Prevention of ventilator-associated pneumonia in newborns.

OBJECTIVE: The aim of the study is to optimize the prevention of the development of ventilator-associated pneumonia in newborns by developing a method for tracheal rehabilitation and assessment of its effectiveness. PATIENTS AND METHODS: Materials and methods: A prospective cohort randomized clinical study was organized, particularly artificial ventilation of the lungs was conducted on 90 newborns. Patients were divided into two groups. In the main group (n = 50) an intubation tube of author's design was used, which design allowed prophylactic tracheal sanation on the outer wall of the intubation tube, which included vacuum aspiration of the tracheal secretion and irrigation with a solution of antiseptic decamethoxin 0.02% every 3 hours. In the comparative group (n = 40) the classical non-cuff structure of the intubation tube was used; preventive tracheal sanation on the outer wall of the intubation tube was not carried out. RESULTS: Results and conclusions: Preventive tracheal sanation on the outer surface of the intubation tube in newborns units that undergo artificial ventilation of the lungs exhibit high efficiency against the main types of microorganisms that are dangerous from the point of view of the development of ventilator-associated pneumonia. The use of prophylactic tracheal sanitization in newborns - patients of neonatal intensive care units, which undergoes artificial ventilation of the lungs, can significantly lower the frequency of the implementation of ventilator-associated pneumonia.

Utilizing simulation technology for competency skills assessment and a comparison of traditional methods of training to simulation-based training.

BACKGROUND: The respiratory care department of one campus within our health system evaluated simulation-based medical education for training and competency evaluation of the mini bronchoalveolar lavage (mini-BAL) procedure, with an emphasis on patient safety and procedure performance standards. METHODS: Training and competency evaluation occurred in 4 phases. In phase one, 24 staff respiratory therapists (RTs) were randomly chosen and individually underwent a simulation-based test of their mini-BAL performance, using a patient-simulator mannequin. Their performance on this test reflected the effectiveness of traditional training methods. In phase two, 83 staff RTs were given unlimited access to a Web-based curriculum on mini-BAL, including a video of a mini-BAL. They then took 2 tests: one online Web-based test, then a patient-simulator test. In phase three, the same 83 RTs attended a workshop that used the patient simulator for training and practice, then were re-evaluated with the patient-simulator test. Phase four was another simulator-based re-evaluation, 90 days after phase three, to study skills retention. RESULTS: The mean scores were: phase one 73 +/- 10%, phase two 77 +/- 11%, phase three 95 +/- 5% (p < 0.01), phase four 92 +/- 8%. CONCLUSION: Our results suggest that employing simulation technology within a comprehensive departmental program can enhance staff training.

[Nursing care in the conduct of alveolar lavage].

Pulmonary alveolar proteinosis (PAP) is a rare disease reported to affect adults between the ages of 20 and 50, in a male:female ratio of 2-3:1. Alveolar lavage is the most effective proven treatment. This article introduces PAP, alveolar lavage and nursing intervention in preparation, during, and after the procedure, and home care. We hope this article can provide new information on the nursing care necessary for patients with PAP.

Whole lung lavage in the treatment of pulmonary alveolar proteinosis.

Although a rare condition, pulmonary alveolar proteinosis (PAP) can be a very devastating diagnosis with life-altering consequences. This case study follows the path of a young woman who is currently undergoing whole lung lavage as treatment for pulmonary alveolar proteinosis. The entire concept of flooding a lung with large quantities of saline as a treatment for lung disease is contrary to normal respiratory care. Caring for the patient with PAP provides many challenges for the perianesthesia nurse. Management of the postanesthesia airway, oxygen administration and maintenance of oxygen saturation, and pain relief skills are all of high importance to the patient with PAP. These skills plus the emotional support provided by the experienced perianesthesia nurse can ensure a safe recovery from this unusual procedure.

[Bronchoalveolar lavage technique in patients with alveolar proteinosis]. / Técnica del lavado broncoalveolar total en pacientes con proteinosis alveolar.

Bronchoalveolar Lavage (BAL) was first described more than fifteen years ago; it is still the treatment of choice in Alveolar Proteinosis. Despite several clinical therapeutic trials, for new therapeutics none of them has achieved the results of Bronchoalveolar Lavage. It has been proved that, not only are they ineffective, but they can also have dangerous consequences. Alveolar proteinosis is a rare lung illness that implies the patient's hypoxia and progressive incapacity, being clinical dyspnea its most frequent characteristic. The BAL. with sodium chloride by filling and emptying the lungs allows to wash the fosfolipid material. That its on the alveoli giving the patient a great improve in short space of time. The aim of our work is to describe the technique used in Bronchoalveolar Lavage as well as the changes that have taken place since the beginning of its practice in our Critical Care Unit for the last fifteen years and so the nursing work that it is on this technic. This procedure needs to be made on a UCI for the need of mechanical ventilation. The time of instance on UCI is 24 h. In our experience we are able to make the BAL. in both lungs in the same session, there are no important complications and there is no need of readmission. We conclude that there is evidence that these treatment is effective.