Intensive Care Unit-Acquired Weakness in Patients With COVID-19: Occurrence and Associated Factors.

OBJECTIVE: The primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)-acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among individuals with ICUAW and those without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables. METHODS: In this prospective observational study, individuals admitted to the ICU for >72 hours with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored. RESULTS: The occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [IQR = 16.3-42.5] vs 11 [IQR = 6.5-16] days), the length of the hospital stay (43.5 [IQR = 22.8-55.3] vs 16 [IQR = 12.5-24] days), and time on MV (25.5 [IQR = 13.8-41.3] vs 10 [IQR = 5-22.5] days) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW. Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02 to 1.28) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00 to 1.03) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV. CONCLUSION: The occurrence of ICUAW was high on patients' awakening in the ICU but decreased throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19. IMPACT: Patients who had COVID-19 and developed ICUAW had longer periods of ICU stay, hospital stay, and MV. Bed rest time and use of corticosteroids (for those who required MV) were factors independently associated with ICUAW.

Perfil clínico e complicações em pacientes pronados: uma coorte de um hospital universitário / Clinical profile and complications in prone patients: a cohort from a university hospital

Introdução: Este arquivo busca verificar a incidência de lesões por pressão (LP) e eventos adversos graves em pacientes submetidos à posição prona. Métodos: Estudo de coorte retrospectivo realizado entre 2015 a 2017 no Centro de Terapia Intensiva (CTI) de um Hospital Universitário de Porto Alegre. Os dados foram coletados no prontuário eletrônico por meio de um questionário estruturado e analisados através de estatística descritiva e analítica. Resultados: Foram avaliados 37 pacientes. A incidência de LP após prona foi 8 (21,6%). A ocorrência de eventos adversos durante posicionamento em prona foi 1 (2,7%), durante alternância da posição nadador foram 3 (8%) e nenhum no retorno à posição supina. Conclusões: A incidência de eventos adversos graves e de LP é menor comparados aos outros estudos. A hipótese é que o uso de coxins para o posicionamento, cuidados de enfermagem padronizados, aplicação do checklist e treinamento da equipe são responsáveis para esse resultado. (AU)

Introduction: This paper aims to determine the incidence of pressure ulcers (PUs) and serious adverse events in patients in the prone position. Methods: A retrospective cohort study was conducted from 2015 to 2017 in the intensive care unit of a university hospital in Porto Alegre, southern Brazil. Data were collected from electronic medical records using a structured questionnaire and analyzed by descriptive and analytical statistics. Results: Thirty-seven patients were evaluated. Of these, 8 (21.6%) had PUs after prone positioning. One (2.7%) adverse event occurred during prone positioning, 3 (8%) when patients were alternately placed in the swimmer's position, and none when patients were returned to the supine position. Conclusions: The incidence of serious adverse events and PUs was lower than that reported in previous studies. A hypothesis is that the use of cushions for positioning, standardized nursing care, checklists, and team training are responsible for this outcome. (AU)

Safe prone checklist: construction and implementation of a tool for performing the prone maneuver. / Checklist da prona segura: construção e implementação de uma ferramenta para realização da manobra de prona.

OBJECTIVE: To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver. METHODS: This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane). RESULTS: We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice. CONCLUSION: The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.

OBJETIVO: Construir e implementar um instrumento (checklist) para melhoria do cuidado na manobra prona. MÉTODOS: Estudo aplicativo, qualitativo e descritivo. O instrumento foi desenvolvido a partir de ampla revisão da literatura, para construção de um protocolo de atendimento assistencial, utilizando as principais bases eletrônicas (MEDLINE, LILACS e Cochrane). RESULTADOS: Descrevemos a construção de uma ferramenta de segurança do paciente com suas inúmeras modificações e adaptações, a partir das observações da equipe multidisciplinar com seu uso na prática diária. CONCLUSÃO: A aplicação do checklist na manobra de prona acrescentou confiabilidade e segurança ao procedimento. O entendimento da importância da ferramenta na segurança do paciente, por parte da equipe, e sua capacitação são necessários para seu sucesso.

Checklist da prona segura: construção e implementação de uma ferramenta para realização da manobra de prona / Safe prone checklist: construction and implementation of a tool for performing the prone maneuver

RESUMO Objetivo: Construir e implementar um instrumento (checklist) para melhoria do cuidado na manobra prona. Métodos: Estudo aplicativo, qualitativo e descritivo. O instrumento foi desenvolvido a partir de ampla revisão da literatura, para construção de um protocolo de atendimento assistencial, utilizando as principais bases eletrônicas (MEDLINE, LILACS e Cochrane). Resultados: Descrevemos a construção de uma ferramenta de segurança do paciente com suas inúmeras modificações e adaptações, a partir das observações da equipe multidisciplinar com seu uso na prática diária. Conclusão: A aplicação do checklist na manobra de prona acrescentou confiabilidade e segurança ao procedimento. O entendimento da importância da ferramenta na segurança do paciente, por parte da equipe, e sua capacitação são necessários para seu sucesso.

ABSTRACT Objective: To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver. Methods: This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane). Results: We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice. Conclusion: The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.

Good practices for prone positioning at the bedside: Construction of a care protocol.

Last year, interest in prone positioning to treat acute respiratory distress syndrome (ARDS) resurfaced with the demonstration of a reduction in mortality by a large randomized clinical trial. Reports in the literature suggest that the incidence of adverse events is significantly reduced with a team trained and experienced in the process. The objective of this review is to revisit the current evidence in the literature, discuss and propose the construction of a protocol of care for these patients. A search was performed on the main electronic databases: Medline, Lilacs and Cochrane Library. Prone positioning is increasingly used in daily practice, with properly trained staff and a well established care protocol are essencial.

Good practices for prone positioning at the bedside: Construction of a care protocol / Boas práticas da manobra de prona à beira do leito: construção de um protocolo de cuidados

SUMMARY Last year, interest in prone positioning to treat acute respiratory distress syndrome (ARDS) resurfaced with the demonstration of a reduction in mortality by a large randomized clinical trial. Reports in the literature suggest that the incidence of adverse events is significantly reduced with a team trained and experienced in the process. The objective of this review is to revisit the current evidence in the literature, discuss and propose the construction of a protocol of care for these patients. A search was performed on the main electronic databases: Medline, Lilacs and Cochrane Library. Prone positioning is increasingly used in daily practice, with properly trained staff and a well established care protocol are essencial.

RESUMO No último ano, o interesse pela posição prona no tratamento da síndrome da angústia respiratória aguda (Sara) ressurgiu com a demonstração da redução da mortalidade por um grande estudo clínico randomizado. Os relatos, na literatura, sugerem que a incidência de eventos adversos é significativamente reduzida com uma equipe treinada e experiente no processo. O objetivo desta revisão é revisitar as evidências atuais, discutir e propor a construção de um protocolo de cuidados para esses pacientes. Foi realizada busca nas principais bases eletrônicas: Medline, Lilacs e Cochrane Library. A posição prona é cada vez mais utilizada na prática diária, sendo imprescindível a presença de uma equipe adequadamente treinada e um protocolo de cuidados bem estabelecido.