Continuous positive pressure on aircraft in neonates: care provided by the nursing team / Presión positiva continua en las vías aéreas en neonatos: cuidados prestados por el equipo de enfermería / Pressão positiva contínua nas vias aéreas em neonatos: cuidados prestados pela equipe de enfermagem

ABSTRACT Objective: to describe the nursing care of the neonate in continuous positive airway pressure (CPAP) with prong analyzing them in the light of the systematization of nursing care / process. Method: Descriptive research, qualitative approach. We interviewed 30 nursing professionals from the neonatal intensive and intermediate care units of a school hospital in Maceió / Alagoas, from August / 2016 to January / 2017, through a semi-structured interview, in the light of Bardin's content analysis. Results: Although unit nurses are aware of the use of CPAP and the care associated with this therapy, mid-level professionals still find it difficult to systematize systematized knowledge about the system. The tripod's correlation between CPAP, the formation of nasal lesions and the assistance provided was highlighted. Conclusion: It is necessary to carry out training, such as raising the awareness of professionals about the importance of keeping records up to date and applying protocols.

RESUMEN Objetivo: describir los cuidados de enfermería al neonato en presión positiva continua en las vías aéreas (CPAP) con preñez analizándolos a la luz de la sistematización de la asistencia / proceso de enfermería. Método: Investigación descriptiva, enfoque cualitativo. Se entrevistó a 30 profesionales de enfermería de las unidades de terapia intensiva e intermedia neonatales de un hospital escuela de Maceió / Alagoas, de agosto / 2016 a enero / 2017, a través de una entrevista semiestructurada, a la luz del análisis de contenido de Bardin. Resultados: Aunque los enfermeros de las unidades tienen el conocimiento sobre el uso de la CPAP y los cuidados inherentes a esa terapéutica, los profesionales de nivel medio todavía sienten dificultades en enumerar de forma sistematizada conocimientos sobre el sistema. Se destacó la correlación del trípode entre la CPAP, la formación de lesiones nasales y la asistencia prestada. Conclusión: Se hace necesaria la realización de capacitaciones, como sensibilización de los profesionales acerca de la importancia del mantenimiento actualizado de los registros y aplicación de protocolos.

RESUMO Objetivo: Descrever os cuidados de enfermagem ao neonato em pressão positiva contínua nas vias aéreas (CPAP) com pronga, analisando-os à luz da sistematização da assistência/processo de enfermagem. Método: Pesquisa descritiva, abordagem qualitativa. Foram entrevistados 30 profissionais de enfermagem das unidades de terapia intensiva e intermediária neonatais de um hospital escola de Maceió/Alagoas, de agosto/2016 a janeiro/2017, através de entrevista semiestruturada, à luz da análise de conteúdo de Bardin. Resultados: Embora os enfermeiros das unidades tenham o conhecimento sobre o uso da CPAP e os cuidados inerentes a essa terapêutica, os profissionais de nível médio ainda sentem dificuldades em elencar de forma sistematizada conhecimentos sobre o sistema. Destacou-se a correlação do tripé entre a CPAP, a formação de lesões nasais e a assistência prestada. Conclusão: Faz-se necessária a realização de capacitações, como sensibilização dos profissionais acerca da importância da manutenção atualizada dos registros e aplicação de protocolos.

A Nurse-Led Limited Risk Factor Modification Program to Address Obesity and Obstructive Sleep Apnea in Atrial Fibrillation Patients.

Background Obesity and obstructive sleep apnea ( OSA ) are associated with atrial fibrillation ( AF ), yet these conditions remain inadequately treated. We report on the feasibility and efficacy of a nurse-led risk factor modification program utilizing a pragmatic approach to address obesity and OSA in AF patients. Methods and Results AF patients with obesity (body mass index ≥30 kg/m2) and/or the need for OSA management (high risk per Berlin Questionnaire or untreated OSA ) were voluntarily enrolled for risk factor modification, which comprised patient education, lifestyle modification, coordination with specialists, and longitudinal management. Weight loss and OSA treatment were monitored by monthly follow-up calls and/or continuous positive airway pressure ( CPAP ) unit downloads. Quality of life and arrhythmia symptoms were assessed with the SF -36 and AF Severity Scale at baseline and at 6 months. From November 1, 2016 to October 31, 2017, 252 patients (age 63±11 years; 71% male; 57% paroxysmal AF ) were enrolled, 189 for obesity and 93 for OSA . Obese patients who enrolled lost significantly greater percent body weight than those who declined (3% versus 0.3%; P<0.05). Among 93 patients enrolled for OSA , 70 completed sleep studies, OSA was confirmed in 50, and the majority (76%) started CPAP therapy. All components of quality of life and arrhythmia symptoms improved significantly from baseline to 6 months among enrolled patients. Conclusions A nurse-led risk factor modification program is a potentially sustainable and generalizable model that can improve weight loss and OSA in AF patients, translating into improved quality of life and arrhythmia symptoms.

Using a Standardized Patient to Improve Collaboration and Problem Solving Skills With CPAP Usage in the Home.

A review of literature revealed a lack of research pertaining to nurses' or student nurses' knowledge of continuous positive airway pressure (CPAP) and the ability to troubleshoot CPAP malfunction. This study sought to answer the following questions: What are associate degree nursing (ADN) students' knowledge, interdisciplinary communication, and problem-solving skills regarding patients' home use of CPAP? Is there a change after participation in a simulation with a patient on CPAP in home setting? Twenty-one ADN students enrolled in small Midwest college participated. A preexperimental design of one group pretest posttest was used. Each student completed a demographic questionnaire, Mayo High Performance Teamwork Scale, Interprofessional collaborative simulation experience survey, and a CPAP knowledge base survey before and upon completion of the simulation. There were no changes in students' comfort, baseline knowledge, and basic understanding regarding CPAP. However, after the simulation, students described more detailed problem-solving skills, which included using respiratory therapists, durable medical equipment providers, and community resources. On the Mayo High Performance Teamwork Scale, all 16 items demonstrated improved scores (baseline mean = 21.65 and postsimulation mean = 25.6).

Delivery room continuous positive airway pressure and early pneumothorax in term newborn infants.

OBJECTIVE: To assess the association between delivery room (DR) continuous positive airway pressure (CPAP) and pneumothorax (PT) in term newborns. METHODS: Two studies performed in community hospitals used data extracted from computerized records of term newborns. Infants receiving positive pressure ventilation in the DR were excluded. Tabulated data included receipt of DR CPAP, PT on the day of birth, and gestational age (GA). In a case-control study from 2001-2013, infants with PT were compared to controls without PT but with respiratory distress or hypoxia persisting from birth for receipt of DR CPAP. In a cohort study from 2014-2016, infants receiving and not receiving DR CPAP were compared for the incidence of PT. RESULTS: In the case-control study, data were obtained for 169 cases and 850 controls. Compared to controls, PT infants were more likely to have received DR CPAP (16.8% vs. 40.2%, respectively, P < 0.001). Logistic regression revealed DR CPAP (Adjusted Odds Ratio [AOR] = 3.30, 95% confidence interval [CI] = 2.31, 4.72, P < 0.001) and GA (AOR = 1.21, 95% CI = 1.05, 1.39, P = 0.009) to be independent predictors of early PT.In the cohort study, PT was observed in 0.1% of 9255 control infants not receiving DR CPAP and 4.8% of 228 infants receiving DR CPAP (P < 0.001). In logistic regression analyses, DR CPAP significantly predicted PT (OR = 59.59, 95% CI = 23.34, 147.12, P < 0.001) and remained a significant predictor of PT after controlling for gestational age. CONCLUSION: Respiratory conditions treated with CPAP in delivery rooms are associated with increased risk of PT. A cause-and-effect relationship between CPAP and PT cannot be claimed in this study. Further research is needed to better understand this relationship.

Administração de CPAP selo d'água em RNPT de muito baixo peso na sala de parto e no transporte neonatal: contribuições da fisioterapia / Water seal CPAP administration in very low birth weight preterm infants in the delivery room and neonatal transport: contributions of physical therapy

Os avanços da assistência perinatal, em parceria com as inovações tecnológicas tem beneficiado o diagnóstico precoce e, consequentemente, o tratamento das patologias da prematuridade, principalmente as respiratórias. Atualmente são preconizadas estratégias ventilatórias menos invasivas, entre elas, o uso da pressão positiva contínua nas vias aéreas (CPAP) na Síndrome do desconforto respiratório (SDR) visando evitar a intubação orotraqueal ( IOT) e ventilação mecânica (VM ) nos recém-nascidos pré-termo ( RNPT) . Dentre as modalidades de oferecer CPAP tem se destacado o sistema de CPAP selo d'água , por apresentar simplicidade na execução e segurança para os RN. Objetivo ­ Este estudo realizou uma análise retrospectiva de 6 anos em uma única UTIN do Hospital Universitário Pedro Ernesto de RNPT nascidos ≤ 32 semanas de idade gestacional ( IG ) e com peso ≤ 1500 com SDR de (2010-2015). Metodologia - Análise comparativa dos resultados respiratórios em duas séries temporais: - grupo Pré-CPAP selo d'água (2010-2012) e o grupo Pós-CPAP selo d'água (2013-2015). Foi realizado em um hospital universitário referência em maternidade de risco da rede pública do Estado do Rio de Janeiro.A amostra foi composta de 85 RNPT ,sendo que 45 alocados no grupo Pré-CPAP e 40 no grupo Pós-CPAP. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (CEP), recebendo o número CAAE: 55021016.0.3001.5259. Os dados coletados durante os dois períodos foram analisados pelo programa estatístico SPSS 18.0. Foi utilizado o teste de Shapiro Wilk ,o teste de Mann Whitney e o teste de correlação de Spearman. O estudo adotou o valor de p<0,05 para o valor de significância estatística. As tabelas e gráficos foram plotados no programa Data Office Excel 2016. Resultados : Não foram encontradas diferenças significativas para os dados maternos revelando homogeneidade entre os grupos. Já nos dados referentes na sala de parto e no transporte neonatal foram encontradas diferenças significativas para as varíaveis : reanimação na sala de parto , dispositivos na reanimação e FiO2 na reanimação e transporte até a Unidade de terapia intensiva neonatal ( UTIN ) (onde o grupo Pós-CPAP utilizou-se mais CPAP em detrimento da VPP+TOT,utilizado no grupo Pré-CPAP). Quanto aos dados descritivos e inferenciais, das variáveis numéricas dos grupos, verifica-se que o grupo Pós-CPAP, com a utilização da CPAP selo d'água, obteve-se resultados satisfatórios e significativos, em relação ao grupo Pré-CPAP, nas variáveis: número de doses de surfactante (com menor dose no grupo Pós-CAP , p = 0,008 ); dias de ventilação mecânica invasiva -VMI (com menor número de dias de utilização no grupo Pós-CPAP, p = 0,000 ) e o uso de FiO2 ≤ 30% também foi estatisticamente significativa p = 0,043 (com menor necessidade de suporte de O2 do grupo Pós-CPAP, em relação ao grupo Pré-CPAP ). Conclusão: A CPAP selo d'água precoce pode ser recomendado como método menos invasivo e dispendioso na gestão da SDR de RNPT de muito baixo peso

Telemonitoring of CPAP therapy may save nursing time.

PURPOSE: Telemonitoring might enhance continuous positive airway pressure (CPAP) adherence and save nursing time at the commencement of CPAP therapy. We tested wireless telemonitoring (ResTraxx Online System®, ResMed) during the habituation phase of the CPAP therapy in obstructive sleep apnea syndrome (OSAS). METHODS: In total, 111 consecutive OSAS patients were enrolled. After CPAP titration, patients were followed with the telemonitoring (TM, N = 50) or the usual care (UC, N = 61). The TM group used fixed pressure CPAP device with and the UC group similar device without wireless telemonitoring. Patients and study nurses were unblinded. The evaluated end-points were hours of CPAP use >4 h/day, mask leak <0.4 L/s, and AHI <5/h. Nursing time including extra phone calls, visits, and telemonitoring time was recorded during the habituation phase. CPAP adherence was controlled in the beginning and at the end of the habituation phase and after 1-year of use. RESULTS: TM and UC groups did not differ in terms of patient characteristics. The average length of the habituation phase was 4 weeks in the TM group and fixed 3 months in the UC group. Median nursing time was 39 min (range 12-132 min) in the TM group and shorter compared to that of 58 min (range 40-180 min) (p < 0.001) per patient in the UC group. Both treatment groups had high CPAP usage hours (>4 h/day) and the change in usage at the end of the habituation phase did not differ between the groups (p = 0.39). Patients in both groups were equally satisfied with the treatment protocol. CPAP adherence (6.4 h in TM vs. 6.1 h in UC group, p = 0.63) and residual AHI (1.3 in TM vs. 3.2 in UC group, p = 0.04) were good in both groups at 1-year follow-up. CONCLUSIONS: Wireless telemonitoring of CPAP treatment could be relevant in closing the gap between the increasing demand and available health-care resources. It may save nursing time without compromising short- or long-term effectiveness of CPAP treatment in OSAS.

Aplicación de presión positive continua en la vía aérea con el dispositivo no mecánico de Boussignac / CPAP generation by a non mechanical device: the Bousignac system

La CPAP (presión positiva continua en la vía aérea) consiste en establecer una presión supraatmosférica durante todo el ciclo respiratorio sobre la que el paciente ventila de forma espontánea. Su uso mejora los parámetros clínicos y gasométricos cuando se aplica con criterios adecuados de selección en el contexto de la insuficiencia respiratoria aguda (IRA) hipoxémica. Está demostrado que aplicar la CPAP precozmente disminuye la necesidad de intubación y las complicaciones asociadas, mejora la supervivencia y reduce la estancia hospitalaria y el coste asistencial. La utilización de la válvula de Boussignac para aplicar una CPAP se está extendiendo especialmente en el ambiente extrahospitalario y de urgencias por ser un dispositivo no mecánico, sencillo, de fácil aplicación y transporte, que puede administrar presiones suficientes para manejar al paciente hipoxémico [1]. Su aplicación es tan sencilla que no precisa un adiestramiento exhaustivo y los cuidados generales no difieren de otros métodos de ventilación mecánica no invasiva (VMNI). De hecho, ya existen en España ambulancias medicalizadas dotadas con este dispositivo, que la enfermera puede aplicar y manejar ella sola (AU)

CPAP (continuous positive airway pressure) is to establish a supraatmosferica pressure throughout the respiratory cycle on which the patient vent spontaneously. Its use improves the clinical and gasometrics parameters when applied with appropriate selection criteria in the context of respiratory failure acute (IRA) hypoxemic. It has been demonstrated that applying CPAP early, decreases the need for intubation and associated complications, as well as survival, reducing health care costs and hospital stay. The use of valve Boussignac for applying a CPAP is spreading especially in the delivered environment and emergencies as a device not mechanical, simple, easy to use and transport, which can manage enough pressures to manage the patient hypoxemia [1]. Its application is so simple that it does not need a comprehensive training and general care does not differ from other methods of mechanical ventilation noninvasive (adapted). In fact, already exist in Spain ambulances equipped with this device that can be applied and managed only by the nurse (AU)

Nursing perceptions of high-flow nasal cannulae treatment for very preterm infants.

AIM: This study aims to assess nursing perceptions of high-flow nasal cannulae (HFNC) in comparison with nasal continuous positive airway pressure (NCPAP) as post-extubation respiratory support for very preterm infants. METHODS: A standardised questionnaire form was distributed in person to nursing staff in The Royal Women's Hospital neonatal unit, where HFNC had been recently introduced in the context of a clinical trial. Nursing staff were eligible to participate if they routinely cared for infants receiving respiratory support. RESULTS: The survey was completed by 99/144 eligible nurses. The majority of the 99 nurses surveyed felt that HFNC was less likely than NCPAP to prevent re-intubation of infants 24-26 weeks' gestation but equally likely to prevent re-intubation of infants 28-30 weeks' gestation. Nurses preferred NCPAP for post-extubation support of 24- and 26-week infants, and HFNC for 28- and 30-week infants, despite being less experienced with HFNC. Perceptions of HFNC compared with NCPAP included increased ease-of-use, improved infant comfort and reduced nasal trauma. CONCLUSIONS: Neonatal nurses preferred NCPAP for post-extubation support of infants <28 weeks' gestation and HFNC for infants of 28 or 30 weeks' gestation. Nurses accurately predicted varying efficacy of HFNC across different gestational ages, consistent with the findings of a contemporaneous randomised trial. In the context of clinical non-inferiority, as shown in the randomised trial, nursing preference for HFNC over NCPAP in preterm infants ≥28 weeks' gestation supports the use of HFNC as post-extubation support in this population.

Prevenção de lesão de septo nasal em neonatos pré-termo: revisão integrativa da literatura / Preventing lesions of nasal septum in preterm newborns: an integrative literature review / Prevención de lesión de septo nasal en neonatos prematuros: revisión integrativa de la literatura

Este estudo objetivou investigar as evidências científicas relacionadas aos cuidados de enfermagem na prevenção de lesão de septo nasal em pré-termos em ventilação utilizando prongas. Foi realizada uma revisão integrativa da literatura nas bases eletrônicas LILACS, BDENF, CINAHAL, PUBMED e na biblioteca SciELO. Foram selecionados nove estudos entre 2000 e 2013, disponibilizados on-line ou pelo autor, publicados em português, inglês e espanhol. Os resultados evidenciaram que 70% dos estudos abordam cuidados ligados à qualidade e adequação dos dispositivos nasais e à vigilância contínua da equipe de enfermagem. A inspeção do septo e columela nasal, proteção com hidrocoloide e a instalação adequada do sistema foram considerados cuidados importantes para a prevenção de lesões. Conclui-se que existe necessidade de adequação dos cuidados de enfermagem e monitorização contínua do dispositivo e do neonato, durante a ventilação, para a prevenção das lesões de septo nasal

The goal of this study is to investigate scientific evidence related to nursing care for preventing lesions of the nasal septum in preterm infants who are using nasal prong ventilation. It is an integrative literature review through LILACS, BDENF, CINAHAL, PUBMED and SciELO library electronic databases. We selected 09 studies between 2000 and 2013, available online or through the author, published in Portuguese, English and Spanish. The results displayed that 70% of the studies examine the quality and adaptation of nasal devices and the nursing team's continual vigilance. Septum and nasal columella inspection, hydrocolloid protection and adequate system installation were considered important factors which contribute towards preventing lesions. We conclude that the adaptation of nursing care and constant monitoring of the device and of the newborn during ventilation are necessary to prevent nasal septum lesions.

Se objetivó investigar las evidencias científicas relativas a cuidados de enfermería en prevención de lesiones de septo nasal en prematuros ventilados mediante cánulas. Se realizó una revisión integrativa de literatura en las bases informáticas LILACS, BDENF, CINAHL, PUBMED y en la biblioteca SciELO. Fueron seleccionados 9 estudios, entre 2000 y 2013, disponibilizados online o por el autor, publicados en portugués, inglés y español. Los resultados evidenciaron que 70% de los estudios abordan cuidados vinculados a la calidad y adecuación del dispositivo nasal y la vigilancia continua del equipo de Enfermería. La inspección del septo y columela nasal, protección con hidrocoloide e instalación adecuada del sistema fueron consideradas cuidados importantes para prevención de lesiones. Se concluye en que existe necesidad de adecuación de cuidados de enfermería y monitoreo continuo del dispositivo y del neonato durante la ventilación, para la prevención de lesiones de septo nasal.

[Invasive and non-invasive ventilation: impact on nursing workload]. / Ventilazione invasiva e non invasiva: impatto sul carico di lavoro infermieristico.

INTRODUCTION: Non invasive ventilation (NIV) is increasingly used in intensive and non intensive wards. OBJECTIVE: To detect the impact of ventilation modes on nursing workload. METHODS: Retrospective observational study of 200 patients admitted to a general Intensive Care Unit (ICU). Nursing Activities Score (NAS) was used to measure the nursing workload. Patients enrolled were treated with the following ventilation modes: oxygen therapy without positive end-expiratory pressure (PEEP), helmet Continuous Positive Airway Pressure (CPAP), controlled mechanical ventilation, Invasive pressure support ventilation (I-PSV). RESULTS: The overall mean NAS score of patients was 74.3% (SD ±8.88 - range 39/143) corresponding to an ideal nurse/patient ratio of 0.7 and varied with the different ventilation modes. In the days in oxygen therapy, the average NAS was 64.5% (±11.9), with helmet CPAP 69.7% (±12.7), with controlled mechanical ventilation 86.1% (SD ±15.1) and with invasive assisted ventilation 76.4% (±11.4) [p=0.0001]. In patients with helmet CPAP the NAS increased of 14% when FiO2 >0.6 and PEEP >10 compared to oxygen therapy. The average NAS score of the 15 patients (7.5%) with mask-PSV was 80.2% (±12:5). CONCLUSIONS: Overall, the nursing workload of patient with helmet CPAP was lower than with invasive ventilation. In Helmet CPAP, with FiO2 >0.6 and PEEP level >10 cmH2O and mask-PSV, the nursing workload is similar to that of patients with invasive ventilation. NAS scores in patients with Invasive ventilation in the controlled mode is higher than with assisted mode.

Airway pressure release ventilation: improving oxygenation: indications, rationale, and adverse events associated with airway pressure release ventilation in patients with acute respiratory distress syndrome for advance practice nurses.

Airway pressure release ventilation (APRV) is a mode of ventilation that has been around since the 1980s and was originally viewed as a type of continuous positive pressure mode of ventilation. Conceptually, APRV can be thought of as a type of inverse-ratio, pressure-controlled, intermittent mandatory ventilation during which the maintenance of spontaneous breathing and prolonged application of high mean airway pressure contribute to the clinical benefits. The aim of this review article was to familiarize the bedside clinician working in the intensive care unit with the theory and rationale behind this mode of ventilation. The potential advantages and disadvantages of APRV will also be discussed to empower the advance practice clinician and bedside nurse to advocate for their patient diagnosed with the often-high mortality disease of acute respiratory distress syndrome.

Defining hazards of supplemental oxygen therapy in neonatology using the FMEA tool.

PURPOSE: To prospectively evaluate hazards in the process of supplemental oxygen therapy in very preterm infants hospitalized in a Dutch NICU. METHODS: A Failure Mode and Effects Analysis (FMEA) was conducted by a multidisciplinary team. This team identified, evaluated, and prioritized hazards of supplemental oxygen therapy in preterm infants. After accrediting "hazard scores" for each step in this process, recommendations were formulated for the main hazards. RESULTS: Performing the FMEA took seven meetings of 2 hours. The top 10 hazards could all be categorized into three main topics: incorrect adjustment of the fraction of inspired oxygen (FiO2), incorrect alarm limits for SpO2, and incorrect pulse-oximetry alarm limits on patient monitors for temporary use. The FMEA culminated in recommendations in both educational and technical directions. These included suggestions for (changes in) protocols on alarm limits and manual FiO2 adjustments, education of NICU staff on hazards of supplemental oxygen, and technical improvements in respiratory devices and patient monitors. CONCLUSIONS: The FMEA prioritized flaws in the process of supplemental oxygen therapy in very preterm infants. Thanks to the structured approach of the analysis by a multidisciplinary team, several recommendations were made. These recommendations are currently implemented in the study's center.

Poor sleep, hazardous breathing: an overview of obstructive sleep apnea.

Obstructive sleep apnea is a chronic disorder resulting from upper airway collapse during sleep. It is linked to a variety of health and safety risks but can often be effectively treated. This article provides an overview of the disorder, including an evidence-based approach to diagnosis and management.

[Nursing care in the use of neonatal continuous positive airway pressure]. / Cuidados de enfermería en la CPAP neonatal.

Noninvasive neonatal ventilation, and principally the method of Continuous Positive Airway Pressure (CPAP), has become an essential tool in the management of respiratory pathology and a vital support for the newborn. Its use has become a common procedure in the majority of our hospitals. Actually, it is the treatment of choice for neonatal respiratory distress syndrome, as much for full-term newborns as for premature babies. This is an alternative technique to invasive ventilation and one that aims to diminish the occurrence of bronchopulmonary dysplasia and other associated complications. The administering of prenatal steroids, pulmonary surfactants, and CPAC are the fundamental pillars that have contributed to the decrease in neonatal mortality in the last few years. We rely on a variety of devices to administer CPAP. Nursing care is the fundamental pillar of success in noninvasive ventilation. For this reason, it is essential to know how to carry it out, its principle characteristics, the proper care, as well as the most frequent complications and technical problems that can arise. Few published works concentrate on the nursing care and work, despite the fact that this is the base of its correct application. This article will briefly review the latest published data, go over the basic nursing care, underlining the necessity to establish protocols based on the available evidence and the experience acquired in recent years.