Administración de Oxigenoterapia de Alto Flujo en pacientes pediátricos del Hospital de Niños Santísima Trinidad / Administration of High Flow Oxygen Therapy in pediatric patients of the Santísima Trinidad Children's Hospital

La manera de proveer oxígeno ha sido una idea en permanente evolución que ha gatillado en los médicos la inquietud de implementar distintos dispositivos de soporte, desde la cánula nasal, la máscara de reinhalación y bajo flujo, hasta la presión continua en la vía aérea (CPAP) y la ventilación no invasiva (VNI). Recientemente se ha insertado entre ambos extremos mencionados un nuevo dispositivo que provee oxígeno a alto flujo. El objetivo del presente trabajo fue describir aspectos clínicos y técnicos en la administración de Oxigenoterapia de Alto Flujo (OAF) en pacientes pediátricos del Hospital de Niños de la Santísima Trinidad, en el servicio de UEPE (Unidad estabilización pediátrica en emergencia) 2017 y SIP (sala de internación pediátrica) 500 2018, 2019, en el periodo estival. Se realizó un Estudio descriptivo transversal, retrospectivo. El universo fueron los pacientes pediátricos que recibieron OAF en el Hospital de Niños Santísima Trinidad, en el servicio de UEPE del 2017 y SIP 500 2018, 2019 en el periodo estival. Se utilizó como instrumento la tabla de volcado de datos. Los principales resultados demuestran que se asistieron un total de 697 pacientes. La edad prevalente fue de menores de 6 meses, con un promedio del 60%. Los niños que requerían este tratamiento, en su gran mayoría ingresaban por diagnóstico de bronquiolitis, seguido de BOR (bronquitis obstructiva recurrente).En relación al escore de tal modifcado al ingreso, podemos observar que en el sector de UEPE la media es de 8, mientras que la SIP 500 es de 7. En referente al recurso material, existen varios sistemas de OAF. No hay estudios que demuestren la superioridad de un sistema sobre otro.Por último, se observó que el haber implementado esta técnica en la institución, se logró evitar en gran numero la escalada ventilatoria máxima requerida, ya que en el servicio de UEPE la evolución fue 65% la OAF, mientras que en la SIP 500 en el 2018 fue 72%y en el 2019 fue 79%. Por lo que podemos establecer que la OAF logra una mejoría clínica a través de su impacto en el síndrome funcional respiratorio, así como en el score de Tal modifcado en los niños y permite un tratamiento de estos pacientes en salas de internado general, con mínimos efectos adversos, disminuyendo el ingreso a cuidados intensivos[AU]

Te way to provide oxygen has been an idea in constant evolution that has triggered in doctors the concern to implement different support devices, from the nasal cannula, the rebreathing mask and low flow, to continuous pressure in the airway (CPAP). ) and noninvasive ventilation (NIV). Recently, a new device that provides high-flow oxygen has been inserted between both extremes. Te objective of the present work was to describe clinical and technical aspects in the administration of High Flow Oxygen Terapy (OAF) in pediatric patients of the Santísima Trinidad Children's Hospital, in the UEPE service (Emergency Pediatric Stabilization Unit) 2017 and SIP ( pediatric hospitalization room) 500 2018, 2019, in the summer period. A retrospective cross-sectional descriptive study was carried out. Te universe was the pediatric patients who received HFO at the Santísima Trinidad Children's Hospital, in the UEPE service in 2017 and SIP 500 2018, 2019 in the summer period. Te data dump table was used as an instrument. Te main results show that a total of 697 patients were attended. Te prevalent age was under 6 months, with an average of 60%. Te vast majority of children who required this treatment were admitted due to a diagnosis of bronchiolitis, followed by BOR (recurrent obstructive bronchitis). In relation to the score of such modifed on admission, we can observe that in the UEPE sector the mean is 8, while the SIP 500 is 7. Regarding the material resource, there are several OAF systems. Tere are no studies that demonstrate the superiority of one system over another. Finally, it was observed that having implemented this technique in the institution, the maximum required ventilatory escalation was avoided in large numbers, since in the UEPE service the evolution was 65% of the OAF, while in the SIP 500 in 2018 it was 72% and in 2019 it was 79%. Terefore, we can establish that HFO achieves clinical improvement through its impact on functional respiratory syndrome, as well as on the modifed Tal score in children, and allows treatment of these patients in general hospital wards, with minimal effects. adverse effects, reducing admission to intensive care[AU]

A forma de fornecer oxigênio tem sido uma ideia em constante evolução que desencadeou nos médicos a preocupação em implementar diferentes dispositivos de suporte, desde a cânula nasal, a máscara de reinalação e baixo fluxo, até a pressão contínua nas vias aéreas (CPAP). ) -ventilação invasiva (VNI). Recentemente, um novo dispositivo que fornece oxigênio de alto fluxo foi inserido entre os dois extremos. O objetivo do presente trabalho foi descrever aspectos clínicos e técnicos na administração de Oxigenoterapia de Alto Fluxo (OAF) em pacientes pediátricos do Hospital Infantil Santísima Trinidad, no serviço UEPE (Unidade de Emergência Pediátrica de Estabilização) 2017 e SIP (internação pediátrica quarto) 500 2018, 2019, no período de verão. Foi realizado um estudo descritivo transversal retrospectivo. O universo foram os pacientes pediátricos que receberam HFO no Hospital Infantil Santísima Trinidad, no serviço da UEPE em 2017 e SIP 500 2018, 2019 no período de verão. A tabela de despejo de dados foi utilizada como instrumento. Os principais resultados mostram que foram atendidos um total de 697 pacientes, sendo a idade prevalente inferior a 6 meses, com média de 60%. A grande maioria das crianças que necessitaram desse tratamento foi internada por diagnóstico de bronquiolite, seguido de BOR (bronquite obstrutiva recorrente). Em relação ao escore desta modifcada na admissão, observa-se que no setor da UEPE a média é 8 , enquanto o SIP 500 é 7. Em relação ao recurso material, existem vários sistemas OAF. Não há estudos que demonstrem a superioridade de um sistema sobre o outro. Por fm, observou-se que com a implantação dessa técnica na instituição, evitou-se em grande número o escalonamento ventilatório máximo necessário, pois no serviço da UEPE a evolução foi de 65% de na OAF, enquanto no SIP 500 em 2018 foi de 72% e em 2019 foi de 79%. Portanto, podemos estabelecer que a HFO obtém melhora clínica por meio de seu impacto na síndrome respiratória funcional, bem como no escore de Tal modifcado em crianças, e permite o tratamento desses pacientes em enfermarias de hospital geral, com efeitos mínimos. tratamento intensivo[AU]

Nasal cannula or high-flow oxygen for patients with COPD in acute respiratory distress?

ABSTRACT: There may be some confusion regarding the use of supplemental oxygen in patients with chronic obstructive pulmonary disease (COPD) who are experiencing acute respiratory distress. This article addresses a common nursing misconception regarding the use of high-flow oxygen administration via non-rebreather masks instead of low-flow oxygen administration via nasal cannulas in patients with COPD who are in acute respiratory distress, an issue that was investigated in a simulation education exercise and survey of the nursing staff at the authors' facility.

Clinical outcome of standardized oxygen therapy nursing strategy in COVID-19.

BACKGROUND: Novel coronavirus pneumonia (COVID-19) has become a global pandemic. However, a technical standard for oxygen therapy nursing, as well as how this would improve clinical outcomes and symptoms, is yet to be explored. METHODS: From February 9, 2020, to March 31, 2020, 58 patients of confirmed COVID-19 were admitted to the 20th ward of the Eastern Branch, Renmin Hospital of Wuhan University. Fifteen patients who did not receive oxygen therapy and 13 patients who were transferred from other hospitals were excluded. The rest of the 30 patients that received standardized oxygen therapy in our unit were included in the study. Baseline characteristics, symptoms, and finger pulse oxygen saturation were collected during hospitalization. RESULTS: Clinical outcomes of the 30 patients were as follows: 27 patients (90.00%) were cured and discharged; 3 patients (10.00%) who continued to stay in hospital were stabilized with symptoms relieved. The fingertip oxygen saturation was 94.80%±3.49% at ICU admission and 97.8%±1.27% when transferred out of ICU after standardized oxygen therapy (P<0.005). The symptoms of dyspnea, fatigue, and muscle aches of the patients were improved when transferred out of ICU, compared with their condition when admitted to ICU (P<0.05). CONCLUSIONS: The standardized oxygen therapy nursing strategy for patients with COVID-19 emphasizes the nursing measurement, which focuses on the patient's oxygenation. It is led by nurses and starts oxygen therapy at an earlier stage. It not only improves the clinical outcomes of critical patients but also effectively reduces the infection risk of medical staff while emphasizing nursing quality management.

Alterações cardiorrespiratórias de pacientes submetidos à oxigenoterapia hiperbárica / Alteraciones cardiorrespiratorias de pacientes sometidos a la oxigenoterapia hiperbárica / Cardiorespiratory alterations in patients undergoing hyperbaric oxygen therapy

RESUMO Objetivo Avaliar modificações cardiorrespiratórias em decorrência de sessão única de oxigenoterapia hiperbárica. Método Estudo aleatorizado com pacientes: grupos-controle e oxigenoterapia hiperbárica. As avaliações ocorreram no início, durante e após a exposição ao oxigênio puro acima de uma atmosfera, durante 2 horas. A pressão arterial sistêmica, saturação periférica de oxigênio, frequência de pulso, volume e capacidade pulmonar, pressões inspiratória e expiratória máximas foram avaliadas. A saturação periférica de oxigênio, frequência de pulso e pressão arterial sistêmica foram avaliadas durante a pressurização na primeira hora. Os dados foram avaliados pelo teste de ANOVA, Mann-Whitney e teste t independente (p<0,05). Resultados Foram avaliados 14 pacientes adultos. No grupo sob terapia (sete sujeitos), idade: 49,57±14,59 anos houve redução da frequência de pulso de 16 batimentos por minuto após 35 minutos de terapia (análise intragrupo), e a saturação periférica de oxigênio foi maior neste mesmo período se comparado ao grupo-controle. Conclusão A oxigenoterapia hiperbárica promove alterações cardiorrespiratórias com o aumento da saturação periférica de oxigênio e redução da frequência de pulso, sem alterar os níveis pressóricos arteriais e a força, volumes e capacidades respiratórios.

RESUMEN Objetivo Evaluar modificaciones cardiorrespiratorias consecuentes de sesión única de oxigenoterapia hiperbárica. Método Estudio aleatorizado con pacientes: grupos de control y oxigenoterapia hiperbárica. Las evaluaciones ocurrieron en el inicio, durante y después de la exposición al oxígeno puro por encima de una atmósfera, durante dos horas. La presión arterial sistémica, saturación periférica de oxígeno, frecuencia de pulso, volumen y capacidad pulmonar, presiones inspiratoria y espiratoria máximas fueron evaluadas. La saturación periférica de oxígeno, frecuencia de pulso y presión arterial sistémica fueron evaluadas durante la presurización en la primera hora. Los datos fueron evaluados por el test de ANOVA, Mann Whitney y prueba t independiente (p<0,05). Resultados Fueron evaluados 14 pacientes adultos. En el grupo bajo terapia (siete sujetos), edad: 49,57±14,59 años, hubo reducción de la frecuencia de pulso de 16 latidos por minuto tras 35 minutos de terapia (análisis intragrupo), y la saturación periférica de oxígeno fue mayor en ese mismo período si comparado con el grupo de control. Conclusión La oxigenoterapia hiperbárica proporciona alteraciones cardiorrespiratorias con el aumento de la saturación periférica de oxígeno y la reducción de la frecuencia de pulso, sin alterar los niveles de presión arteriales y la fuerza, volúmenes y capacidades respiratorios.

ABSTRACT Objective To evaluate cardiorespiratory alterations due to a single session of hyperbaric oxygen therapy. Method Randomized study with patients: a control group and hyperbaric oxygen therapy. Evaluations occurred in the beginning, during, and after exposure to pure oxygen above atmosphere for 2 hours. Systemic blood pressure, peripheral oxygen saturation, pulse rate, lung volume and lung capacity, and maximal inspiratory and expiratory pressures were evaluated. Peripheral oxygen saturation, pulse rate, and systemic blood pressure were evaluated during the pressurizing in the first hour. Data were evaluated by means of ANOVA, Mann-Whitney, and independent t-test (p<0.05). Results A total of 14 adult patients were evaluated. In the group under therapy (seven subjects), aged: 49.57±14.59 years, there was a decrease in the pulse rate of 16 beats per minute after 35 minutes of therapy (intragroup analysis), and the peripheral oxygen saturation was higher within the same period compared to the control group. Conclusion The hyperbaric oxygen therapy promotes cardiorespiratory alterations with the increase of the peripheral oxygen saturation and decrease of the pulse rate, without altering blood pressure levels and the strength, volumes, and respiratory capacities.

Dutch Neonatal Intensive Care Nurses' Perceptions of Pulse Oximeter Saturation Target Limits for Preterm Infants.

PURPOSE: To conduct a national survey to assess practice, knowledge, barriers, and perceptions regarding oxygen saturation (SpO2) target limits among Dutch neonatal intensive care unit (NICU) nurses. DESIGN AND METHODS: Cross-sectional, web-based survey among 667 nurses from 9 level 3 Dutch NICUs. Part of the questions were based on a clinical scenario (28-weeks preterm infant, treated with CPAP, FiO2 0.4). RESULTS: 328 (53.6%) nurses responded to the survey. Of these, 281 (85.7%) reported to know the local policy of SpO2 target limits, and 261 (79.6%) and 244 (74.4%) rightly identified the lower and upper limit, respectively. Six NICUs recently increased their lower SpO2 limit and for 62.0% of their nurses this led to a significant alarm increase. For the majority of the respondents, the baby from the clinical scenario would spend <10% of the time outside the lower or upper SpO2 limits. Automated oxygen control systems were considered a good idea by 59.2% of the respondents, but 53.9% considered allowing parents to participate in FiO2 titration a bad or very bad idea. CONCLUSIONS: The majority of the respondents identified their unit's policy-specified SpO2 target limits and reported that the increase in SpO2 target limits may have led to more alarms. Titration of FiO2 is a part of care that respondents were reluctant to share with parents. PRACTICE IMPLICATIONS: A potential increase in the number of SpO2 alarms may lead to alarm fatigue. Although family-centered care philosophy is widely accepted across Dutch NICUs, there are still barriers to overcome.

Home oxygen therapy in patients with COPD: safety issues for nurse prescribers.

Two landmark studies demonstrated survival benefit in chronic obstructive pulmonary disease (COPD) complicated by chronic hypoxaemia with the prescription of long-term oxygen therapy (LTOT). Best practice evidence therefore recommends that individuals with stable COPD and resting hypoxaemia (PaO2≤7.3 kPa) should be assessed for long-term oxygen therapy. However, it is estimated that up to one-quarter of COPD patients prescribed LTOT continue to smoke. Oxygen therapy consequently presents an obvious fire hazard in the case of such patients, who are therefore at greater risk of death or sustaining devastating head and neck burns. This article critically analyses, through the context of a care study, the professional, ethical and legal issues involved in making a safe prescribing decision for LTOT in an individual with COPD who is a current smoker. Home oxygen prescription is a growing trend in the COPD population, and it is important for nurse prescribers to be aware of the issues highlighted in the article to ensure safe prescribing practices.

Development and validation of a questionnaire to assess the doctors and nurses knowledge of acute oxygen therapy.

BACKGROUND: Prescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health care providers on various aspects of oxygen therapy, and this may be a barrier to optimal oxygen administration. Hence, it is essential to ascertain providers' knowledge of acute oxygen therapy so that appropriate educational interventions are instituted for better delivery. There is no available validated instrument to assess knowledge of acute oxygen therapy. The study aimed to develop, validate and evaluate the test-retest reliability of a questionnaire to determine the doctors and nurses understanding of acute oxygen therapy. METHODS: This study involved the development of the questionnaire contents by a literature review, assessment of face validity (n = 5), content validity, using a panel of experts (n = 10), item analysis and test-retest reliability among a sample (n = 121) of doctors and nurses. RESULTS: Face validity indicated that the questionnaire was quick to complete (10-15 min), most items were easy to follow and comprehensible. The global content validity index (S-CVI) was 0.85. The test-retest reliability statistics showed a kappa coefficient of 0.546-0.897 (all P<0.001) and percentage agreement of 80-98.3% indicating high temporal stability in the target population. In total, 90% of the items fulfilled the reliability acceptance criteria. Item discrimination analysis showed that most questions were at an acceptable level. The final questionnaire included 37 item questions and eight sections. CONCLUSION: The designed questionnaire is a reliable and valid tool for assessing knowledge of acute oxygen therapy among doctors and nurses.

Compreensão do enfermeiro sobre o cuidado ao recém-nascido em oxigenoterapia / Nurses' understanding of newborn care in oxygen therapy / La comprensión de las enfermeras de la atención a los recién nacidos en la terapia de oxígenoterapia

Objetivo: Analizar la comprensión de las enfermeras acerca de la atención prestada a los recién nacidos en la terapia de oxígeno en la unidad neonatal de cuidados intermedios e intensivos. Método: Se realizó un estudio descriptivo de enfoque cualitativo, realizado con 16 enfermeros de la unidad neonatal de un hospital público de Petrolina / PE, de diciembre 2015 a enero 2016 a través de entrevistas semiestructuradas. Los datos se analizaron utilizando el análisis de contenido temático. Resultados: Las enfermeras entienden lo que se configura como la terapia de oxígeno, sus indicaciones, efectos y posibles complicaciones asociadas, así como los principales cuidados de enfermería cuales deben estar orientados a los recién nacidos en la terapia con oxígeno suplementario. Conclusión: La calificación y la capacidad de la enfermera que atiende al recién nacido en el uso de la terapia de oxígeno en la unidad neonatal, es esencial para garantizar una atención segura, la identificación precoz de los signos de la adversidad y la prevención de posibles complicaciones

Objective: To analyze nurses' understanding of the care given to newborns in oxygen therapy in the Intermediate and Intensive Neonatal Care Unit. Method: This is a descriptive, qualitative study conducted with 16 nurses from the Neonatal Unit of a public hospital in Petrolina/PE, from December 2015 to January 2016, through a semi-structured interview. Data were analyzed through thematic content analysis. Results: Nurses understand what constitutes oxygen therapy, its indications, purposes and possible associated complications, as well as the main nursing care that should be directed to the newborns in therapy with supplemental oxygen. Conclusion: The qualification and the ability of the nurse to assist the newborn in the use of oxygen therapy, within the Neonatal Unit, is essential in guaranteeing a safe care, in the early identification of signs of adversity and in the prevention of possible complications

Objetivo: Analisar a compreensão do enfermeiro sobre a assistência prestada ao recém-nascido em oxigenoterapia na Unidade de Cuidados Neonatais Intermediários e Intensivos. Método: Trata-se de estudo descritivo, de abordagem qualitativa, realizado com 16 enfermeiros da Unidade Neonatal de um hospital público de Petrolina/PE, de dezembro de 2015 a janeiro de 2016, por meio de entrevista semiestruturada. Os dados foram analisados mediante análise de conteúdo temática. Resultados: Os enfermeiros compreendem o que se configura como oxigenoterapia, suas indicações, finalidades e possíveis complicações associadas, bem como os principais cuidados de enfermagem que devem ser direcionados aos recém-nascidos em terapia com oxigênio suplementar. Conclusão: A qualificação e a habilidade do enfermeiro que assiste ao recém-nascido em uso de oxigenoterapia, dentro da Unidade Neonatal, é imprescindível na garantia de uma assistência segura, na identificação precoce dos sinais de adversidade e na prevenção de possíveis complicações

Beneficios y cuidados enfermeros en el uso de cánula nasal de alto flujo en el paciente con insuficiencia respiratoria aguda / Benefits and nursing care in the use of high-flow nasal cannula for patients with acute respiratory failure

OBJETIVO: identificar los beneficios y los principales cuidados del dispositivo de cánula nasal de alto flujo como tratamiento en los pacientes diagnosticados de insuficiencia respiratoria aguda (IRA). MÉTODO: se ha realizado una revisión narrativa. Se buscaron artículos en las siguientes bases de datos: PubMed, Cinhal, Cochrane Library Plus y Cuiden, con los siguientes términos libres de búsqueda: oxigenoterapia alto flujo; insuficiencia respiratoria aguda y cuidados enfermeros. Limitados con idioma inglés o español, edad +18 años y publicados en los últimos 10 años (2007-2017). RESULTADOS: se incluyeron 19 documentos. El principal beneficio del tratamiento con dispositivo de cánula nasal de alto flujo es la mejora de la oxigenación. La terapia utiliza un sistema de humidificación térmica que favorece la función mucociliar, facilita la expulsión de secreciones y reduce la aparición de atelectasias pulmonares. Además, mediante la humidificación del aire inspirado se reducen las molestias de la sequedad bucal relacionadas con la oxigenoterapia convencional. Puede llegar a aliviar asincronías, reducir la frecuencia respiratoria y mejorar la eficacia también de los esfuerzos respiratorios incrementando la ventilación alveolar. CONCLUSIONES: el uso de la cánula nasal de alto flujo es un tratamiento beneficioso en los pacientes diagnosticados de insuficiencia respiratoria aguda

OBJECTIVE: to identify the benefits and main care measures for the high-flow nasal cannula as treatment for patients diagnosed with acute respiratory failure. METHOD: a narrative review was conducted; there was a search for articles in the following databases: PubMed, Cinhal, Cochrane Library Plus and Cuiden, with the following free search terms: "oxigenoterapia alto flujo" (high-flow oxygen therapy); "insuficiencia respiratoria aguda" (acute respiratory failure) and "cuidados enfermeros" (nursing care).The search was limited to articles in English or Spanish, >18-year-old, and published within the past 10 years (2007-2017). RESULTS: nineteen (19) articles were included. The main benefit of the treatment with high-flow nasal cannula was an improvement in oxygenation. This therapy involves a thermal humidification system that boosts the mucociliary function, encourages the discharge of secretions, and reduces the development of pulmonary atelectasis. Moreover, through the humidification of the air inhaled, there is a reduction in the mouth dryness discomfort associated with traditional oxygen therapy. It can even alleviate asynchrony, reduce the respiratory frequency, and improve also the efficacy of respiratory efforts, by increasing alveolar ventilation. CONCLUSIONS: the use of high-flow nasal cannula is a beneficial treatment for patients diagnosed with acute respiratory failure

The nasal oxygen practice in intensive care units in China: A multi-centered survey.

BACKGROUND: Nurses frequently administer nasal oxygen therapy for patients in intensive care units (ICUs). However, little is known about the current status, nurses' management and perception on the nasal oxygen therapy in China. Therefore, we aimed to investigate the nasal oxygen practice of ICUs in China to provide insights into future direction. METHODS: A cross-sectional survey on 10 hospitals was conducted. A self-designed questionnaire was administered to ICU nurses. Descriptive statistics, univariate, and multiple stepwise regression analyses were performed to analyze the respondents' questionnaires. RESULTS: A total of 580 respondents with a response rate of 96.67% were included in this study. The average correct answer rate was 58.28%. The current status of nasal oxygen administration in ICUs in Chinese hospitals lagged behind the recommendations of related guidelines. Nurses in China were eager to learn about the updated knowledge on oxygen therapy. The gender, age, clinical experience, degree, job title, and classification of working hospitals were not related to the oxygen therapy-related knowledge scores (all P>0.05). CONCLUSION: Many deficiencies are observed regarding the nasal oxygen practice in ICUs of Chinese hospitals. Increased efforts by authorities and medical staff are required to narrow the gap between the current status of oxygen practice and the recommendations from related guidelines.

Evaluación de conocimientos sobre oxigenoterapia y lectura del flujómetro en el personal de salud de pediatría del Hospital Universitario San Ignacio, Bogotá, Colombia / Knowledge Evaluation of Oxygen Therapy and Flowmeter's Reading among Health Workers in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia

Introducción: el oxígeno (O2) es un medicamento que puede generar efectos adversos. Discrepancias en la lectura del flujómetro y metas de saturación de oxígeno (SpC>2) pueden repercutir en la toma de decisiones clínicas, paraclínicas y estancia hospitalaria de pacientes pediátricos. Objetivo: evaluar conocimientos sobre SpO2, efectos adversos del O2 y lectura del flujómetro en el personal de salud del Departamento de Pediatría del Hospital Universitario San Ignacio, Bogotá, Colombia. Métodos: estudio transversal, mediante encuesta autodiligenciada en una muestra por conveniencia durante diciembre de 2016 y enero de 2017. Evaluación de conocimientos sobre oxigenoterapia, SpC>2, efectos adversos y lectura del flujómetro mediante fotografías de flujómetros del hospital con diferente fracción inspirada de oxígeno (FiC>2). Resultados: de 259 personas, el 77% respondió la encuesta. El 22% de los participantes respondió que la SpC>2 aumenta o se mantiene igual cuando el niño duerme; el 78% sabía de complicaciones del uso prolongado de O2, y el 67%, las relacionadas con la administración de una FiC>2 mayor a la necesaria. Con relación a la población neonatal, el 10% consideró que se deben buscar metas de SpO2 iguales o superiores al 96%; entre el 9% y el 19% de las lecturas en las diferentes fotografías de flujómetros fueron respuestas incorrectas. Discusión: es necesario reforzar conceptos actualizados sobre oxigenoterapia, con énfasis en metas de saturación, efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.

Introduction: Supplemental oxygen is considerad a pharmaceutical drug; therafora, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and peripheral oxygen saturation (SpC>2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpC>2 goals and oxygen flowmeter's reading among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied poli between December 2016 and January 2017. The poli evaluated topics on supplemental oxygen therapy fundamentáis and adverse effects, SpC>2 goals and flowmeter readings through flowmeters photographs indicating a specific ffaction of inspirad oxygen (FÍO2). Results: Response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplementary oxygen concentration greater than required amounts. In neonatal population, 10% considered oxygen saturation efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.

Cánulas nasales de alto flujo ¿aportan valor? / High-flow nasal cannulas. Do they give value?

No disponible

The Effect of Apneic Oxygenation on Reducing Hypoxemia During Rapid Sequence Induction and Intubation in the Acutely Ill or Injured.

Apneic oxygenation during intubation is the application of oxygen via a nasal cannula, which is left in place throughout laryngoscopy. The flow rate of oxygen is set to at least 15 L/min and theoretically reduces the risk of oxygen desaturation and hypoxemia during the procedure. Over the last 5 years, there have been several studies published on this topic with differing results. Despite conflicting results, use of apneic oxygenation is becoming more prevalent and is being implemented into standard operating procedures in some clinical settings. Because of the low risk of adding a nasal cannula during intubation and the potential benefit of reducing the incidence of hypoxemia and severe oxygen desaturation, it would be prudent to implement apneic oxygenation when available.

Oxigenoterapia de alto flujo administrada mediante el sistema AIRVO 2(R) / High-flow oxygen therapy delivered by Airvo 2(TM) system

La oxigenoterapia de alto flujo es un procedimiento que permite administrar todo el gas inspirado al paciente, humidificado y calentado para mejorar su tolerancia y a una FiO2 constante que puede alcanzar el 1, independientemente de su patrón ventilatorio. Uno de los dispositivos en auge en el mercado es el sistema AIRVO 2(R). El AIRVO 2(R) es un aparato compacto con una turbina integrada. Mediante la conexión a un caudalímetro de oxígeno de 30 litros y una bolsa de agua estéril, el sistema es fácilmente configurable mediante una pantalla con 5 botones. La conexión al paciente se realiza mediante una tubuladura calefactada y una interfase, siendo la más utilizada una cánula nasal. Otras interfases permiten adaptarlo a la traqueotomía del paciente o a una mascarilla. Ha demostrado su eficacia en pacientes con insuficiencia respiratoria hipoxémica, sin hipercapnia, como soporte tras una extubación precoz, en pacientes posquirúrgicos, en apneas del sueño o en reagudizaciones de la insuficiencia cardiaca. Para lograr una técnica segura y eficaz, la enfermera debe conocer las ventajas del procedimiento y estar formada en la aplicación, mantenimiento y retirada del sistema AIRVO 2(R) (AU)

High-flow oxygen therapy is a procedure that allows for heating and humidifying all inspired gas administered to patients, improving tolerance and a constant FiO2 that can reach 1, regardless of their breathing pattern. One of the market's current booming devices is known as AIRVO 2TM system. AIRVO 2(TM) is a compact unit with an integrated turbine. Connected to a 30 liter oxygen flow meter and a sterile water bag, the system is easily configurable by means of a 5-button display. The connection to the patient is made through a heated nozzle and an interface, being a nasal cannula the most commonly used. Other interfaces allow for adaptation to the patient's tracheotomy or to a mask. It has demonstrated its effectiveness in patients with hypoxemic respiratory insufficiency, without hypercapnia, as a support after early extubation, post-surgical patients, sleep apnea and exacerbations of heart failure. To achieve safe and effective skills, nurses must be aware of AIRVO 2(TM) system's advantages and procedure, and should be trained in its implementation, maintenance and withdrawal (AU)

Nasal high flow oxygen therapy in the ward setting: A prospective observational study.

BACKGROUND: Whilst research demonstrates the benefits of nasal high flow oxygen in the intensive care setting, limited literature exists on its benefits in ward patients. OBJECTIVES: This study evaluated the use of nasal high flow oxygen in adult ward patients with respiratory failure or at risk of respiratory deterioration. Primary outcome was an improvement in pulmonary function as indicated by decreases in respiratory and heart rates and an increase in arterial oxygen saturation via pulse oximetry. RESEARCH METHODOLOGY: Using a prospective observational research design, purposeful sampling recruited 67 adult ward patients receiving nasal high flow oxygen between May and July 2015 (inclusive). All recruited patients were included in the data analysis. RESULTS: The median age was 71.0 years (q25, q75=58.0, 78.0) and most patients were medical specialty patients (n=46, 68.7%). After commencing nasal high flow oxygen, respiratory rate (t=2.79, p=<0.01) and heart rate (t=2.23, p=0.03) decreased and arterial oxygen saturation via pulse oximetry increased (t=4.08, p=<0.001). CONCLUSION: Nasal high flow oxygen appears effective in a selective group of ward patients with respiratory failure, or at risk of respiratory deterioration, and may reduce demand on critical care beds; this warrants further research.

The effects of health education given by nurses to COPD patients on the daily oxygen concentrator usage time.

INTRODUCTION: Long-term oxygen therapy is the most effective method which has been shown to prolong the lifespan in people with COPD. The aim of the study was to investigate the effects of health education given by nurses to patients with COPD on the daily oxygen concentrator (OC) usage time. MATERIAL AND METHODS: The study was carried out in a State Hospital, Turkey, between July and November 2015. After given consent to the study, participants were divided into intervention and control groups by simple random sampling method. Then data forms were filled during face-to-face interview. Firstly, the data describing patients' arrival times were collected retrospectively. Afterwards, the patients from the intervention group were educated through educational booklets prepared by the researchers. They were phoned in the weeks 4, 8 and 12th for problems they might have encountered during the use of OC. After the 14th week, data forms of patients from the both groups were filled again; the results were compared with previous clinical findings. Data were analysed using SPSS 15.0 for Windows. RESULTS: It was determined that 95.5% of patients did not get information about the use of OC. Daily OC usage time (hour) by patients in the intervention group firstly amounted to 5.69 ± 3.90, later on to 11.94 ± 4.73 (p < 0.05). Whereas when clinical findings concerning pre- and post educational periods were compared; a significant improvement in PaO2, PaCO2, FEV1 and SaO2 of patients in the intervention group (p<0.05) was shown, contrary to the control group. CONCLUSIONS: It may be recommended that patients receive continuous education and close monitoring of their results.

Improving manual oxygen titration in preterm infants by training and guideline implementation.

To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) % vs 61.9 (48.5-72.3) %; p < 0.005, with a decrease in the %SpO2 > 95% (44.0 (27.8-66.2) % vs 30.8 (22.6-44.5) %; p < 0.05). There was no effect on the %SpO2 < 85% (5.9 (2.8-7.9) % vs 6.2 (2.5-8) %; ns) and %SpO2 < 80% (1.9 (1.0-3.0) % vs 1.7 (0.8-2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2 < 80% reduced (2 (1-2) vs 1 (1-2) minutes; p < 0.05), the occurrence of SpO2 > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004). CONCLUSION: Training and guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.

Quality of life improves in patients with chronic heart failure and Cheyne-Stokes respiration treated with adaptive servo-ventilation in a nurse-led heart failure clinic.

AIMS AND OBJECTIVES: The aim of this study was to investigate if quality of life improved in chronic heart failure patients with Cheyne-Stokes respiration treated with adaptive servo-ventilation in nurse-led heart failure clinic. BACKGROUND: Cheyne-Stokes respiration is associated with decreased quality of life in patients with chronic heart failure. Adaptive servo-ventilation is introduced to treat this sleep-disordered breathing. DESIGN: Randomised, controlled design. METHODS: Fifty-one patients (ranging from 53-84 years), New York Heart Association III-IV and/or left ventricular ejection fraction ≤40% and Cheyne-Stokes respiration were randomised to an intervention group who received adaptive servo-ventilation or a control group. Minnesota Living with Heart Failure Questionnaire was used to assess quality of life at randomisation and after three months. Both groups were followed in the nurse-led heart failure clinic. RESULT: Adaptive servo ventilation improved quality of life-scores both in a per protocol analysis and in an intention to treat analysis. Twenty-one patients dropped out of the study, nine in the control and 12 in the intervention group. CONCLUSION: Use of adaptive servo-ventilation improved quality of life in chronic heart failure patients with Cheyne-Stokes respiration. However, the drop-out rate was high. RELEVANCE TO CLINICAL PRACTICE: Chronic heart failure patients come regularly to the nurse-led heart failure clinic. The heart failure nurses' competency has to include knowledge of equipment to provide support and continuity of care to the patients.

Experiences of caring for infants with severe bronchiolitis.

Background Common in children under two years, bronchiolitis is usually caused by respiratory syncytial virus (Jhawar 2003). Symptoms are usually self-limiting although some children develop respiratory distress requiring hospitalisation (Scottish Intercollegiate Guidelines Network 2006). Supplemental oxygen, fluid support and ventilator assistance may also be necessary. In cases of moderately severe bronchiolitis, oxygen can be delivered through a head box, but some hospitals deliver high-flow oxygen therapy with nasal prongs to treat respiratory distress.