram categorizados em alinhamento do corpo para a prevenção de lesões neuromusculares, cuidados com equipamentos diversos, cuidados tegumentares e recomendações neurológicas. Conclusões: o enfermeiro deve ter conhecimento sobre as implicações e as complicações de se manter um paciente na posição prona. Tal conhecimento permitirá tomadas de decisões na construção ou no seguimento de protocolos institucionais que contribuam com a prevenção de riscos e resultem em melhores desfechos para o paciente.

Objetivo: explorar dentro de la literatura científica las prácticas o intervenciones actuales del cuidado de enfermería para los pacientes con síndrome respiratorio agudo grave (SRAG) sometidos a la posición de decúbito prono. Síntesis de contenido: revisión integradora mediante búsquedas en las bases de datos Pubmed, CINAHL, Scopus, Web of Science y LILACS, entre septiembre de 2020 y enero de 2022, sin recorte temporal, a través de la pregunta: ¿cuáles son los cuidados de enfermería para los pacientes con SRAS sometidos a la posición de decúbito prono? En total, se seleccionaron 15 artículos tras la búsqueda en bases. Tras la lectura de estos documentos, se observó que los cuidados identificados se podían categorizar en lineación corporal para prevenir lesiones neuromusculares, cuidados con equipos diversos, cuidados cutáneos y recomendaciones neurológicas. Conclusiones: el profesional de enfermería debe conocer las implicaciones y complicaciones de mantener a los pacientes en decúbito prono. Este conocimiento permitirá tomar decisiones para la construcción o el seguimiento de protocolos institucionales que contribuyan a la prevención de riesgos y generen mejores resultados para el paciente.

Objective: To explore within scientific literature the current nursing care practices or interventions for patients with severe acute respiratory syndrome (SARS) submitted to prone positioning. Content synthesis: Integrative review carried out in Pubmed, CINAHL, Scopus, Web of Science and LILACS databases from September 2020 to January 2022, with no time cutting, addressing the question: What are the nursing care practices for patients with SARS and placed under prone positioning? A total of 15 articles were selected from the database search. After analysis, it was observed that the care provided by nursing professionals could be categorized in body alignment to prevent neuromuscular injuries, care with various equipment, cutaneous care, and neurological recommendations. Conclusions: Nurses must acknowledge the implications and complications of keeping a patient in the prone position. Such awareness will allow decision making in the development or follow-up of institutional protocols that contribute to risk prevention and that will result in better outcomes for patients.

Awake pronation with helmet continuous positive airway pressure for COVID-19 acute respiratory distress syndrome patients outside the ICU: A case series.

OBJECTIVE: Continuous positive airway pressure (CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission. CPAP during pronation has seldom been described and never during sedation. DESIGN: Case series. SETTING: High dependency unit of San Carlo University Hospital (Potenza, Italy). PATIENTS: Eleven consecutive patients with COVID-19 ARDS. INTERVENTION: Helmet CPAP in prone position after failing a CPAP trial in the supine position. MAIN VARIABLE OF INTEREST: Data collection at baseline and then after 24, 48 and 72h of pronation. We measured PaO2/FIO2, pH, lactate, PaCO2, SpO2, respiratory rate and the status of the patients at 28-day follow up. RESULTS: Patients were treated with helmet CPAP for a mean±SD of 7±2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO2/FIO2 improved from 107.5±20.8 before starting pronation to 244.4±106.2 after 72h (p<.001). We also observed a significantly increase in Sp02 from 90.6±2.3 to 96±3.1 (p<.001) and a decrease in respiratory rate from 27.6±4.3 to 20.1±4.7 (p=.004). No difference was observed in PaCO2 or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU. CONCLUSIONS: Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO2/FIO2, SpO2 and a reduction in respiratory rate.

Avaliação da resposta à posição prona em pacientes acordados com COVID-19 / Evaluación de la respuesta a la posición prono en pacientes despiertos hospitalizados con COVID-19 / Evaluation of the response to prone positioning in awake patients with COVID-19

RESUMO O objetivo deste estudo foi avaliar os efeitos agudos dos tipos de resposta à posição prona (PP) em pacientes acordados com COVID-19. Realizou-se um estudo prospectivo, unicêntrico, com 32 pacientes acordados com COVID-19, e com uso de oxigênio suplementar. A resposta à posição prona foi feita durante 30 minutos. Após o teste, os pacientes foram orientados a permanecer na PP diariamente, de acordo com a tolerância de cada um. As variáveis saturação de oxigênio (SpO2), frequência cardíaca, frequência respiratória, índice ROX e taxa de internação na unidade de terapia intensiva (UTI) foram registradas. Um total de 25 pacientes (78,1%) responderam à PP, sendo que 13 (40,6%) apresentaram resposta persistente e 12 (37,5%) transitória. Sete pacientes (21,9%) não responderam. Os pacientes com respostas persistente e transitória tiveram aumento da SpO2 (p<0,001) e do índice ROX (p=0,001 e p<0,001, respectivamente), e redução das frequências cardíaca (p=0,01 e p=0,02, respectivamente) e respiratória (p=0,003 e p=0,001, respectivamente). Não houve diferença em nenhuma das variáveis nos pacientes que não responderam à PP. A taxa de internação na UTI dos pacientes que apresentaram resposta persistente, transitória ou que não responderam foi de 30,8% (4/13), 41,7% (5/12) e 57,1% (4/7), respectivamente. Conclui-se que os pacientes que responderam à PP apresentaram redução das frequências cardíaca e respiratória e aumento do índice ROX, sem interferir na taxa de internação.

RESUMEN El propósito de este estudio fue evaluar los efectos agudos de los tipos de respuesta a la posición prona (PP) en los pacientes despiertos hospitalizados por COVID-19. Se realizó un estudio prospectivo, unicéntrico, con la participación de 32 pacientes hospitalizados por COVID-19 y con el uso de oxígeno suplementario. La respuesta a la posición prono se realizó durante 30 minutos. Después de la prueba, se orientó que los pacientes permanezcan en la PP diariamente según su tolerancia. Se registraron las variables saturación de oxígeno (SpO2), frecuencia cardiaca, frecuencia respiratoria, índice ROX y tasa de ingreso a la unidad de cuidados intensivos (UCI). Un total de 25 pacientes (78,1%) respondieron a la PP, de los cuales 13 (40,6%) tuvieron respuesta persistente y 12 (37,5%) presentaron respuesta transitoria. Siete pacientes (21,9%) no respondieron. Los pacientes con respuestas persistentes y transitorias presentaron un incremento de la SpO2 (p<0,001) y el índice ROX (p=0,001 y p<0,001, respectivamente), y una reducción de las frecuencias cardiaca (p=0,01 y p=0,02, respectivamente) y respiratoria (p=0,003 y p=0,001, respectivamente). No hubo diferencia en ninguna de las variables en los pacientes que no respondieron a la PP. La tasa de ingreso en la UCI de pacientes que tuvieron una respuesta persistente, transitoria o que no respondieron a la PP fue de un 30,8% (4/13), un 41,7% (5/12) y un 57,1% (4/7), respectivamente. Se concluye que los pacientes que respondieron a la PP tuvieron una reducción de las frecuencias cardiaca y respiratoria, e incremento del índice ROX, sin interferir en la tasa de hospitalización.

ABSTRACT This study aims to evaluate the acute effects of the responses to prone positioning (PP) in awake patients with COVID-19. A prospective, single-centered study, using supplemental oxygen, was conducted with 32 awake patients with COVID-19. The response to PP was performed for 30 minutes. According to their tolerance, the patients were instructed to daily remain in PP. The variables for oxygen saturation (SpO2), heart rate, respiratory rate, ROX index and intensive care unit (ICU) admission rate were registered. In total, 25 patients (78.1%) responded to PP, with 13 (40.6%) showing persistent response and 12 (37.5%) showing transient response. Seven patients (21.9%) did not respond. Patients with persistent and transient responses increased SpO2 (p<0.001) and ROX index (p=0.001 and p<0.001, respectively), and reduced heart rate (p=0.01 and p=0.02, respectively), and respiratory rate (p=0.003 and p=0.001, respectively). The variables were similar in patients who did not respond to PP. The ICU admission rate of patients who had persistent or transient response, or did not respond was 30.8% (4/13), 41.7% (5/12), and 57.1% (4/7), respectively. The patients who responded to PP showed reduced heart and respiratory rates and increased ROX index, without interfering in the hospitalization rate.

Incidência de lesão por pressão em posição prona durante a pandemia de COVID-19: um estudo de coorte / Incidence of prone position pressure sores during the COVID-19 pandemic: a cohort study / Incidencia de lesión por presión en decúbito prono durante la pandemia de COVID-19: un estudio de cohorte

OBJETIVO: avaliar a incidência de lesão por pressão na posição prona e seus fatores de risco em pacientes admitidos em unidades de terapia intensiva diagnosticados com COVID-19. MÉTODO: trata-se de um estudo de coorte prospectiva (n=30) com duração de seis meses. Informações relacionadas a estado da prona, tempo de duração, presença ou ausência de lesão por pressão e características sociodemográficas e clínicas foram coletadas. Estatística descritiva e inferencial foi realizada para comparar os pacientes que desenvolveram e os que não desenvolveram lesão por pressão. Para análise dos dados, foi utilizada Regressão de Poisson com variância robusta. RESULTADOS: o tempo médio na posição prona foi de 20,1 horas (DP=3,9). A incidência de lesão por pressão foi de 70%, sendo as localizações mais comuns: tórax esquerdo, abdômen, bochechas e testa. Ao comparar os grupos com e sem lesão por pressão, não houve diferença entre eles (p>0,05). CONCLUSÃO: a incidência não foi associada a nenhuma variável sociodemográfica ou clínica dos pacientes.

OBJECTIVE: this study aimed to assess the incidence of prone-positioning pressure sores and its risk factors in patients admitted to intensive care units diagnosed with COVID-19. METHOD: a six-month follow-up prospective cohort study (n=30) was conducted. Information regarding proning status, duration of prone position (PP), presence or absence of PPPS, and sociodemographic and clinical variables were collected. Descriptive and inferential statistics were performed to compare the patients who developed or did not develop pressure sores. Poisson regression with robust variance was used for data analysis. RESULTS: the mean PP time was 20.1 hours (SD=3.9). The incidence of PPPS was 70%, with the most common locations being the left chest, abdomen, cheek, and forehead. When comparing the groups with and without prone-positioning pressure sores, there was no difference between them (p>0.05). CONCLUSION: the incidence of prone-positioning pressure sores was not associated with any sociodemographic or clinical variable of the patients.

OBJETIVO: evaluar la incidencia de lesión por presión en decúbito prono y sus factores de riesgo en pacientes ingresados ​​en unidades de cuidados intensivos con diagnóstico de COVID-19. MÉTODO: se trata de un estudio de cohorte prospectivo (n=30) con una duración de seis meses. Se recolectó información relacionada con el decúbito prono, tiempo de duración, presencia o ausencia de lesión por presión y características sociodemográficas y clínicas. Se realizó estadística descriptiva e inferencial para comparar pacientes que desarrollaron y no desarrollaron lesiones por presión. Para el análisis de datos se empleó la regresión de Poisson con varianza robusta. RESULTADOS: el tiempo medio en decúbito prono fue 20,1 horas (DE=3,9). La incidencia de lesiones fue 70%, siendo las localizaciones más frecuentes: tórax izquierdo, abdomen, mejillas y frente. Al comparar los grupos, no hubo diferencia (p>0,05). CONCLUSIÓN: la incidencia no se asoció con ninguna variable sociodemográfica o clínica de los pacientes.