Prevención de úlcereas por presión en neonatos con ventilación mecánica no invasiva / Prevention of pressure ulcers in neonates with non-invasive mechanical ventilation

OBJETIVO: Determinar el apósito con mayor efectividad (hidrocoloide o espuma de poliuretano) en neonatos ingresados en las unidades de cuidados intensivos neonatal y pediátrica del Hospital Clínico Universitario de Valencia, sometidos a ventilación mecánica no invasiva para la prevención de úlceras por presión nasales y/o faciales. MATERIAL Y MÉTODOS: Proyecto de investigación de tipo observacional, prospectivo y analítico cuya muestra estaba formada por 13 neonatos con ventilación mecánica no invasiva, hospitalizados en la unidad de cuidados intensivos neonatales y pediátrica. Los neonatos fueron divididos en dos grupos: en el grupo A (7 pacientes) se empleó el apósito de espuma de poliuretano y en el grupo B se utilizó el hidrocoloide (6 pacientes). La recogida de datos se realizó durante el período comprendido entre abril y mayo de 2018. RESULTADOS: De los neonatos incluidos en el estudio, 5 (38,5%) presentaron úlceras por presión nasales; el resto (62%) no presentó úlceras. Además, se obtuvo que, del total de pacientes con lesión, un 60% llevaba el apósito hidrocoloide y un 40% el de espuma de poliuretano. CONCLUSIONES: Tras el estudio, se determinó que el apósito de espuma de poliuretano presentaba un menor porcentaje de aparición de UPP en comparación con el hidrocoloide. Sin embargo, sería recomendable valorar la posibilidad de emplear alguno de ellos como medida de protección

OBJECTIVE: To determine the most effective dressing (hydrocolloid or polyurethane foam) in neonates admitted by the Neonatal and Pediatric Intensive Care Unit of the Hospital Clínico Universitario de Valencia, subjected to non-invasive mechanical ventilation for the prevention of pressure ulcers nasal and/or facial. MATERIAL AND METHODS: observational, prospective and analytical research project whose sample considered of 13 neonates with non-invasive mechanical ventilation hospitalized in the Neonatal and Pediatric Intensive Care Unit. They were divided into two groups, where group A (7 patients) used the polyurethane foam dressing and group B used the hydrocolloid dressing (6 patients). The data collection was carried out during the period from April to May 2018. RESULTS: Of the neonates included in the study, 5 presented nasal pressure ulcers (38.5%) and the rest did not (62%). In addition, it was obtained that, of the total of patients with injury, 60% wore the hydrocolloid dressing and 40% that of polyurethane foam. CONCLUSIONS: After the study, it was determined that the polyurethane foam dressing had a lower percentage of appearance of pressure ulcers compared to the hydrocolloid. However, it would be advisable to appraise the possibility of using any of them as a protection measure

A vigilância da pessoa em situação crítica submetida a ventilação não invasiva: a intervenção especializada em enfermagem / Surveillance of the person in critical situation submitted to non-invasive ventilation: the specialized intervention in nursing

O presente relatório, ancorado no tema A Vigilância da Pessoa em Situação Crítica submetida a Ventilação Não Invasiva: Uma Intervenção Especializada em Enfermagem, demonstra o percurso de aquisição de competências no âmbito da Unidade Curricular Estágio com Relatório, do 9º Curso de Mestrado em Enfermagem na Área de Especialização à Pessoa em Situação Crítica da Escola Superior de Enfermagem de Lisboa. Os estágios, realizados em contexto de Unidade de Cuidados Intensivos e em Serviço de Urgência, tiveram como objetivo geral desenvolver competências especializadas na prestação de cuidados à pessoa em situação crítica submetida a ventilação não invasiva e sua família, com especial foco na vigilância. O referencial teórico escolhido foi a Teoria da Vigilância de Meyer e Lavin e a Teoria de Benner. A vigilância profissional de enfermagem reúne um estado de observação e de atenção à pessoa no seu processo de doença crítica, com identificação de sinais e sintomas clinicamente significativos; o cálculo do risco inerente à prática de enfermagem; a formação para agir de forma eficaz e eficiente, minimizando os riscos e complicações (Meyer & Lavin, 2005). A vigilância de enfermagem, dando enfase à deteção precoce de problemas, pode ser observada como uma primeira forma de defesa do indivíduo, que contribuirá para a melhoria do seu estado de saúde (Benner, 2001). A ventilação não invasiva (VNI) é utilizada cada vez mais em situações de insuficiência respiratória aguda e/ou crónica, consistindo na aplicação de um suporte ventilatório mecânico sem recurso a métodos invasivos, através de um interface, em doentes com estímulo respiratório (Fonseca & Fontes, 2013). O enfermeiro tem ao seu dispor estratégias e técnicas que contribuem não exclusivamente para o aumento da eficácia da VNI, como também para a redução dos fatores de intolerância a esta terapêutica (Maciel, 2011). Para isso, é necessária uma vigilância eficaz e eficiente por parte do enfermeiro, prevenindo ou diminuindo as complicações que possam surgir.

The present report, The Surveillance of the Person in Critical Condition treated with Non-Invasive Ventilation: A Specialized Intervention in Nursing, demonstrates the course of acquiring skills within the Curricular Internship Unit of the 9th Master's Course in Nursing, Specializing in the Area for People with Critical Conditions at the Lisbon College School of Nursing. The internships, carried out in the context of the Intensive Care Unit and in the Emergency Department, had the general objective of developing specialized skills in providing care to the person in critical condition treated with non-invasive ventilation and their family, with a special focus on surveillance. The theoretical framework chosen was Meyer and Lavin's Theory of Surveillance and Benner's Theory. Professional nursing surveillance joins a state of observation and attention to the person with a critical illness, with the identification of clinically significant signs and symptoms, the calculation of the risk inherent to nursing practice, training to act effectively and efficiently, and minimizing risks and complications (Meyer & Lavin, 2005). Nursing surveillance and the emphasis on the early detection of problems can be seen as a first form of defense for the individual, which will contribute to the improvement of their health status (Benner, 2001). Non-Invasive ventilation (NIV) is increasingly used in situations of acute and/or chronic respiratory failure, consisting of the application of mechanical ventilation support without the use of invasive methods, through an interface, in patients with respiratory stimulus (Fonseca & Fontes, 2013). The nurse has at their disposal strategies and techniques that contribute not only to increase the effectiveness of NIV, but also to reduce factors of intolerance to this therapy (Maciel, 2011). For this, effective and efficient surveillance by the nurse is necessary, preventing or reducing the complications that may arise.

The use of non-invasive ventilation in an exacerbation of chronic obstructive pulmonary disease: a case study.

This article aims to assist nurses and other health professionals to care for patients who have type 2 respiratory failure as a result of chronic obstructive pulmonary disease, and who require non-invasive ventilation. It outlines findings of a case study that are commonplace in the acute medical setting and aims to highlight important factors that impact on patient care and patient outcome, and to help nursing staff to implement recommended and best practices.

Experiencias, percepciones y necesidades de los pacientes en AVM en UTI. Revisión bibliográfica sistemática de estudios cualitativos, en los últimos 10 años / Experiences, perceptions and needs of patients in avm in uti. Systematic bibliographic review of qualitative studies, in the last 10 years

El objetivo de este trabajo fue analizar los resultados de las publicaciones en bases de datos científicas sobre las experiencias, percepciones y necesidades del paciente en asistencia ventilatoria mecánica en los últimos 10 años. Se realizó una revisión bibliográfica sistemática. Se consideró estudios originales, revisiones críticas, proyectos de investigación, tesis. Que fueran de diseño cualitativo cuyos participantes fueran mayores de edad y que hayan estado intubados o con dispositivos de ventilación mecánica no invasiva. Para el análisis de los datos de la presente investigación se utilizó un conjunto de técnicas de análisis para obtener información que permitan la inferencia de conocimientos relativos a las condiciones de producción o recepción de estos mensajes. El paciente sufre, se siente morir, se siente vulnerable, no se puede comunicar y eso lo desestabiliza. Los sentimientos sobre la despersonalización y un au mento del tecnocentrismo en los cuidados, los lleva a experimentar con más intensidad la ansiedad, el pánico y la pérdida de control. La deshumanización es percibida por los pacientes, entorpece la identificación de los problemas reales y favorece la presencia de malestar e incomodidad. En este estudio se intentó comprobar que el paciente oye, siente, padece y es vulnerable ante el estado de su salud. Se siente indefenso e inútil en su autocuidado, percibe su incapacidad y la dependencia que experimenta. Pero aunque se lo complejice, se impida la comunicación verbal por el método de tratamiento ventilatorio; el paciente sigue siendo un ser humano requirente de un cuidado humanizado y profesional, esencialmente de enfermería[AU] .

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients. The European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients. The task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode. Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

Non-invasive positive pressure ventilation in the home setting.

Noninvasive ventilation is becoming a more commonly used long-term treatment for various conditions in which the patient experiences chronic hypercapnic respiratory failure (type 2 respiratory failure). This article aims to discuss why patients require long-term noninvasive positive pressure ventilation (NPPV), and to describe some of the care considerations required for this patient group, in addition to challenges that nurses in the home care environment face when supporting these patients at home. The article provides a brief pathophysiological overview, while also discussing the use of NPPV as symptom support for patients with severe disease in the later stages of their lives. The term 'noninvasive positive pressure ventilation' is used to cover a number of different noninvasive systems, although the study primarily focuses on bi-level ventilation systems.

Involvement of patients' perspectives on treatment with noninvasive ventilation in patients with chronic obstructive pulmonary disease-A qualitative study.

AIMS AND OBJECTIVES: To clarify chronic obstructive pulmonary disease patients' perspectives on treatment with noninvasive ventilation and develop management strategies for the treatment based on these perspectives. BACKGROUND: The effect of treating chronic obstructive pulmonary disease patients with noninvasive ventilation is well-documented, as is the problem of patient difficulties in tolerating the treatment. Knowledge of how patients with chronic obstructive pulmonary disease experience and evaluate treatment with noninvasive ventilation is limited; therefore, more information of patient perspectives is needed to develop treatment practices in respiratory medicine. METHOD: This study is based on critical psychological practice research. DESIGN: A co-researcher group comprising diverse health professionals was set up and headed by the principal researcher. The group convened seven times over 12 months to develop new management strategies based on patients' perspectives on noninvasive ventilation. Health professionals contributed with experience-based perspectives, and the researcher contributed with data from participant observation in the department and semi-structured interviews with 16 patients and four relatives. RESULTS: Interviews revealed that patients with chronic obstructive pulmonary disease regarded noninvasive ventilation treatment positively even though they experienced discomfort and anxiety. Patients' perspectives revealed that patients with chronic obstructive pulmonary disease conduct their everyday lives with chronic obstructive pulmonary disease looking at chronic obstructive pulmonary disease as a basic life condition rather than an illness. This approach had a major impact on chronic obstructive pulmonary disease patients' attitudes to noninvasive ventilation treatment and hospitalisation. CONCLUSION: Investigation of patient perspectives generated results that were highly productive in facilitating multidisciplinary collaboration and in developing and sustaining new management strategies. Critical psychological practice research facilitated ongoing development of clinical practice related to noninvasive ventilation treatment. RELEVANCE TO CLINICAL PRACTICE: Focus on patients' perspectives in treatment with noninvasive ventilation resulted in the development of new management strategies regarding patient care, joint ward rounds, and in addition, one room at the ward, to which a nurse was assigned, was designated for chronic obstructive pulmonary disease patients treated with noninvasive ventilation.

¿Cómo viven la ventilación no invasiva los enfermos y sus cuidadores? Revisión bibliográfica sistemática de investigaciones cualitativas / How do sick people their caregivers live non-invasive ventilation? Systematic literature review of qualitative research

Introducción. Sabemos que la ventilación no invasiva (VNI) es un soporte ventilatorio de elección, aunque a veces fracasa, por intolerancia, falta de adherencia, incumplimiento, etc. ¿Cómo podemos anticiparnos a ese fracaso? Objetivo. Explorar la evidencia cualitativa sobre las vivencias de las personas en tratamiento con VNI y sus cuidadores formales e informales. Método. Revisión bibliográfica sistemática de artículos originales indexados entre 2005 y 2015 que estudian la VNI en población adulta con metodología cualitativa, en seis bases de datos. Evaluación por pares de la calidad científica con herramienta del Programa CASPe. Metasíntesis cualitativa de los hallazgos. Resultados. 15 artículos cumplen criterios de selección, basados en la Teoría Fundamentada y en Fenomenología, que utilizan: entrevistas, observación y grupo focal, tanto a enfermos como a familias y profesionales de salud. Destaca la sensación de angustia y pérdida de control, aunque la VNI les alivia la disnea (ambivalencia). Búsqueda del bienestar cotidiano a través de rutinas y participación activa. Interacción dependencia/autonomía, sobre todo en la toma de decisiones, y se encuentran divergencias que hacen complejo el proceso de información y voluntades anticipadas. La sabiduría práctica de enfermería se describe como básica, y se manifiestan dificultades: falta de tiempo, sobrecarga de trabajo, tecnocentrismo, inexperiencia. Conclusiones. La evidencia cualitativa del tratamiento con VNI, aunque escasa, es variada, pues se exploran diferentes parcelas (situaciones agudas, crónicas, terminales), y desde diferentes puntos de vista. Integrar esos hallazgos en nuestra práctica profesional nos ayudará a aumentar la adherencia y el éxito del tratamiento, pero sobre todo a mejorar la calidad de vida de los pacientes ventilados y sus familias (AU)

Introduction. We know that non-invasive ventilation (NIV) is a basic ventilator support, but sometimes it fails, because of intolerance, lack of adherence, breach, etc. How can we anticipate that failure? We intend to explore the qualitative evidence on the experiences of people with this treatment and their formal and informal caregivers. Method. Systematic literature review of original articles indexed from 2005 to 2015, which study the NIV in adult population with qualitative methodology in six databases. Peer review of scientific quality with tool of the CASPe Program. Qualitative metasynthesis of the findings. Results. 15 articles met selection criteria, based on Grounded Theory and Phenomenology, which use interviews, observation and focus group, directed both patients, and families and health professionals. Its studies emphasize the feeling of anxiety and loss of control, although the NIV relieves them dyspnea (ambivalence). Search daily well-being through routines and active participation. Interaction dependence/autonomy, especially in decision-making, finding differences that make complex the process information and advance directives. Practical wisdom of nursing care 24 hours with patients is described basic, and difficulties being narrated: lack of time, overload of work, technocentrism, inexperience. Conclusions. The qualitative evidence of treatment with VNI is varied although scarce; different plots (acute situations, chronic, terminals) are explored, from different points of view. The integration of these findings in our practice will help us to increase adherence and become the treatment successful, but especially to improve the quality of life of ventilated patients and their families (AU)

Noninvasive Ventilation in Premature Neonates.

BACKGROUND: The use of noninvasive ventilation is a constantly evolving treatment option for respiratory disease in the premature infant. The goals of these noninvasive ventilation techniques are to improve gas exchange in the premature infant's lungs and to minimize the need for intubation and invasive mechanical ventilation. PURPOSE: The goals of this article are to consider various uses of nasal interfaces, discuss skin care and developmental positioning concerns faced by the bedside nurse, and discuss the medical management aimed to reduce morbidity and mortality. This article explores the nursing role, the advances in medical strategies for noninvasive ventilation, and the team approach to noninvasive ventilation use in this population. SEARCH STRATEGY: Search strategy included a literature review on medical databases, such as EBSCOhost, CINAHL, PubMed, and NeoReviews. FINDINGS: Innovative products, nursing research on developmental positioning and skin care, and advanced medical management have led to better and safer outcomes for premature infants requiring noninvasive ventilation. IMPLICATIONS FOR PRACTICE: The medical focus of avoiding long-term mechanical ventilation would not be possible without the technology to provide noninvasive ventilation to these premature infants and the watchful eye of the nurse in terms of careful positioning, preventing skin breakdown and facial scarring, and a proper seal to maximize ventilation accuracy. IMPLICATIONS FOR RESEARCH: This article encourages nursing-based research to quantify some of the knowledge about skin care and positioning as well as research into most appropriate uses for noninvasive ventilation devices.

Special Considerations in the Nursing Care of Mechanically Ventilated Children.

Mechanical ventilation is often required to support the recovery of critically ill children. Critical care nurses must understand the unique needs of the children and design supportive care that is sensitive to their changing physiology, developmental stage, and socioemotional needs. This article describes the unique considerations in providing care for mechanically ventilated children. It addresses invasive and noninvasive ventilation and the needs of long-term ventilated children and family in critical care. Supportive nursing care that is aligned with the unique needs of the critically ill child is paramount to ensuring best outcomes for these vulnerable patients.

Sleep quality of mother-caregivers of Duchenne muscular dystrophy patients.

BACKGROUND: Sleep disturbance is a common problem for caregivers. In general, patients with Duchenne muscular dystrophy (DMD) use noninvasive ventilation to maintain quality of life and improve survival. OBJECTIVE: The aim of this study was to evaluate the sleep quality of caregiver-mothers of sons with DMD and factors that are associated with their sleep quality. METHODS: We evaluated 32 caregiver-mothers of sons with DMD and 32 mothers of sons without any neuromuscular or chronic disease (control-CTRL group). The evaluation of quality of sleep was made using the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Caregiver-mothers had poor sleep quality, specifically longer sleep latency and reduced sleep efficiency. The impaired sleep quality of the caregiver-mothers was associated with the length of time of noninvasive ventilation used by their sons. CONCLUSIONS: Our results suggest that caregiver-mothers of sons with DMD have poor quality of sleep, and the length of use of noninvasive ventilation of their sons is associated with better sleep of caregiver-mothers.

Análisis comparativo de los conocimientos en ventilación mecánica no invasiva de profesionales de cuidados intensivos / Intensive care unit profesionals's knowledge about non invasive ventilation comparative analysis

Objetivo: La bibliografía destaca la falta de protocolos de ventilación mecánica no invasiva (VNI) y la variabilidad de conocimientos entre unidades y hospitales, por lo que se pretende comparar los conocimientos en VNI en enfermeras de 4 UCI polivalentes y una quirúrgica. Métodos: Estudio descriptivo multicéntrico en hospitales universitarios de nivel 3. Se diseñó una encuesta ad-hoc, con fiabilidad interobservador Kappa = 0,9. Contestar la encuesta era indicación de consentimiento informado. Análisis con Chi cuadrado. Resultados: Respondieron 117 (65%) enfermeras, con 11 ± 9,7 años de experiencia en UCI y 9,2 ± 7,2 en uso de VNI. Una de las UCI polivalentes había iniciado la VNI una media de 6 años más tarde que las otras (IC 95% [3,3 a 8,6], P <0,001).Solo el 23,1% de las enfermeras colocaría una mascarilla sin puerto espiratorio en respirador convencional, el resto cualquier mascarilla buconasal. El 12,7% cree que la mascarilla debe permitir el paso de 2 dedos mientras que el 29% apretaría la máscara a la cara del paciente y taparían el puerto espiratorio para facilitar la sincronización con el respirador. En la UCI quirúrgica se identifica mayoritariamente la agitación como una complicación de la VNI comparado con las polivalentes (31,6 vs. 1,8%, P < 0,001).El 56,4% de las enfermeras no consideran la fisioterapia respiratoria como un cuidado enfermero, sin diferencia entre unidades. Conclusiones: El conocimiento en tipos de interfase es muy dependiente del material de la unidad. Falta formación para detectar complicaciones de VNI como la agitación y el manejo de secreciones

Aims: The literature highlights the lack of noninvasive vntilation (NIV) protocols and the variability of the knowledge of NIV between intensive care units (ICU) and hospitals, so we want to compare NIV nurses's Knowledge from 4 multipurpose ICU and one surgical ICU. Methods: Multicenter, crosscutting, descriptive study in three university hospitals. The survey instrument was validated in a pilot test, and the calculated Kappa index was 0.9. Returning a completed survey is an indication of informed consent. Analysis by Chi square test. Results: 117 responded (65%) nurses, 11 ± 9.7 years of experience in ICU and 9.2 ± 7.2 in use of NIV. One of the multipurpose ICU, was initiated NIV an average of 6 years later than the others (95% CI [3.3 to 8.6], P < .001). Only 23.1% of nurses would place a non-vented mask (with no exhalation port) by conventional ventilator, the rest any kind of face mask. 12.7% believed that the mask must be adjusted to the '2-finger' fit while 29% would seal the mask to the patient's face and cover the mask opening where air escapes to facilitate patient/ventilator synchronization. In the surgical ICU agitation identifies mostly as a complication of NIV compared with multipurpose UCIs (31.6% vs 1.8%, P < .001). 56.4% of nurses do not consider respiratory physiotherapy as nursing care, with no difference between units. Conclusions: Knowledge about types of interface is very dependent on the material of the unit. More training for complications of NIV as agitation and handling secretions it is necessary

[Intensive care unit profesionals's knowledge about non invasive ventilation comparative analysis]. / Análisis comparativo de los conocimientos en ventilación mecánica no invasiva de profesionales de cuidados intensivos.

AIMS: The literature highlights the lack of noninvasive ventilation (NIV) protocols and the variability of the knowledge of NIV between intensive care units (ICU) and hospitals, so we want to compare NIV nurses's Knowledge from 4 multipurpose ICU and one surgical ICU. METHODS: Multicenter, crosscutting, descriptive study in three university hospitals. The survey instrument was validated in a pilot test, and the calculated Kappa index was 0.9. Returning a completed survey is an indication of informed consent. Analysis by Chi square test. RESULTS: 117 responded (65%) nurses, 11±9.7 years of experience in ICU and 9.2±7.2 in use of NIV. One of the multipurpose ICU, was initiated NIV an average of 6 years later than the others (95% CI [3.3 to 8.6], P<.001). Only 23.1% of nurses would place a non-vented mask (with no exhalation port) by conventional ventilator, the rest any kind of face mask. 12.7% believed that the mask must be adjusted to the "2-finger" fit while 29% would seal the mask to the patient's face and cover the mask opening where air escapes to facilitate patient/ventilator synchronization. In the surgical ICU agitation identifies mostly as a complication of NIV compared with multipurpose UCIs (31.6% vs 1.8%, P<.001). 56.4% of nurses do not consider respiratory physiotherapy as nursing care, with no difference between units. CONCLUSIONS: Knowledge about types of interface is very dependent on the material of the unit. More training for complications of NIV as agitation and handling secretions it is necessary.

Non-invasive ventilation in the emergency department for patients in type II respiratory failure due to COPD exacerbations.

INTRODUCTION: Acute chronic obstructive pulmonary disease (COPD) exacerbations can cause respiratory failure and may require non-invasive ventilation (NIV). There is a paucity of studies examining their NIV implementation within the emergency department (ED). AIM OF THE STUDY: The aims were (i) to establish whether NIV was beneficial for patients using arterial blood gas analysis (ABG), (ii) to observe whether current ED practice met the guidelines of obtaining ABG measurements within 15 minutes of arrival and commencement of NIV within 1 hour of clinical indication and (iii) to examine which healthcare professionals (HCPs) initiated NIV. METHODS: A retrospective observational study reviewing all patients commenced on NIV in the ED due to COPD exacerbations was undertaken. RESULTS: A total of 48 patients were included and the majority received NIV within 1 hour (n = 6, 75%) as recommended by the guidelines. Over 50% of the patients in the study had ABG analysis within 15 minutes and 89% (n = 43) within 30 minutes and statistically significant improvements were noted in respiratory rate, oxygen saturation and ABGs from baseline to repeat measurements undertaken 58 minutes post NIV initiation (p < 0.001). The largest healthcare group to initiate NIV was the nursing team (50% n = 24) with the majority of emergency nurses being experienced nurses [band 6 (n = 17)]. CONCLUSION: From this small single centre study, early ABG analyses and NIV initiation were beneficial to COPD patients presenting in respiratory failure with the majority receiving treatment within the recommended guidelines.

Striving for habitual well-being in noninvasive ventilation: a grounded theory study of chronic obstructive pulmonary disease patients with acute respiratory failure.

AIMS AND OBJECTIVES: To present a theoretical account of the pattern of behaviour in patients with acute respiratory failure due to chronic obstructive pulmonary disease while undergoing noninvasive ventilation in a hospital setting. BACKGROUND: Strong evidence supports a positive effect of noninvasive ventilation, but successful treatment remains a challenge. Little attention has been given to patient intolerance to noninvasive ventilation as a cause of treatment failure. A better understanding of the patients' patterns of behaviour during noninvasive ventilation may improve treatment success. DESIGN: A constant comparative classic grounded theory study was performed. METHODS: Data collection consisted of participant observation during the treatment of 21 patients undergoing noninvasive ventilation, followed by interviews with 11 of the patients after treatment completion. Data were collected from December 2009-January 2012. RESULTS: A substantive theory of striving for habitual well-being was developed. The theory included three phases: initiation, transition and determination. Each phase contained a set of subcategories to indicate the dimensions of and variations in the participants' behaviour. CONCLUSIONS: The substantive theory revealed that the patients' behaviour was related to their breathlessness, sensation of being restrained by the mask and head gear, and the side effects of noninvasive ventilation. RELEVANCE TO CLINICAL PRACTICE: This inter-relationship should be addressed in the use of noninvasive ventilation for the treatment of patients with chronic obstructive pulmonary disease to achieve treatment success.

Ventilación mecánica no invasiva con interfase tipo helmet / Interface type helmet non-invasive mechanical ventilation

La ventilación mecánica no invasiva es una técnica que ha dejado de ser utilizada exclusivamente en los Servicios de Medicina Intensiva para formar parte del arsenal terapéutico de los Servicios de Urgencias y Críticos, suponiendo una adaptación a este procedimiento por parte del personal de enfermería, cuya participación es crucial para conseguir el triunfo de la técnica. Compuesta básicamente por un ventilador mecánico y una mascarilla (interfase) que se interpone entre el paciente y el ventilador sin invadir la vía aérea, se precisa la colaboración del paciente a diferencia de la ventilación mecánica convencional e, inicialmente, un mayor tiempo de dedicación de la enfermera. Los modelos de interfases y la evolución de las mismas para conseguir los efectos deseados con una buena tolerancia por el paciente llegaron al desarrollo del Helmet, un dispositivo en forma de escafandra, bien tolerado por el paciente, que permite el uso de presiones altas para el reclutamiento alveolar, pero que, por su diseño, tiene connotaciones que deben conocerse antes de su utilización (AU)

Non-invasive mechanical ventilation is a technique that has ceased to be exclusively used in intensive medicine services to form part of the armamentarium of emergency and critical services, assuming an adaptation to this procedure by the nursing staff, whose participation is crucial to achieve the triumph of technique. Composed basically of a mechanical ventilator and a mask (interface) which is interposed between the patient and the fan without invading the airway, requires the collaboration of the patient unlike conventional mechanical ventilation and, initially, a longer time of dedication of the nurse. Interfaces models and the evolution of the same to achieve the effects desired with good tolerance by the patient came to the development of the Helmet, a device in the form of diving, well tolerated by the patient, allowing the use of high pressure for alveolar recruitment, but that, by design, has connotations that must be known before use (AU)

[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.

Stillbirth and newborn mortality in India after helping babies breathe training.

OBJECTIVE: This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs. METHODS: This prospective study included 4187 births at >28 weeks' gestation before and 5411 births after HBB training in Karnataka. A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics, using a train-the-trainer cascade. Pre-post written trainee knowledge, posttraining provider performance and skills, SB, predischarge mortality, and NMR before and after HBB training were assessed by using χ(2) and t-tests for categorical and continuous variables, respectively. Backward stepwise logistic regression analysis adjusted for potential confounding. RESULTS: Provider knowledge and performance systematically improved with HBB training. HBB training reduced resuscitation but increased assisted bag and mask ventilation incidence. SB declined from 3.0% to 2.3% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98) and fresh SB from 1.7% to 0.9% (OR 0.54, 95% CI 0.37-0.78) after HBB training. Predischarge mortality was 0.1% in both periods. NMR was 1.8% before and 1.9% after HBB training (OR 1.09, 95% CI 0.80-1.47, P = .59) but unknown status at 28 days was 2% greater after HBB training (P = .007). CONCLUSIONS: HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended.