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1.
Rev. Esc. Enferm. USP ; 53: e03508, Jan.-Dez. 2019. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1020384

RESUMO

RESUMO Objetivo Avaliar a estrutura e a adesão às medidas de precauções-padrão e específicas dos profissionais de saúde em Unidade de Terapia Intensiva de hospital de ensino, no Distrito Federal. Método Estudo descritivo, transversal e prospectivo. Utilizou-se de questionário estruturado mediante observações que registraram as práticas dos profissionais com Equipamentos de Proteção Individual e indicações de precauções. Foi aplicado o teste Qui-quadrado, e calculado o p-valor . Resultados Participaram do estudo 52 profissionais, e foram observados 445 procedimentos assistenciais em 36 sessões de auditoria. A média da taxa de adesão ao uso de equipamentos foi de 72,72%, sendo 94,91% às luvas, 91,43% ao avental, 80% à máscara e 24,56% aos óculos de proteção. Quando não havia indicação e não foi utilizado o Equipamento de Proteção Individual, a média da taxa foi de 68,01%, sendo 30,77% em relação às luvas, 87,58% ao avental, 57,58% à máscara, e 96,13% aos óculos. As precauções de contato foram indicadas desnecessariamente em 35% dos pacientes. Conclusão Verificou-se boa adesão ao uso de luvas, avental e máscara, baixa adesão ao uso de óculos de proteção e uso desnecessário de máscaras e precauções de contato admissionais.


RESUMEN Objetivo Evaluar la estructura y la adhesión a las medidas de precauciones estándar y específicas de los profesionales sanitarios en Unidad de Cuidados Intensivos de hospital de enseñanza, en el Distrito Federal. Método Estudio descriptivo, transversal y prospectivo. Se utilizó un cuestionario estructurado mediante observaciones que registraron las prácticas de los profesionales con Equipos de Protección Individual e indicaciones de precauciones. Se aplicó la prueba de Chi cuadrado y se calculó el p-valor. Resultados Participaron en el estudio 52 profesionales y se observaron 445 procedimientos asistenciales en 36 sesiones de auditoría. El promedio de la tasa de adhesión al uso de equipos fue del 72,72%, siendo el 94,91% a los guantes, el 91,43% al delantal, el 80% a la mascarilla y el 24,56% a los anteojos de protección. Cuando no había indicación y no fue utilizado el Equipo de Protección Individual, el promedio de la tasa fue del 68,01%, siendo el 30,77% con relación a los guantes, el 87,58% al delantal, el 57,58% a la mascarilla y el 96,13% a los anteojos. Las precauciones de contacto fueron indicadas innecesariamente al 35% de los pacientes. Conclusión Se verificó buena adhesión al uso de guantes, delantal y mascarilla, baja adhesión al uso de anteojos de protección y uso innecesario de mascarillas y precauciones de contacto de ingreso.


ABSTRACT Objective To evaluate the structure and adherence to the standardized and specific precautionary measures of health professionals in the Intensive Care Unit of a teaching hospital in the Federal District of Brazil. Method A descriptive, cross-sectional and prospective study. A structured questionnaire was used via observations which recorded the practices of professionals with Individual Protection Equipment and indications of precautions. The chi-square test was applied, and the p-value was calculated. Results A total of 52 professionals participated in the study, and 445 care procedures were observed in 36 audit sessions. The average adhesion rate for equipment use was 72.72%, with 94.91% for gloves, 91.43% for aprons, 80% for masks and 24.56% for safety glasses. When there was no indication and no personal protective equipment was used, the average rate was 68.01%, with 30.77% for gloves, 87.58% for aprons, 57.58% for masks, and 96.13% for safety glasses. Contact precautions were unnecessarily indicated for 35% of patients. Conclusion Good adherence to using gloves, aprons and masks were observed, but there was poor adherence to using safety glasses and unnecessary use of masks and admission contact precautions.


Assuntos
Humanos , Prática Profissional , Precauções Universais , Controle de Infecções , Pessoal de Saúde , Unidades de Terapia Intensiva , Estudos Transversais , Estudos Prospectivos , Segurança do Paciente , Hospitais de Ensino
2.
Zhonghua Nei Ke Za Zhi ; 58(11): 814-818, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665856

RESUMO

Objective: To investigate the clinical significance of transcranial Doppler (TCD) in early diagnosis of sepsis-associated encephalopathy(SAE). Methods: Septic patients admitted to the intensive care unit(ICU) were recruited at Xiangya Hospital, Central South University from July 2015 to March 2016. Clinical data and TCD parameters during 24 hours after admission were collected. All patients were screened for delirium using the confusion assessment method for the intensive care unit (CAM-ICU) twice a day. The gold standard of the diagnosis of SAE was positive CAM-ICU evaluation. Patients were divided into SAE group and the non-SAE group. TCD data including systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI) and resistant index (RI) were analyzed to determine the optimal diagnostic cut-off value. Results: A total of 43 patients were enrolled including 12 in SAE group and 31 in non-SAE group. Vm and Vd were lower in SAE group [Vm: (53.50±12.22) cm/s vs. (61.68±9.63) cm/s, P<0.05; Vd: (33.42±10.87) cm/s vs. (43.16±7.84) cm/s, P<0.01] but PI and RI were significant higher in SAE group[PI:(1.16±0.2) vs. (0.90±0.15), P<0.01;RI:(0.65±0.08) vs. (0.56±0.06), P<0.01] than in non-SAE group. The cut-off values of Vs, Vm, Vd, PI and RI for the diagnosis of SAE were 112cm/s, 55.50cm/s, 34.50cm/s, 1.16, 0.65, respectively, with the relevant sensitivities of 19.4%, 83.9%, 93.5%, 58.3%, 58.3% and the specificities of 100.0%, 50.0%, 58.3%, 96.8%, 96.8%, respectively. The diagnostic AUC of Vd, PI and RI were 0.741, 0.808 and 0.808 respectively. Conclusions: The parameter changes of TCD suggest that the pathogenesis of SAE is related to cerebral hypoperfusion, TCD is a helpful method for the early diagnosis of SAE.


Assuntos
Circulação Cerebrovascular , Artéria Cerebral Média/diagnóstico por imagem , Encefalopatia Associada a Sepse/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Diagnóstico Precoce , Humanos , Unidades de Terapia Intensiva
3.
Rev Lat Am Enfermagem ; 27: e3153, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596405

RESUMO

OBJECTIVE: to identify the predicting factors and sensitivity, specificity, positive and negative related value of nursing diagnosis Ineffective Breathing Pattern among patients of an intensive care unit. METHOD: cross-sectional study. A logistic regression was fitted to assess the simultaneous effects of related factors. RESULTS: among the 120 patients, 67.5% presented Ineffective Breathing Pattern. In the univariate analysis, the related factors were: group of diseases, fatigue, obesity and presence of bronchial secretion, and the defining characteristics were: changes in respiratory depth, auscultation with adventitious sounds, dyspnea, reduced vesicular murmurs, tachypnea, cough and use of the accessory musculature to breathe. The mean age of patients with was higher than those without this diagnosis. The defining characteristics reduced murmurs had high sensitivity (92.6%), specificity (97.4%), negative related value (86.4%) and positive related value (98.7%). The related factors of Ineffective Breathing Pattern were the related factors fatigue, age and group of diseases. CONCLUSION: fatigue, age and patients with a group of diseases were related factors of Ineffective Breathing Pattern in this study. Reduced vesicular murmurs, auscultation with adventitious sounds and cough may be defining characteristics to be added in the international classification, as well as the related factors bronchial secretion and group of diseases.


Assuntos
Diagnóstico de Enfermagem/classificação , Insuficiência Respiratória/enfermagem , Idoso , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Diagnóstico de Enfermagem/normas , Respiração
4.
Rev Lat Am Enfermagem ; 27: e3182, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31596416

RESUMO

OBJECTIVE: to evaluate job satisfaction and its relationship with the personal and professional characteristics of the nursing team. METHOD: a descriptive and cross-sectional study with 163 nursing workers from the intensive care units of a teaching hospital. For data collection, the Brazilian version of the Job Satisfaction Survey and a personal and professional characterization form were used. Data were analyzed using descriptive statistics, comparisons and correlations. RESULTS: the professionals demonstrated ambivalence for job satisfaction in a global way and concerning the communication domain. They were satisfied with the supervision, co-workers, and nature of work, while dissatisfied with other domains. There was a correlation between the intention to stay in the job and the majority of the Job Satisfaction Survey domains, except for co-workers and operating procedures, and a correlation between time working at the unit and at the institution with the domains pay, contingent rewards, and supervision. CONCLUSION: there was an ambivalence regarding job satisfaction and the variables intention of stay in the job and time working at the unit and at the institution were correlated with job satisfaction concerning the domains pay, contingent rewards, and supervision.


Assuntos
Cuidados Críticos/psicologia , Unidades de Terapia Intensiva , Satisfação no Emprego , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1087-1090, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657330

RESUMO

OBJECTIVE: To investigate the implementation and application effect of 1-hour bundle in the treatment of patients with sepsis. METHODS: A convenient sampling method was conducted. 102 patients with sepsis admitted to central intensive care unit (ICU) of Henan Provincial People's Hospital from January 2018 to February 2019 were enrolled. Thirty-five patients with 3-hour and 6-hour bundle from January to September in 2018 were served as the control group, and 67 patients who received 1-hour bundle from October 2018 to February 2019 were served as the observation group. The patients in the control group was treated with 3-hour and 6-hour bundle according to 2012 international guidelines for the diagnosis and treatment of severe sepsis and septic shock; and those in the observation group were treated and nursed according to the 1-hour bundle published by Surviving Sepsis Campaign (SSC) update 2018, and the sepsis cluster treatment medical team was established. The team members were trained in relevant knowledge and discussed the possible obstacles within the team and propose feasible measures. The implementation of the 1-hour bundle in the observation group was recorded. The general data of the patients in both groups including gender, age, acute physiology and chronic health evaluation II (APACHE II), etc. were collected, and the outcome indicators (duration of mechanical ventilation, length of ICU stay, 28-day mortality) were observed. RESULTS: In the observation group, 37 of 67 patients receiving 1-hour bundle met the target, with the overall achievement rate of 55.2% (37/67). Of the 37 eligible patients, 5 patients receiving 1-hour bundle met the target before the training of 1-hour bundle, accounting for only 33.3% (5/15) of the 15 patients who received 1-hour bundle during the same period. With the extension of training time, the achievement rate of sepsis 1-hour bundle was gradually increased [the achievement rate at 1 week and 4 weeks of training was 40.0% (4/10) and 52.4% (11/21), respectively], and increased to 81.0% (17/21) at the end of 12 weeks training. Thirty-seven patients who received 1-hour bundle and met the criteria were enrolled and compared with the control group. There was no significant difference in gender, age, or APACHE II score between the two groups. Compared with the control group, the duration of mechanical ventilation and length of ICU stay of the observation group were significantly shortened (days: 6.15±0.49 vs. 7.24±0.53, days: 8.21±1.49 vs. 9.51±1.92), and the 28-day mortality was decreased significantly [10.8% (4/37) vs. 31.4% (11/35)], with statistically significant differences (all P < 0.05). CONCLUSIONS: Through teamwork, discussion and improvement, the achievement rate of sepsis 1-hour bundle can be significantly improved. The use of sepsis 1-hour bundle can effectively decrease the duration of mechanical ventilation and length of ICU stay, and reduce the 28-day mortality.


Assuntos
Sepse/terapia , APACHE , Humanos , Unidades de Terapia Intensiva , Prognóstico , Choque Séptico
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1128-1132, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657338

RESUMO

OBJECTIVE: To investigate the effect of circadian heart rate variation on short-term and long-term mortality in intensive care unit (ICU) patients. METHODS: A retrospective cohort study was conducted. A total of 32 536 ICU patients were recorded from 2001 to 2008 published by Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II v2.6) in April 2011. The circadian heart rate variation was defined as the ratio of mean nighttime (23:00 to 07:00) heart rate to mean daytime (07:00 to 23:00) heart rate. The 28-day mortality and 1-year mortality were defined as outcome events. The information such as age, gender, ethnicity, first sequential organ failure assessment (SOFA) score, first simplified acute physiology score I (SAPS I), usage of sedatives and catecholamines within 24 hours admission of ICU, clinical complications [hypertension, chronic obstructive pulmonary disease (COPD), diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.], and the complete heart rate records within 24 hours after ICU admission were collected. Cox proportional risk regression models were used to investigate the association between circadian heart rate variation and 28-day mortality and 1-year mortality in ICU patients. Besides, subgroup analysis was also performed in patients with different first SOFA scores. RESULTS: Totally 15 382 ICU patients in MIMIC-II database were enrolled, excluding the patients without heart rate records or death records, using pacemaker with arrhythmia, without SOFA or SAPS I score records. Finally, 9 439 patients were enrolled in the study cohort. (1) Cox regression analysis of the whole patient showed that the higher circadian heart rate variation was correlated with the increased 28-day mortality [hazard ratio (HR) = 1.613, 95% confidence interval (95%CI) was 1.338-1.943, P < 0.001] and 1-year mortality (HR = 1.573, 95%CI was 1.296-1.908, P < 0.001). After adjustment for demographic factors (age, gender and ethnicity), severity of illness (SOFA and SAPS I scores), clinical complications (hypertension, COPD, diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.), and influence of medications (sedatives and catecholamines), the night-day heart rate ratio was also correlated with 28-day mortality (HR = 1.256, 95%CI was 1.018-1.549, P = 0.033) and 1-year mortality (HR = 1.249, 95%CI was 1.010-1.545, P = 0.040). (2) According to the SOFA score (median value of 5), the patients were divided into two subgroups, in which 5 478 patients with SOFA score ≤ 5 and 3 961 patients with SOFA score > 5. Cox regression subgroup analysis showed that circadian heart rate variation was related with higher 28-day mortality (HR = 1.430, 95%CI was 1.164-1.756, P = 0.001) and 1-year mortality (HR = 1.393, 95%CI was 1.123-1.729, P = 0.003) in patients with SOFA score > 5. After adjustment for covariates, the 28-day mortality (HR = 1.279, 95%CI was 1.032-1.584, P = 0.025) and 1-year mortality (HR = 1.255, 95%CI was 1.010-1.558, P = 0.040) also increased with the increasing of night-day heart rate ratio in patients with SOFA score > 5. However, the relationships did not exist in patients with SOFA score ≤ 5. CONCLUSIONS: In ICU patients, the 28-day mortality and 1-year mortality increase with the higher circadian heart rate variation, which indicates that the circadian heart rate variation in ICU patients is positively correlated with the short-term and long-term mortality, especially in patients with relatively severe illness.


Assuntos
Relógios Circadianos , Frequência Cardíaca/fisiologia , Unidades de Terapia Intensiva , Mortalidade/tendências , Cuidados Críticos , Humanos , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos
7.
Am Surg ; 85(10): 1171-1174, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657318

RESUMO

Avoiding excess fluid administration is necessary when managing critically ill surgical patients. The aim of this study was to delineate the current practices of IV electrolyte (IVE) replacement in a surgical ICU and quantify their contribution to the fluid balance (FB) status. Patients admitted to the surgical ICU over a six-month period were reviewed. Patients undergoing dialysis and those with ICU stay <72 hours were excluded. A total of 248 patients were included. The median age was 60 years, and 57 per cent were male. Overall, 1131 patient ICU days were analyzed. The median daily FB was 672 mL. IVEs were administered in 62 per cent of ICU days. In days that IVEs were used, negative FB was significantly less likely to be achieved (62% vs 69%, P = 0.02). The most commonly administered IVE was calcium (32% of ICU days); however, the largest volume of IVE was administered in the form of phosphorus (median 225 mL). Diuretics were administered in 17 per cent of ICU days. Patients who received diuretics were significantly more likely to receive IVE (70% vs 61%, P = 0.02). Administration of IVE may contribute to the daily positive FB of surgical ICU patients. Implementation of practices that can ameliorate this effect is encouraged.


Assuntos
Estado Terminal , Eletrólitos/administração & dosagem , Infusões Intravenosas/métodos , Procedimentos Cirúrgicos Operatórios , Equilíbrio Hidroeletrolítico , Cálcio/administração & dosagem , Diuréticos/administração & dosagem , Feminino , Hidratação/efeitos adversos , Hidratação/métodos , Humanos , Infusões Intravenosas/estatística & dados numéricos , Unidades de Terapia Intensiva , Sulfato de Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fósforo/administração & dosagem , Potássio/administração & dosagem , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 98(38): e17278, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568009

RESUMO

INTRODUCTION: Pneumonia is one of the leading causes of death worldwide, represents a potentially life-threatening condition. In recent studies, adjuvant corticosteroids therapy has been shown to improve outcome in severe community-acquired pneumonia (CAP); however, the treatment response to corticosteroids vary. It is important to select patients likely to benefit from the treatment. Currently, the optimal patient selection of corticosteroids treatment is not yet clearly defined. METHODS: Sphingosine-1-phosphate and pneumonia (SOPN) trial is a double-blinded, randomized, placebo-controlled trial that will investigate if sphingosine-1-phosphate (S1P) can be an indicator for initiating adjuvant corticosteroids therapy in patients with severe CAP. Participants will be recruited from the emergency department and randomized to receive 20 mg of methylprednisolone twice daily or placebo for 5 days. The primary outcome will be "in-hospital mortality." Secondary outcomes will include intensive care unit (ICU) admission, length of ICU stay, length of hospital stay, and clinical outcomes at Day 7 and Day 14. CONCLUSION: SOPN trial is the first randomized placebo-controlled trial to investigate whether S1P can be a predictive biomarker for adjuvant corticosteroids therapy in patients with severe CAP. The trial will add additional data for the appropriate use of adjuvant corticosteroids therapy in patients with severe CAP. Results from this clinical trial will provide foundational information supporting that if the S1P is appropriate for guiding the patient selection for corticosteroids adjuvant therapy.


Assuntos
Glucocorticoides/uso terapêutico , Lisofosfolipídeos/sangue , Metilprednisolona/uso terapêutico , Pneumonia/tratamento farmacológico , Esfingosina/análogos & derivados , Adjuvantes Farmacêuticos , Adulto , Biomarcadores/sangue , Protocolos Clínicos , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Método Duplo-Cego , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pneumonia/sangue , Pneumonia/mortalidade , Esfingosina/sangue
9.
Rev Saude Publica ; 53: 83, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576943

RESUMO

OBJECTIVE: Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015. METHODS: This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation. RESULTS: Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3). CONCLUSION: An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.


Assuntos
Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/tendências , Ferimentos e Lesões/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Distribuição por Sexo , Fatores de Tempo , Adulto Jovem
10.
Medicine (Baltimore) ; 98(40): e17392, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577746

RESUMO

This study aims to construct a neural network to predict weaning difficulty among planned extubation patients in intensive care units.This observational cohort study was conducted in eight adult ICUs in a medical center about adult patients experiencing planned extubation.The data of 3602 patients with planned extubation in ICUs of Chi-Mei Medical Center (from Dec. 2009 through Dec. 2011) was used to train and test an artificial neural network (ANN) model. The input features contain 47 clinical risk factors and the outputs are classified into three categories: simple, difficult, and prolonged weaning. A deep ANN model with four hidden layers of 30 neurons each was developed. The accuracy is 0.769 and the area under receiver operating characteristic curve for simple weaning, prolonged weaning, and difficult weaning are 0.910, 0.849, and 0.942 respectively.The results revealed that the ANN model achieved a good performance in prediction the weaning difficulty in planned extubation patients. Such a model will be helpful for predicting ICU patients' successful planned extubation.


Assuntos
Extubação/métodos , Redes Neurais (Computação) , Desmame do Respirador/métodos , APACHE , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 98(40): e17395, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577748

RESUMO

To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.


Assuntos
Neoplasias Hematológicas/epidemiologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Cuidados Paliativos/organização & administração , Assistência Terminal/organização & administração , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Comorbidade , Feminino , Gastos em Saúde/estatística & dados numéricos , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/economia , Serviços de Assistência Domiciliar/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/economia , Cuidados Paliativos/estatística & dados numéricos , Características de Residência , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Taiwan , Assistência Terminal/economia , Assistência Terminal/estatística & dados numéricos
12.
JAMA ; 322(13): 1261-1270, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573637

RESUMO

Importance: Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS). Objective: To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS. Design, Setting, and Participants: The CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018. Interventions: Patients were randomly assigned to receive intravenous infusion of vitamin C (50 mg/kg in dextrose 5% in water, n = 84) or placebo (dextrose 5% in water only, n = 83) every 6 hours for 96 hours. Main Outcomes and Measures: The primary outcomes were change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours. Results: Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60. There were no significant differences between the vitamin C and placebo groups in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; difference, -0.10; 95% CI, -1.23 to 1.03; P = .86) or in C-reactive protein levels (54.1 vs 46.1 µg/mL; difference, 7.94 µg/mL; 95% CI, -8.2 to 24.11; P = .33) and thrombomodulin levels (14.5 vs 13.8 ng/mL; difference, 0.69 ng/mL; 95% CI, -2.8 to 4.2; P = .70) at 168 hours. Conclusions and Relevance: In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS. Trial Registration: ClinicalTrials.gov Identifier: NCT02106975.


Assuntos
Ácido Ascórbico/administração & dosagem , Insuficiência de Múltiplos Órgãos/prevenção & controle , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Sepse/tratamento farmacológico , Vitaminas/administração & dosagem , Adulto , Idoso , Ácido Ascórbico/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Escores de Disfunção Orgânica , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Sepse/complicações , Sepse/mortalidade , Trombomodulina/sangue , Vitaminas/uso terapêutico
13.
Medicine (Baltimore) ; 98(42): e17592, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626132

RESUMO

Data on outcomes of patients receiving mechanical ventilation (MV) in China are scarce.To investigate factors associated with the prognosis of patients given MV in the intensive care unit (ICU).A 12-year (January 1, 2006-December 31, 2017) retrospective cohort study.ICU of Beijing Geriatric Hospital, China.A total of 905 patients aged ≥16 years given MV during the study period.None.Among 905 patients included (610 men; median age, 78 years; Acute Physiology and Chronic Health Evaluation [APACHE]-II score, 27.3 ±â€Š8.9), 585 survived (388 men; median age, 77 years; average APACHE-II score, 25.6 ±â€Š8.4), and 320 died in the ICU (222 men; median age, 78 years; APACHE-II score, 30.6 ±â€Š8.9). All-cause ICU mortality was 35.4%. In patients aged <65 years, factors associated with ICU mortality were APACHE-II score (odds ratio [OR], 1.108; 95% confidence interval [95% CI], 1.021-1.202; P = .014), nosocomial infection (OR, 6.618; 95% CI, 1.065-41.113; P = .043), acute kidney injury (OR, 17.302; 95% CI, 2.728-109.735; P = .002), invasive hemodynamic monitoring (OR, 10.051; 95% CI, 1.362-74.191; P = .024), MV for cardiopulmonary resuscitation (OR, 0.122; 95% CI, 0.016-0.924; P = .042), duration of MV (OR, 0.993; 95% CI, 0.988-0.998; P = .008), successful weaning from MV (OR, 0.012; 95% CI, 0.002-0.066; P < .001), and renal replacement therapy (OR, 0.039; 95% CI, 0.005-0.324; P = .003). In patients aged ≥65 years, factors associated with mortality were APACHE-II score (OR, 1.062; 95% CI, 1.030-1.096; P < .001), nosocomial infection (OR, 2.427; 95% CI, 1.359-4.334; P = .003), septic shock (OR, 2.017; 95% CI, 1.153-3.529; P = .014), blood transfusion (OR, 1.939; 95% CI, 1.174-3.202; P = .010), duration of MV (OR, 0.999; 95% CI, 0.999-1.000; P = .043), and successful weaning from MV (OR, 0.027; 95% CI, 0.015-0.047; P < .001).APACHE-II score, successful weaning, and nosocomial infection in the ICU are independently associated with the prognosis of patients given MV in the ICU.


Assuntos
Estado Terminal/terapia , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Respiração Artificial/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estado Terminal/mortalidade , Infecção Hospitalar/etiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
14.
Rev Med Suisse ; 15(667): 1871-1875, 2019 Oct 16.
Artigo em Francês | MEDLINE | ID: mdl-31617975

RESUMO

Phosphate is widely spread in the human body, filling many roles across various tissues, both in the intra- and extracellular space. Serum phosphorus makes up only a slight fraction of the total body stocks but acts as an exchange between the different compartments. Hypophosphatemia is commonly found among hospitalized patients, especially those in an intensive care unit. Clinical manifestations associated with hypophosphatemia are mainly respiratory, neuromuscular, cardiac and hematologic, all of which are more common in the presence of severe hypophosphatemia. Interventional evidence on the benefit of correcting hypophosphatemia is lacking. Currently available recommendations vary and are based on weak evidence.


Assuntos
Hipofosfatemia/diagnóstico , Hipofosfatemia/terapia , Humanos , Hipofosfatemia/sangue , Hipofosfatemia/fisiopatologia , Unidades de Terapia Intensiva , Fosfatos/sangue , Fosfatos/metabolismo , Fósforo/sangue
15.
Rev Assoc Med Bras (1992) ; 65(9): 1168-1173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618332

RESUMO

OBJECTIVE: Treatment limitation, as well as do-not-resuscitate (DNR) directives, are difficult but important to improve patients' quality of life and minimize dysthanasia. We aimed to study the approach to withholding, withdrawal, and DNR decisions, patients' characteristics, and process documentation in a general Intensive Care Unit (ICU) in Portugal. METHODS: A retrospective analysis of data regarding the limitation of treatment decisions collected from previously-designed forms and complemented by medical record consultation. RESULTS: A total of 1602 patients were admitted to the ICU between 2011 and 2016. DNR decisions were documented in 127 cases (7.9%). Patients with treatment limitations were older and had higher Simplified Acute Physiology Score II. The most frequent diagnosis preceding these decisions was sepsis (52.0%, n = 66); the most common main reason for limiting treatment was a poor prognosis of acute illness. Of the patients to whom a DNR was implemented, 117 (92.1%) died in the ICU (40.1% of the total number of ICU deaths), and hospital mortality was 100%. Participants in these decisions, as well as types of treatment withdrawn and their respective timings, were not registered in medical records. CONCLUSION: Treatment limitation and DNR decisions were relatively common, in line with other Southern European studies, but behind Northern European and North American centers. Patients with these limitations were older and more severely ill than patients without such decisions. Documentation of these processes should be clear and detailed, either in specific forms or computerized clinical records; there is room for improvement in this area.


Assuntos
Unidades de Terapia Intensiva/organização & administração , Registros Médicos , Ordens quanto à Conduta (Ética Médica) , Suspensão de Tratamento/normas , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Portugal , Qualidade de Vida , Estudos Retrospectivos , Sepse/mortalidade
16.
Medicine (Baltimore) ; 98(42): e17534, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626115

RESUMO

The knowledge of weaning ventilation period is fundamental to understand the causes and consequences of prolonged weaning. In 2007, an International Consensus Conference (ICC) defined a classification of weaning used worldwide. However, a new definition and classification of weaning (WIND) were suggested in 2017. The objective of this study was to compare the incidence and clinical relevance of weaning according to ICC and WIND classification in an intensive care unit (ICU) and establish which of the classifications fit better for severely ill patients. This study was a retrospective cohort study in an ICU in a tertiary University Hospital. Patient data, such as population characteristics, mechanical ventilation (MV) duration, weaning classification, mortality, SAPS 3, and death probability, were obtained from a medical records database of all patients, who were admitted to ICU between January 2016 and July 2017. Three hundred twenty-seven mechanically ventilated patients were analyzed. Using the ICC classification, 82% of the patients could not be classified, while 10%, 5%, and 3% were allocated in simple, difficult, and prolonged weaning, respectively. When WIND was used, 11%, 6%, 26%, and 57% of the patients were classified into short, difficult, prolonged, and no weaning groups, respectively. Patients without classification were sicker than those that could be classified by ICC. Using WIND, an increase in death probability, MV days, and tracheostomy rate was observed according to weaning difficult. Our results were able to find the clinical relevance of WIND classification, mainly in prolonged, no weaning, and severely ill patients. All mechanically ill patients were classified, even those sicker with tracheostomy and those that could not finish weaning, thereby enabling comparisons among different ICUs. Finally, it seems that the new classification fits better in the ICU routine, especially for more severe and prolonged weaning patients.


Assuntos
Estado Terminal/classificação , Unidades de Terapia Intensiva/normas , Respiração Artificial/normas , Desmame do Respirador/classificação , Brasil , Consenso , Estado Terminal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Escala Psicológica Aguda Simplificada , Fatores de Tempo , Traqueostomia , Desmame do Respirador/normas
17.
Invest. educ. enferm ; 37(3): [E06], 15 Octubre 2019. Tab 1, Fig 1
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1023485

RESUMO

Objective. The work, herein, sought to determine the effect of yoga on the quality of life of nurses working in intensive care units (ICU). Methods. This was a randomized controlled clinical trial of a preventive intervention of three weekly sessions of yoga exercises, which included aspects of meditation, breathing control, and slow body movements. The study selected 70 nurses working in ICU and assigned them to two groups: experimental (n = 35) and control (n = 35). The World Health Organization Quality of Life brief questionnaire (WHOQoL-Bref) was used to evaluate on four moments (baseline, one, two, six months after the start of the study); this scale has 26 items with Likert-type response options ranging from 1 to 5; higher total score indicates better quality of life. Results. The baseline score of quality of life in the experimental group was 62.3, which increased to 70.7 on the first month and continued improving in the evaluations on the second month (72.8) and sixth month (74.1), with this change being statistically significant. Instead, the control group showed no differences in scores of the different moments of evaluation (baseline = 62, first month = 61.9, second month = 62.4, and sixth month = 60.4). In the four domains of the WHOQoL-Bref (physical, psychological, social relationships, and environment), it was also noted that the experimental group obtained better scores over time compared with the control group. Conclusion. The intervention of yoga exercises was effective in improving the quality of life of nurses working in ICU.


Objetivo. Determinar el efecto del yoga en la calidad de vida de las enfermeras que trabajan en Unidades de Cuidados Intensivos (UCI). Métodos. Ensayo clínico controlado aleatorizado de una intervención preventiva de 3 sesiones semanales de ejercicios de yoga que incluyeron aspectos de meditación, control de la respiración, y movimientos corporales lentos. Se seleccionaron 70 enfermeras que trabajan en UCI y se asignaron aleatoriamente a dos grupos: experimental (n=35) y de control (n=35). El cuestionario de Calidad de Vida de la Organización Mundial de la Salud -WhoQol-Bref- se utilizó para la evaluación en cuatro momentos (basal, uno, dos y seis meses posinicio del estudio), esta escala tiene 26 items con opciones de respuesta tipo Likert de 1 a 5, a mayor puntaje total se considera que es mejor la calidad de vida. Resultados. La puntuación basal de calidad de vida en el grupo experimental fue de 62.3, la cual se incrementó a 70.7 en el primer mes y continuó mejorando en las evaluaciones del 2º mes (72.8) y 6º mes (74.1), cambio estadísticamente significativo. Por el contrario, en el grupo control no se encontraron diferencias en el puntaje en los diferentes momentos de evaluación (basal =62, primer mes =61.9, segundo mes =62.4 y sexto mes =60.4). En los cuatro dominios de WhoQol-Bref (físico, psicológico, relaciones sociales y ambiente), también se apreció que el grupo experimental obtuvo mejores puntajes en el tiempo comparado con el grupo control. Conclusión. La intervención con ejercicios de yoga mejoró la calidad de vida de las enfermeras que trabajan en UCI.


Objetivo. Determinar o efeito da yoga na qualidade de vida das enfermeiras que trabalham em Unidades de Tratamentos Intensivos (UTI). Métodos. Ensaio clínico controlado aleatorizado de uma intervenção preventiva de 3 sessões semanais de exercícios de yoga, que incluíam aspectos de meditação, controle da respiração, e movimentos corporais lentos. Se selecionaram 70 enfermeiras que trabalham em UTI e se designaram aleatoriamente a dois grupos experimentais (n=35) e de controle (n=35). O questionário de Qualidade de Vida da Organização Mundial da Saúde -WhoQol-Bref- se utilizou para a avaliação em quatro momentos (basal, um, dois e seis meses pós início do estudo), esta escala tem 26 itens com opções de resposta tipo Likert de 1 a 5, a maior pontuação total se considera que é melhor a qualidade de vida. Resultados. A pontuação basal de qualidade de vida no grupo experimental foi de 62.3, a qual se incrementou a 70.7 no primeiro mês e continuou melhorando nas avaliações do 2º mês (72.8) e 6º mês (74.1), sendo este câmbio estatisticamente significativo. Em câmbio, no grupo controle não se encontraram diferenças na pontuação nos diferentes momentos de avaliação (basal =62, primeiro mês =61.9, segundo mês =62.4 e sexto mês =60.4). Nos quatro domínios de WhoQol-Bref (físico, psicológico, relações sociais e ambiente), também se apreciou que o grupo experimental obteve melhores pontuações no tempo comparado com o grupo de controle. Conclusão. A intervenção de exercícios de yoga foi efetiva no melhoramento da qualidade de vida das enfermeiras que trabalham nas UTIs.


Assuntos
Humanos , Qualidade de Vida , Ioga , Exercício , Inquéritos e Questionários , Ensaio Clínico Controlado Aleatório , Meditação , Unidades de Terapia Intensiva , Enfermeiras e Enfermeiros
18.
Invest. educ. enferm ; 37(3): [E07], 15 Octubre 2019. Tab 1, Tab 2, Tab 3
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1023490

RESUMO

Objective. The purpose, herein, was to determine the moral sensitivity of nurses when caring for terminally ill patients. Methods. Descriptive study conducted in the city of Cartagena (Colombia) with the participation of 118 nurses with minimum experience of six months in caring for the terminally ill in general hospitalization, caring for chronic patients, and intensive care units. The study used the 23-item questionnaire on Moral Sensitivity in Nursing Care ­ (Sensibilidad Moral en el Cuidado Enfermero -CuSMCE-23, in spanish) - by Campillo, which has six Likert-type response options (0 = total disagreement, to 5 = total agreement) and which has two dimensions: Nurse values (12 items) and Care responses (11 items). A higher score meant a higher degree of moral sensitivity. Results. It was found that 89.8% of the participants were women; 20.3% had a graduate degree; 39.8% had less than five years of care experience; 58.5% worked in a public institution ­ by type of service: 58.5% worked in general hospitalization; 32.2% in the intensive care unit; and 9.3% with chronic patients. The global moral sensitivity regarding the terminally ill in the study group was at 80%. By dimensions, while the Values dimension obtained 90%, the Care responses dimension only reached 70.4%, with the latter dimension showing difficulties in the items: 'Often, when I am with a patient, I talk about myself to be more comfortable' (27.1%), 'It is hard for me to accept certain decisions by the patients' (55.1%), and 'It is hard for me to identify concerns regarding the religious expression' (60.2%). Conclusion. Although the global levels of nurse's moral sensitivity regarding the terminally ill and of the dimension Nurse Values are high, the dimension of Care responses has limitations, especially in accepting the diversity of expressions presented by patients


Objetivo. Determinar la sensibilidad moral de las enfermeras al cuidar pacientes terminales. Métodos. Estudio descriptivo realizado en la ciudad de Cartagena (Colombia) con la participación de 118 enfermeras con experiencia mínima de seis meses en cuidado al enfermo terminal en hospitalización general, cuidado al paciente crónico y trabajo en unidades de cuidados intensivos. Se utilizó el Cuestionario de 23 ítems Sensibilidad Moral en el Cuidado Enfermero (CuSMCE-23) de Campillo, el cual tiene seis opciones de respuesta tipo Likert (0 = desacuerdo total a 5 = acuerdo total) y dos dimensiones: Valores enfermeros (12 ítems) y Respuestas de cuidado (11 ítems). A mayor puntaje mayor grado de sensibilidad moral. Resultados. El 89.8% de los participantes fueron mujeres; el 20.3% había realizado un posgrado; el 39.8% tenía menos de 5 años de experiencia asistencial; el 58.5% laboraba en una institución pública. Por tipo de servicio: el 58.5% laboraba en hospitalización general; el 32.2%, en la Unidad de Cuidados Intensivos y 9.3%, en pacientes crónicos. La sensibilidad moral global ante el enfermo terminal en el grupo estudiado fue del 80%. Por dimensiones, mientras que en la dimensión Valores se obtuvo un 90%, en la de Respuestas de cuidado solo se alcanzó el 70.4%, teniendo esta última dimensión dificultades en los ítems: 'A menudo cuando estoy con el paciente hablo de mí misma para estar más cómoda' (27.1%), 'Me cuesta aceptar determinadas decisiones de los pacientes' (55.1%) y 'Me cuesta identificar inquietudes respecto a la expresión religiosa' (60.2%). Conclusión. Aunque el nivel global de sensibilidad moral de la enfermera ante el enfermo terminal y de la dimensión Valores enfermeros son altos, la dimensión Respuestas de cuidado presenta limitaciones, especialmente en la aceptación de la diversidad de expresiones que presentan los pacientes.


Objetivo. Determinar a sensibilidade moral das enfermeiras ao cuidar pacientes terminais. Métodos. Estudo descritivo realizado na cidade de Cartagena (Colômbia) com a participação de 118 enfermeiras com experiência mínima de seis meses em cuidado ao doente terminal em hospitalização geral, cuidado ao paciente crônico e unidades de tratamentos intensivos. Se utilizou o Questionário de 23 itens Sensibilidade Moral no Cuidado Enfermeiro (CuSMCE-23) de Campillo, o qual tem seis opções de resposta tipo Likert (0 = desacordo total a 5 = acordo total) e duas dimensões: Valores enfermeiros (12 itens) e Respostas de cuidado (11 itens). A maior pontuação maior grau de sensibilidade moral. Resultados. Se encontrou que 89.8% eram mulheres, 20.3% havia realizado uma pós-graduação, 39.8% tinha menos de 5 anos de experiência assistencial, 58.5% trabalhava numa instituição pública, por tipo de serviço: 58.5% trabalhava em hospitalização geral, 32.2% na Unidade de Tratamentos Intensivos e 9.3% em pacientes crônicos. A sensibilidade moral global frente ao doente terminal no grupo estudado foi de 80%. Por dimensões, enquanto que na dimensão Valores se obteve um 90%, na de Respostas de cuidado somente se alcançou 70.4%, tendo esta última dimensão dificuldades nos itens: 'Com frequência quando estou com o paciente falo de mim mesma para estar mais cômoda' (27.1%), 'É difícil aceitar determinadas decisões dos pacientes' (55.1%) e 'É difícil identificar inquietudes ao respeito à expressão religiosa' (60.2%). Conclusão. Embora o nível global de sensibilidade moral da enfermeira frente ao doente terminal e da dimensão Valores enfermeiros são altos, a dimensão Respostas de cuidado apresenta limitações, especialmente na aceitação da diversidade de expressões que apresentam os pacientes.


Assuntos
Humanos , Estudos Transversais , Inquéritos e Questionários , Doente Terminal , Ética em Enfermagem , Hospitalização , Unidades de Terapia Intensiva , Princípios Morais , Cuidados de Enfermagem
19.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1242-1249, out.-dez. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022452

RESUMO

Objective: The study's main purpose has been to identify non-pharmacological measures in the management of delirium described by nurses of an adult Intensive Care Unit (ICU). Methods: It is a descriptive exploratory study with a qualitative approach that was performed with nurses working at an ICU from a public hospital in Brazil. Data were collected through a semi-structured interview and analyzed by the Thematic Content Analysis. Results: Nurses have knowledge about delirium and bring several non-pharmacological measures used in prevention and management. They underline the importance of knowledge about the subject, to identify and prevent symptoms, and also the presence of their relatives. The difficulties cited to implement these measures are barriers of physical structure, material resources and lack of information on this topic. Conclusion: It is essential to carry out permanent education activities regarding the addressed matter, furthermore, it is recommended to adopt daily scales aiming to monitor delirium


Objetivo: Identificar medidas não farmacológicas no manejo do delirium descritas por enfermeiros de uma UTI adulto. Método: Estudo descritivo exploratório de caráter qualitativo, realizado com enfermeiros de uma UTI de um hospital público do Brasil. Os dados foram coletados por meio de entrevista semiestruturada e analisados pela Análise de Conteúdo do Tipo Temática. Resultados: Os enfermeiros têm o conhecimento sobre delirium e trazem diversas medidas não farmacológicas utilizadas na prevenção e manejo. Ressaltam a importância do conhecimento sobre o tema, para se identificar e prevenir sintomas, e também a presença de familiares. As dificuldades citadas para implementação destas medidas são: barreiras de estrutura física, de recursos materiais e falta de informação sobre o tema. Conclusão: Destaca-se a importância da realização de atividades de educação permanente sobre o tema e recomenda-se a adoção da aplicação de escalas diárias para monitorar o delirium


Objetivo: Identificar medidas no farmacológicas en el manejo del delirium descritas por enfermeros de una UTI adulto. Método: estudio descriptivo exploratorio de carácter cualitativo, realizado con enfermeros de UTI en hospital público de Brasil. Los datos fueron recolectados por medio de entrevistas semiestructuradas y analizados por Análisis de Contenido del Tipo Temática. Resultados: Los enfermeros tienen conocimiento sobre delirium trayendo diversas medidas no farmacológicas utilizadas en la prevención y manejo. Resaltan la importancia del conocimiento del tema, para identificar y prevenir los síntomas, y también la presencia de familiares. Las dificultades citadas para la implementación de estas medidas son: barreras de estructura física, de recursos materiales y falta de información sobre el tema. Conclusión: Se destaca la importancia de la realizacíon de actividades de educación permanente sobre el tema y se recomienda la adopción de la aplicación de escalas para monitorear el delirium


Assuntos
Humanos , Masculino , Feminino , Delírio/enfermagem , Delírio/terapia , Unidades de Terapia Intensiva , Cuidados Críticos
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 942-948, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537216

RESUMO

OBJECTIVE: To systematically evaluate the effect of vitamin C on prognosis of critically ill patients. METHODS: Randomized controlled trials (RCT) about vitamin C treatment for critically ill patients were searched in CNKI, CBM, VIP database, Wanfang database, PubMed, Springer Link, Embase, Web of Science, and Cochrane Library from their inception to May 2019. Patients in the treatment group received ascorbic acid while patients in the control group received placebo or other treatment. Outcome measures included mortality, the length of intensive care unit (ICU) stay, the length of hospital stay, and incidence of atrial fibrillation. Two researchers were responsible for literature screening, data extraction and quality evaluation independently. Meta-analysis was performed with RevMan 5.2 software. The publication bias was analyzed by funnel plot. RESULTS: A total of 28 RCTs were enrolled and 4 420 patients were included (2 207 in intervention group and 2 213 in control group). Meta-analysis showed that there was no significant difference in mortality between intervention group and control group [odds ratio (OR) = 0.90, 95% confidence interval (95%CI) = 0.75 to 1.08, P = 0.27]. The length of ICU stay [mean difference (MD) = -0.23, 95%CI = -0.29 to -0.16, P < 0.000 01] and the length of hospital stay (MD = -0.96, 95%CI = -1.21 to -0.70, P < 0.000 01) in intervention group were less than those in control group. Subgroup analysis showed that mortality of patients with sepsis and septic shock in intervention group was lower than that in control group (OR = 0.65, 95%CI = 0.43 to 0.99, P = 0.04). For patients undergoing cardiac surgery, the incidence of postoperative atrial fibrillation in intervention group was lower than that in control group (OR = 0.43, 95%CI = 0.34 to 0.54, P < 0.000 01). It was shown by funnel plot that there was less publication bias among studies. CONCLUSIONS: Vitamin C does not reduce mortality in critically ill patients, but it can reduce the length of ICU stay and hospital stay. In addition, vitamin C can reduce mortality of patients with sepsis and septic shock and reduce the incidence of atrial fibrillation post operation in patients undergoing cardiac surgery.


Assuntos
Ácido Ascórbico/uso terapêutico , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
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