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Introducción: Las limitaciones de la percepción sensorial, la inmovilidad, la sedación, la ventilación mecánica, la hipoperfusión tisular, el edema y la humedad se consideran factores que predisponen la aparición de úlceras por presión en pacientes en estado crítico. Objetivo: Caracterizar las úlceras por presión en pacientes críticos, determinar la asociación con variables demográficas, la hospitalización y las condiciones clínicas, e identificar los factores de riesgo para la aparición de úlceras por presión. Materiales y Métodos: Se realizó un estudio transversal mediante una muestra de pacientes > 18 años que no presentaban úlceras por presión al ingreso y habían estado hospitalizados >24 horas en la Unidad de Cuidados Intensivos. La asociación de las úlceras por presión con las variables se verificó a través de la prueba U de Mann-Whitney, prueba de chi-cuadrado, razón de verosimilitud y el test exacto de Fisher. Los factores de riesgo se identificaron mediante regresión logística múltiple. Resultados: De 324 pacientes, 46 (14.2%) desarrollaron úlceras por presión con mayor frecuencia en las regiones sacra y calcánea. Los factores de riesgo para la aparición de úlceras por presión fueron la edad, la duración de la hospitalización y la estancia hospitalaria antes de ingresar a la Unidad de Cuidados Intensivos. Discusión: La alta incidencia, la localización y el estadio de las úlceras por lesión observadas revelan la vulnerabilidad del paciente de la unidad de cuidados intensivos a este tipo de lesiones. Entre los riesgos de las úlceras por presión se encuentran factores relacionados con el paciente, la hospitalización y la gravedad de la enfermedad, y su combinación debe valorarse en la evaluación diaria del paciente crítico. Conclusión: La aparición de úlceras por presión en pacientes críticos es un fenómeno multifactorial, para la que el reconocimiento de factores de riesgo puede contribuir a una rápida adopción de medidas para su prevención Como citar este artículo: Campos, Michelle Mayumi Yoshimura de; Souza, Mariana Fernandes Cremasco de; Whitaker, Iveth Yamaguchi. Risco para lesão por pressão em pacientes de unidade de terapia intensiva. Revista Cuidarte. 2021;12(2):e1196. http://dx.doi.org/10.15649/cuidarte.1196

La ventilación mecánica invasiva (VMI) es una terapia de soporte vital que no está exenta de complicaciones, como la disfunción diafragmática inducida por la ventilación mecánica, que se caracteriza por atrofia y debilidad de dicho musculo. El interés en esta patología parece estar basado en la asociación encontrada con resultados clínicos negativos. La prevalencia oscila entre 29 y 80%, probablemente debido a la variabilidad entre los diferentes métodos diagnósticos y el momento de la evaluación. El patrón de oro continúa siendo la presión negativa transdiafragmática generada por la estimulación bilateral de los nervios frénicos, aunque por la falta de practicidad, se comenzó a utilizar la ecografía diafragmática. Si bien cuenta con varias modalidades, no todas tienen análisis de correlación con el patrón de oro. Otra problemática surge al momento de analizar la asociación independiente entre la patología y la VMI, ya que los factores confusores no son sencillos de aislar.

Introducción: en el paciente crítico el intestino es protagonista de la respuesta al estrés. Los síntomas de insuficiencia intestinal en las unidades de cuidados intensivos no son específicos y no se incluyen en escalas de gravedad comúnmente usadas, sin embargo, el 62% de los pacientes críticos presenta síntomas gastrointestinales al menos una vez al día. Demostrándose la relación existente entre la aparición de problemas gastrointestinales y la mortalidad en pacientes críticos. Objetivo: proporcionar el conocimiento teórico necesario sobre el fallo intestinal como entidad exclusiva, su reconocimiento en el paciente grave, clasificación y enfoque multidisciplinario del tratamiento. Métodos: se realizó una revisión cualitativa y sistemática en los idiomas inglés y español de la literatura publicada y actualizada hasta febrero del 2020. Conclusiones: las alteraciones gastrointestinales son frecuentes en el paciente crítico y un determinante en su mortalidad. Reconocer el fallo y disfunción intestinal permite optimizar el tratamiento, reducir la mortalidad e incidencia de complicaciones, las unidades dedicadas con un equipo de experiencia en el manejo del fallo intestinal agudo constituyen un aspecto clave en este sentido.

Objective: To describe the clinical-epidemiological profile and factors associated with mortality in patients with pneumonia associated with mechanical ventilation in an intensive care unit of a teaching hospital. Methods: Retrospective, documentary and quantitative study, developed in a teaching hospital, located in João Pessoa - Paraíba. Data collection was carried out from September to November 2020, using a systematic questionnaire with a simple random sample of 59 records. Results: Most were female (57.6%), aged 60 years or older (55.9%), had infectious diseases (50.8%) as a medical diagnosis of hospitalization, and had comorbidities (74,6%). The causative microorganism was pseudomonas aeruginosa (30.5%). The length of hospital stay was less than or equal to 30 days (57.6%), the time of mechanical ventilation above 15 days (74.6%) and there was a statistically significant association between age and clinical outcome, as well as length of stay and the outcome. Conclusion: The profile identified both resembles and stands out in some aspects when compared to the consulted literature. [ABSTRACT FROM AUTHOR]

Objective: To analyze the survival time and factors associated with the mortality of patients with long-stay hospitalizations in a hospital of high complexity. Methods: Cross-sectional study. We included records of patients who had long-term hospitalization for the Unified Health System between 2014 and 2017, excluding rehospitalizations. Cox Regression was used to identify the factors associated with mortality. Still, among the patients who were admitted to the intensive care unit, the Roc curve was used to determine the cutoff point to identify the day on which the patients had a higher risk of death. Results: 1,209 long-stay hospitalizations were identified, resulting in a prevalence of 7.3%. Of the total long-stay patients, 50.3% died. The majority were over 60 years old, with diseases of the circulatory system (40%). The factors associated with the mortality of patients with long-term hospitalization were: elderly (HR = 2.31; 95% CI: 1.89-2.81); clinical hospitalization (HR = 1.82, 95% CI: 1.54-2.15); ICU admission (HR = 12.41, 95% CI: 6.74-22.8). Mortality of patients admitted to the intensive care unit was significantly higher after the ninth day (p = 0.036). Conclusion: There was a high mortality rate in patients with long-term hospitalization, mainly among elderly people with chronic degenerative diseases and in palliative care. [ABSTRACT FROM AUTHOR]

This essay aims to discuss the teaching and learning process of the laboratory liver diseases diagnosis and their resizing, using complex thinking as a paradigm. In this perspective, the bibliographic review was carried out in the main databases, with analysis of the works, whose theme was related to the scope of the essay. Laboratory diagnosis in hepatology is a fluid process, which needs to overcome the disciplinary walls imposed by the categorization of medical specialties. Furthermore, the complexity inserted in the act of diagnosing is based on a rationality that implies prudence and attention, and must be disconnected from the apparent dichotomous relationship naturalized by the mechanistic paradigm. Rethinking the way we teach and learn in the medical graduation process is a priority aspect, which can impact changes in attitudes necessary for society. It should be noted that this proposition aims not only to assimilate the content, but also to develop medical competence to establish interconnections with other fields of medical knowledge, as well as with social, political, economic and cultural determinants, giving new meanings to knowledge. Thus, it is expected that this debate about hepatic diagnosis contributes to the curricular discussions of medical schools, in order to promote the revision of menus, strategies, methodologies and reflections on the paradigm that supports the mentioned aspects. In this logic, transversality can structure changes in the field of knowledge about the laboratory diagnosis of the most prevalent liver diseases, promoting more pertinent, contextualized, globalized, complex knowledge and capable of reflecting the plurality of knowledge in contemporary society. [ABSTRACT FROM AUTHOR]

Objective: To analyze the prevalence of Sepsis in Intensive Care Unit from a teaching hospital. Methods: Descriptive study, exploratory, retrospective with quantitative approach produced at the Intensive Care Unit from a reference hospital in Teresina -- PI, Brazil, which data were collected from 221 patients records hospitalized in this sector, in 2018. The data analysis was conducted with the Statistical Package for the Social Sciences, by means of descriptive and inferential statistics. Results: The prevalence of Sepsis at the Intensive Care Unit was 20,36% (n=45). The average length was of 10,73 days (SD +-15,53) and most part of them evolved to death 62,2% (n=28). Conclusion: The prevalence of Sepsis in the present study was low compared to the global index, which are higher. This is a matter of Public Health with high cost services that leads to mortality. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Foundation: Pneumonia associated with mechanical ventilation is associated with high morbidity and mortality, and its integral management is complex.Objective: to describe the clinical and microbiological characteristics in patients with pneumonia associated with mechanical ventilation.Methods: an observational, descriptive, cross-sectional study was conducted. A total of 174 patients diagnosed with pneumonia associated with mechanical ventilation were analyzed in the period between January 2015 and December 2017, at the Provincial Hospital of Cienfuegos. The variables were considered: age, sex, service of origin, year and cause of admission, state at discharge, result of bacteriological culture, isolated microorganisms and resistance in vitro.Results: 26.4% of the patients were between 70-79 years old, with a predominance of males (52.3%). Monomicrobial cultures were present in 71.3% of the samples. The most frequent microorganism was Acinetobacter baumannii, with 50.5%. Cerebrovascular disease was the most frequent cause of admission (28.7%). 47.7% of patients died. There was a high resistance in vitro in most of the isolated microorganisms.Conclusion: the disease appeared mainly in elderly male patients. In correspondence with previous studies in the province, Acinetobacter baumannii was manifested as the most frequent causative agent, with high resistance in vitro. Cerebrovascular disease was the main cause of admission.

Introducción. La aparición y la diseminación de cepas resistentes en hospitales, principalmente en unidades de cuidado intensivo (UCI), se han convertido en un serio problema de salud pública. Objetivo. Analizar la tendencia de los fenotipos de resistencia de Staphylococcus aureus y Staphylococcus epidermidis resistentes y susceptibles a meticilina aislados en pacientes atendidos en UCI de un hospital de alta complejidad de Cartagena, Colombia, del 2010 al 2015. Materiales y métodos. Estudio analítico transversal realizado entre enero de 2010 y diciembre de 2015. Se utilizaron aislamientos de S. aureus y S. epidermidis meticilino-susceptibles y meticilino-resistentes (SARM, SASR, SERM y SESM). La técnica de susceptibilidad empleada fue el método microdilución en caldo para la detección de la concentración mínima inhibitoria. Resultados. Se identificaron 313 aislamientos de Staphylococcus spp., la mayoría resistentes a meticilina (63.6%). Las cepas SARM y SERM correspondieron al 13.7% y al 27.8% del total de aislamientos, respectivamente. Los mayores porcentajes de resistencia en SARM y SERM correspondieron a eritromicina (57.6% y 81.2%, respectivamente), clindamicina (54.6% y 71.0%), ciprofloxacina (48.4% y 36.4%) y trimetoprima-sulfametoxazol (36.4% y 51.4%). Conclusión. Los resultados encontrados sugieren el replanteamiento de las estrategias de control de la resistencia antimicrobiana en el hospital objeto de estudio.

ABSTRACT Objective: identify delirium and subsyndromal delirium in intensive care patients; age, hospitalization time, and mortality. Method: a retrospective, quantitative study conducted in the Intensive Care Unit, using the Richmond Agitation-Sedation Scale to evaluate sedation and the Intensive Care Delirium Screening Checklist for the identification of delirium, with the participation of 157 patients. For statistical analysis, the t-test and the Chi-square test was carried out. Results: the majority presented subsyndromal delirium (49.7%). Mortality was 21.7%. The relationship between delirium and its subsyndromal with hospitalization time was statistically significant for both (p=0.035 and p

Introducción: la limitación de terapias de soporte vital (LTSV) es una práctica habitual y éticamente aceptada. La misma se enmarca en el concepto de adecuación del esfuerzo terapéutico. Objetivo: determinar la frecuencia, las directivas de implementación y los factores asociados a LSTV en los pacientes fallecidos en unidades de cuidados intensivos (UCI). Conocer la frecuencia y características del registro de este proceso en la historia clínica. Diseño: estudio observacional multicéntrico de corte transversal. Ámbito: se analizaron las historias clínicas de ocho UCI polivalentes públicas y privadas de Uruguay. Pacientes: se incluyeron todos los pacientes mayores de 18 años fallecidos en un período de seis meses consecutivos en el año 2011. Intervenciones: análisis de las características de los pacientes mediante revisión de historias clínicas. Resultados: analizamos 210 pacientes fallecidos. Se identificó LSTV en 63 (30%). El 75% de las decisiones consistió en la retirada de medidas terapéuticas. Los factores independientemente asociados a LTSV fueron: mayor edad (OR 1,04 (IC 95% 1,01-1,07), p = 0,001), mayor estadía en UCI (OR 1,06 (IC 95% 1,02 - 1,11), p = 0,001) y limitación para las actividades de la vida diaria (OR 4,65 (IC 95% 1,1-19,6), p=0,035). El 70% de las directivas LTSV fueron registradas en la historia clínica. Los soportes vitales más frecuentemente retirados fueron: nutrición parenteral (100%), vasopresores (79%), nutrición enteral (64%) y antimicrobianos (52%). La asistencia ventilatoria mecánica invasiva se retiró en el 33% de los casos. Conclusiones: un tercio de los pacientes fallece con LTSV. Este tipo de decisiones se asocian a mala calidad de vida previa, mayor edad y mayor estadía en UCI. Un tercio de las decisiones de LTSV no son registradas.

Introducción: En la asistencia sanitaria es necesario registrar las actividades realizadas a través de la historia clínica electrónica del paciente, la cual se constituye como una herramienta que incide en diversas tareas, entre ellas, las realizadas en las unidades de cuidados intensivos. Cualquier problema que se presente en estos sistemas electrónicos tiene un impacto directo en la prestación de la asistencia sanitaria. El objetivo de este estudio fue evaluar la percepción sobre el uso de la historia clínica electrónica y la satisfacción entre los profesionales de enfermería del área de cuidados intensivos, así como evaluar un instrumento de cuestionario para este fin. Materiales y métodos: Se realizó un estudio transversal cuantitativo en la ciudad de São Paulo. El instrumento de recolección fue elaborado por los autores y validado en cuanto a apariencia y contenido. Las variables categóricas se compararon mediante la prueba exacta de Fisher y la prueba de chi-cuadrado, y las variables numéricas a través de la prueba de Krushal-Wallis. Resultados: En el estudio participaron 75 profesionales de enfermería, la mayoría mujeres, que pertenecían a la categoría de técnicos de enfermería. La mayoría de los participantes consideró que la historia clínica electrónica era fácil de usar, indicó tener conocimiento suficiente sobre el manejo de la historia clínica electrónica, señaló que el número de computadores en el hospital era insuficiente y afirmó que había mejorado la seguridad del paciente y del equipo asistencial con el uso de la historia clínica electrónica del paciente. A los enfermeros les resulta más difícil utilizar esta herramienta. Conclusiones: Se encontró que la historia clínica electrónica resulta fácil de usar, mientras que las principales dificultades están relacionadas con su funcionalidad, especialmente por parte de los enfermeros. Como citar este artículo: Costa, Daiane Vieira Medeiros; Gomes, Vanessa Rossato; Godoi, Ana Maria Limeira de. Prontuário eletrônico em terapia intensiva: validação de instrumento sobre percepção e satisfação da enfermagem. Revista Cuidarte. 2021;12(2):e1332. http://dx.doi.org/10.15649/cuidarte.1332

Introducción: Desde la perspectiva de humanizar el cuidado en la Unidad de Cuidados Intensivos, se ha evidenciado la importancia de prestar más atención a los familiares del paciente e incluirlos en las dinámicas de la unidad. El objetivo del estudio fue comprender la relación entre el profesional de enfermería de la Unidad de Cuidados Intensivos adultos y los familiares, desde la perspectiva de estos últimos y elaborar un planteamiento teórico que describa su proceso de construcción. Materiales y métodos: El estudio se desarrolló bajo el enfoque cualitativo de investigación y la tradición de la teoría fundamentada. Se realizaron 26 entrevistas a familiares de pacientes hospitalizados en Unidad de Cuidados Intensivos y 100 horas de observación participante entre julio del 2017 y julio de 2019. El análisis de la información se hizo con base a la propuesta de Strauss y Corbin para la teoría fundamentada. Resultados: se identificó una categoría central, la relación enfermera-familia, hacia una comprensión empática, con cuatro subcategorías: formas de relación, el ideal profesional-la comprensión empática, la construcción de una relación profesional a partir de la interacción, la comunicación y la información; y las barreras en la relación enfermería- familia. Conclusiones: La relación enfermera-familia se fundamenta en la comprensión empática y tiene tres pilares centrales, la interacción, la comunicación y la información ya que propician la comprensión y favorecen la creación de relaciones empáticas y de confianza, lo cual contribuye a la humanización del cuidado profesional.

Aim: To identify aspects that influence the development of delirium, its management, evaluation and care in relation to the promotion and the prevention of delirium. Methodology: An integrative review was carried out in the following databases; CINHAL, SCOPUS and Scielo. 19 articles were selected, limited by year (2016-2017). Result: Four factors that have an impact on delirium were identified: pathophysiology / risk factors, prevention and promotion, objective evaluation and management in critical units. Conclusion: Nursing is in charge of care management, therefore, it is essential not to leave this issue aside because its incidence will increase the days of hospitalization, days of mechanical ventilation and mortality, negatively impacting the quality of care. [ABSTRACT FROM AUTHOR]

Introduction: When providing healthcare, it is necessary to record treatment activities in the patient's electronic medical records, which serves as a tool that impacts several tasks, including those performed in intensive care units. Any failure of these electronic systems has a direct impact on the delivery of healthcare. This study is aimed to assess the perception of the use of electronic medical records and satisfaction levels among intensive care nurses, as well as to evaluate a questionnaire instrument for this purpose. Materials and Methods: A quantitative cross-sectional study was conducted in São Paulo. The instrument used for collection was prepared by the authors, which was also validated in terms of appearance and content. Categorical variables were compared using Fisher's exact test and numerical variables were compared using the Kruskal-Wallis test. Results: 75 nursing professionals, mostly women and classified as nurse technicians, participated in this study. The majority of the participants considered that electronic medical records were easy to use, indicated that they had sufficient knowledge about the management of electronic medical records, noted that the number of computer in the hospital was insufficient, and stated that both patient and healthcare team safety had improved after using the patient's electronic medical records. Male nurses found it more difficult to use this tool. Conclusions: Electronic medical records were found to be easy to use, while the main difficulties are related to their functionality, especially by male nurses. [ABSTRACT FROM AUTHOR]

Introduction: Limited sensory perception, immobility, sedation, mechanical ventilation, tissue hypoperfusion, edema and moisture are considered predisposing factors for the development of pressure ulcers in critically ill patients. Objective: To characterize pressure ulcers in critically ill patients, determine the association with demographic variables, stay in hospital and clinical conditions, and identify risk factors for the development of pressure ulcers. Materials and Methods: A cross-sectional study was conducted with a sample of patients aged 18 years and older who had no pressure ulcers on admission and had been hospitalized > 24 hours in the Intensive Care Unit. The association of pressure ulcers with each of the variables was assessed using the Mann-Whitney U test, chi-squared test, likelihood ratio, and Fisher's exact test. Risk factors were identified by multivariate logistic regression. Results: Among 324 patients, 46 patients (14.2%) developed pressure ulcers most frequently in sacral and calcaneal regions. Risk factors for pressure ulcers development were age, length of hospital stay and hospital stay before admission to the Intensive Care Unit. Discussion: Such high incidence, location and stage of the identified pressure ulcers expose the vulnerability of intensive care unit patients to this type of injury. Risk factors for pressure ulcers development include aspects related to the patient, hospitalization and disease severity, and their combination should be assessed as part of the daily assessment of the critically ill patient. Conclusions: The occurrence of pressure ulcers in critically ill patients is a multifactorial phenomenon, for which the recognition of risk factors can contribute to the early rapid adoption of measures for their prevention. [ABSTRACT FROM AUTHOR]

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The control of oral biofilm with antiseptics should follow the protocols designed for patients in intensive care units (ICUs). Objective: To assess the effects of using 0.12% chlorhexidine solution in reducing the number of microorganisms in the saliva of ICU patients. Methodology: Cohort study with 45 volunteers divided into Medical Clinic (control group, oral self-care), non-intubated ICU, and intubated ICU. Oral hygiene in the ICU was performed with chlorhexidine. Microbiological analysis was performed through salivary bacterial count. Data were analyzed using ANOVA Results: The number of microorganisms decreased after oral hygiene. A significant difference was found between the control and the ICU intubated groups in the immediate period and after 30 minutes. The number of microorganisms in intubated patients decreased 12 hours after oral hygiene with chlorhexidine. Conclusion: The number of oral microorganisms decreases in intubated patients 12 hours after oral hygiene with chlorhexidine. These results may contribute to elaborating oral hygiene protocols for ICUs and planning strategies, for example, to reduce the costs and the side effects associated with chlorhexidine use. [ABSTRACT FROM AUTHOR]

Objective: To measure the organizational climate of the nursing team in the intensive care unit. Method: this is a cross-sectional study, with a quantitative approach, developed in the intensive care unit of a university hospital in the Northeast of Brazil. Data collection was carried out in 2016, with the participation of 30 nursing professionals. Data analysis was carried out using descriptive statistics and a bivariate analysis of data. Results: It was found that nursing professionals perceive a low organizational climate score in the sector they work. The professional Development and the benefits were considered the lowest factor by the workers. The bivariate analysis significantly infers that the professionals who have children have a low perception of the organizational climate. Conclusion: The nursing team investigated is perceives the score of the organizational climate to be low. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem Referência is the property of Escola Superior de Enfermagem de Coimbra and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Sepsis is a serious public health problem. In Cuba, it remains the fourth leading cause of death in children under one year of age. Knowing the behavior of this serious condition in patients will allow scientific support to propose health strategies that guarantee a more comprehensive medical care. Objective: to describe the behavior of sepsis in pediatric patients treated at the pediatric hospital of Cienfuegos. Methods: a descriptive, cross-sectional study was carried out at the Paquito González Cueto Pediatric Hospital in Cienfuegos. The clinical records of the children who, upon admission to the Intensive Care Unit, were diagnosed with sepsis, severe sepsis or septic shock were reviewed; between January 2009 and December 2019. A total of 175 patients met the inclusion criteria. The variables were: age, year, stage of sepsis, biological risk factors and mortality. Results: the incidence of sepsis in the Intensive Care Unit in relation to the total admissions was 3.6%. The general mortality represented the 30.8%; and severe forms of sepsis, the 44.4%. The age group most affected was those under one year of age. The most frequent comorbidities and / or biological risk factors were infantile cerebral paralysis and prematurity. Conclusion: the incidence of sepsis has not changed in the last years, and the mortality associated with it, although lower, remains high. Comorbidities were in half of the patients. [ABSTRACT FROM AUTHOR]

Introducción: la unidad de cuidado intensivo es un área hospitalaria donde se atienden personas con gravedad en su estado de salud, sin embargo la complejidad de la atención no está dada solamente por este aspecto sino por las necesidades de cuidado de la familia; la cual debe ser vista como una unidad; actualmente existe poca literatura sobre las intervenciones para el cuidado en esta área pues existe un trabajo interdisciplinario dentro de ella, siendo necesario un acercamiento al cuidado empírico que realiza enfermería en este entorno. Objetivo: identificar las actividades de cuidado de enfermería para la satisfacción de las necesidades de la familia en unidades de cuidado intensivo adulto. Metodología: se realizó una revisión integrativa fundamentada en los parámetros de Whittermore y Knafl, de artículos publicados entre 2008 y 2018, en las bases de datos: EBSCOhost, LILACS, MEDLINE, Science Direct, Scielo, Google Académico y Cochrane Library, los resultados se organizaron de acuerdo a la declaración PRISMA. Resultados: se incluyeron 16 artículos derivados de investigaciones cuantitativas, cualitativas y de revisiones; los cuales describen actividades para el cuidado de la familia de adultos. Las actividades encontradas se organizan a partir de la propuesta que Nancy Molter hace acerca de las necesidades de Seguridad, Información, proximidad, confort y apoyo, que la familia presenta en la unidad de cuidado intensivo. Conclusión: el cuidado de las necesidades de la familia de adultos en las unidades de cuidados intensivos permite abarcar al paciente y su familia como un ser integral y unitario, esto con el fin de mantener la salud familiar y prevenir crisis en las mismas. Como citar este artículo: Ardila Suárez Edinson Fabian, Arredondo Holguín Edith del Socorro. Actividades de enfermería para la satisfacción de necesidades familiares en cuidado intensivo adulto: una revisión integrativa. Revista Cuidarte. 2021; 12(1):e1229. http://dx.doi.org/10.15649/cuidarte.1229

Objetivo: Conocer la adherencia a las medidas no farmacológicas de los kinesiólogos/as que trabajan en una Unidad de Terapia Intensiva (UTI) de adultos, para prevenir la neumonía asociada a la ventilación mecánica (NAVM) en establecimientos de salud públicos y privados de la Ciudad Autónoma de Buenos Aires (CABA). Materiales y método: Se realizó un estudio observacional descriptivo de tipo encuesta online entre octubre y diciembre de 2018. Se incluyeron kinesiólogas/os que trabajan en una UTI de adultos ubicada geográficamente en CABA. Se los invitó a participar del estudio enviando la encuesta mediante la herramienta Survey Monkey®. Resultados: Se analizaron un total de 97 encuestas, de las cuales un 80,4% correspondían a roles asistenciales y un 19,6% a roles de coordinación. Se obtuvo una adherencia del 12,8% a las medidas de prevención no farmacológicas de la NAVM por parte de los kinesiólogos asistenciales. Conclusión: La baja adherencia a las medidas de prevención obtenida en nuestra encuesta, refleja la brecha que existe entre la práctica diaria de los kinesiólogos intensivistas y las recomendaciones de las guías basadas en la evidencia.

Introducción: el distrés respiratorio agudo y la falla multiorgánica que determinan admisión en una unidad de cuidados intensivos (UCI) son una causa importante de morbimortalidad en pacientes con COVID-19. Los pacientes con peores resultados clínicos –incluido una menor sobrevida en UCI– son aquellos con múltiples comorbilidades, grados variables de inmunocompromiso, adultos mayores e individuos con desnutrición previa o secundaria a la enfermedad crítica. El impacto nutricional de la enfermedad crítica sobre el músculo estriado esquelético puede exacerbarse en algunos pacientes críticamente enfermos, los infectados por SARS-CoV-2 que requieren admisión a UCI. Objetivo: proporcionar una orientación práctica de utilidad para los clínicos basados en la evidencia clínica actualizada y considerando ciertas características claves distintivas de la infección grave por SARS-CoV-2. Método: se realizó una revisión exhaustiva de la literatura científica publicada hasta abril de 2020 en idiomas español e inglés. Conclusiones: la pandemia de COVID-19 determina un desafío sin precedentes en la UCI, dado que no existen al momento medidas preventivas demostradas para evitar la evolución a la enfermedad crítica y los tratamientos curativos disponibles en esta fase de la enfermedad carecen de evidencia clínica de calidad que los sustenten. En este escenario complejo es probable que las medidas que contribuyan a potenciar el sistema inmunitario y las terapias de sostén en la UCI (incluido el soporte nutricional) sean armas sustanciales contra las infecciones graves por SARS-CoV-2; sin embargo, son necesarios más estudios en el entorno de la UCI para realizar recomendaciones específicas.

Objective: to compare the knowledge and attitudes of nursing professionals working in public and private hospitals on oral hygiene in critically ill patients. Method: a cross-sectional study carried out in two adult Intensive Care Units, one public and the other one private, between the period of December 2018 and January 2019, using a structured and self-administered questionnaire. Results: the knowledge rate of professionals in the public hospital was 76.6% and the attitude was 62.7%, while in the private hospital, these rates were 81.8% and 67.1%, respectively. There were significant differences regarding the existence of a protocol (p <0.006), participation in training (p <0.004), and the use of a toothbrush with soft bristles and suction (p <0.001) in the private hospital. Conclusion: the knowledge level was higher, and the attitudes toward oral hygiene were more positive among nursing professionals at the private hospital compared to the professionals at the public hospital. [ABSTRACT FROM AUTHOR]

Objective: To evaluate measures applied by nursing to prevent Pressure Ulcers in patients in pediatric intensive care unit, before and after training. Methods: Quantitative, descriptive, cross-sectional study, developed in tertiary-level hospital. The sample consisted of 118 patients. Data collection was performed in the checklist format according to 3 variables: I) Related to sample characteristics; II) Related to risk avaluation for LPP and III) Related to risk identification for LPP. Subsequently, training was carried out and then a new collection, comparing the data. Results: LPP in the sector corresponded to 7.5% before training and 2.0% after. It can be identified that 57.4% of patients were exposed to the risk of pressure ulcers before and 60.9% after. It was observed at the bedside that, before training, only 46.2% of the patients were in the appropriate position established by the sector at that time of the day and after 92.1% were. Conclusion: There was an improvement in the performance of these preventive measures and the need for frequent training with health professionals. Nurses should work on improving these tools to better the evaluation of risk of pressure ulcers, as well as preventive measures. [ABSTRACT FROM AUTHOR]

Objective: To understand the experience of a family that experienced Intensive Care Unit (ICU) admissions. Methods: Study conducted by referencing oral life history, methodological strategy within the scope of qualitative research. Semi-structured interviews were conducted with six members of a family, each of whom experienced the hospitalization of their loved ones in the ICU. Results: The rescue of individual memories allowed the construction of collective memory which resulted in the elaboration of three themes which revealed the difficulties faced by a family against the hospitalizations of two of its members in the ICU, how they faced this entire hospitalization process and the changes generated in each family member. Conclusion: It was concluded that hospitalizations in the ICU occasioned emotional vulnerability and the need for change in family dynamics, however, it compelled the family to obtain a new understanding about the ICU, making them more resilient, strengthening family bonds and improving perception about living each moment more intensely within the family. [ABSTRACT FROM AUTHOR]

Objective: To analyze the nursing diagnosis focusing on the problem and risks documented in clinical practice by nurses caring of patients in Intensive Care Unit. Methods: Quantitative, transversal, documentary and descriptive study. 122 medical records were selected in the medical file sector, by simple random sampling, with a significance level of 99%, over a one-year time frame, 2016 to 2017. Medical records with a history and diagnosis filled out by nurses from the Intensive Care Unit or by nursing students signed by the responsible nurse were chosen in the first 24 hours after the patients' admission. Medical records with erasures and / or absence of pages in their chronological sequence were excluded. Results: 809 titles of nursing diagnosis were identified, of these 375 (46.3%) with a focus on risks and 434 (53.7%) with a focus on the problem. The diagnosis stood out with the highest percentages: unbalanced nutrition, less than body needs (98.4%); deficit in self-care (96.7%); risk of infection (92.6%); impaired gas exchange (71.3%); risk of impaired skin integrity (54.9%). Conclusions: The identification of nursing diagnosis in the Intensive Care Unit enables nurses to recognize the demands of everyday care, for planning and decision making focused, resolutive and effective in intensive care. [ABSTRACT FROM AUTHOR]

Introduction: Satisfying the family needs at the intensive care unit (ICU) is an integral part of the critically-ill patient’s care, which resolves in benefits to the patient, the family and the health center. Objective: To describe the perception about the frequency, pertinence and suitability of the nursing care activities to fulfil the family needs at the ICU. Methods: It is a cross-sectional, descriptive, quantitative study applied to 75 professional ICU-nurses in a Colombian province under a non-probabilistic sampling in 11 III and IV–level hospitals. Information was gathered during 3 months and an ad hoc instrument designed according to a comprehensive review was used. This instrument underwent both an expert and pilot test. The statistical analyses was conducted using the SPSS 25.0 software and the graphics using the R software and a ≥ 75% perception was adopted as the benchmark in the analysis. Results: Seventy-five professional ICU-nurses perceive that out of 63 activities suggested by the instrument, 16 are carried out more frequently, 27 are more pertinent and 24 very suitable. Conclusions: Based on frequency, pertinence and suitability, the nurses who answered the instrument reported that the most important activities are those intended to satisfy the safety needs, then those intended to inform and getting close, and finally those related to support and comfort. [ABSTRACT FROM AUTHOR]

The Physiotherapist was incorporated into the basic intensive care units (ICUs) teams in 1998. Although the activities of these professionals in these units are already regulated, and therapeutic efficiency has been proven, their identity and recognition seem unstructured to date, thus suggesting their construction in progress, through identification of duties and competences. The objective of this study is to identify the competence profile of physiotherapists working in ICUs, and to relate it to the competences pointed out by the National Curricular Guidelines (NGC) of the Physiotherapy course. The study carried out is a survey type, with a quantitative approach that used a structured questionnaire, elaborated from the analysis of the NCG of the physiotherapy course, which was sent to 75 physiotherapists working in ICUs of 16 hospitals in Paraná, with a return of 66.6%. As a result, it points to a professional who claims to have essential skills, who acts and reacts with pertinence in the face of his activities with professional success, in a valiant and ethical manner, in addition to ensuring his autonomy and security. However, these professionals suggest not acquiring these qualities in basic education, during their graduation. They also indicate that skills pointed out by the NCG, despite being real and alive to them, may not be being considered in undergraduate courses, as they do not appear to be obtained during graduation, but after the beginning of their work activity. In conclusion, the responses of the physiotherapists show the need for the continuous development of competences, the importance of the participation of the physiotherapist in the ICU, and the possibility of acting supported by professional training of excellence. [ABSTRACT FROM AUTHOR]

Objective: to analyze the nurse's conception of professional satisfaction in the Intensive Care Unit environment. Method: descriptive study of qualitative approach, carried out in a university hospital in the state of Sergipe. Data collection was performed in October 2020, through semi-structured interviews with nurses from the general Intensive Care Unit sector, and the data were analyzed through Content Analysis. Results: the following categories emerged from the statements: the work process of nurses in Intensive Care Units; factors that interfere in the professional satisfaction of nurses in the Intensive Care Unit environment; and the relationship of nurses with professional satisfaction in the intensive care environment during the Covid-19 pandemic. Final considerations: in the conception of Intensive Care Unit nurses, professional satisfaction is an important aspect in their work environment and can influence the provision of care offered to patients. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the infusion of enteral nutrition in adult patients admitted to an intensive care unit. Method: a descriptive, quantitative and longitudinal study, carried out over four months in a high-complexity public hospital, with patients using enteral nutritional therapy. Descriptive statistical analyses were performed with mean, standard deviation and percentage. Results: enteral nutrition was administered early after admission to the intensive care unit in most of the cases (64%). In 71% of the patients, the infusion volume of enteral nutrition was between 80% and 100% of that prescribed. The factors that most limited the infusion were complications in the use of the feeding tube (14%), hemodynamic and clinical instability (12%), and gastric stasis (12%). Conclusion: the infusion of enteral nutrition proved to be satisfactory and, among the factors that limited the infusion, many are preventable with the improvement of Nursing care, requiring the training of the team. [ABSTRACT FROM AUTHOR]

Objective: to identify the knowledge produced in the literature on patient safety culture in intensive care. Method: this is an integrative review based on the theoretical framework of Whittemore and Knaf, carried out at the portals PubMed, Virtual Health Library (VHL) and Scientific Electronic Library Online (SciELO), through the crossing of the descriptors "organizational culture", "patient safety", and "intensive care units", through the Boolean operator "AND", totaling 22 publications. Results: three categories of evidence were identified: instruments for assessing the patient safety culture, strengths and weaknesses of the patient safety culture in intensive care, patient safety culture in intensive care and associated factors. Conclusion: the publications demonstrated the difficulty to build a local safety culture, since none presented a positive patient safety culture. However, factors associated with the safety culture were demonstrated, in which it is possible to intervene for its better implementation. [ABSTRACT FROM AUTHOR]

Introduction: The ventilator-associated pneumonia is an infection related to health care that predominates in intensive care units and compromises patient safety. Objective: To identify the effects of care bundles in preventing ventilator-associated pneumonia in the Intensive Care Unit (ICU). Materials and Methods: An integrative literature review was conducted based on the studies available in the online databases Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online and Scopus. Articles were selected from these databases between June 2 and July 18, 2018 in English and Portuguese without any publication time limit using DeCS and MeSh descriptors. Two independent researchers carried out the article selection process, from which information related to publication year, country of origin, objective(s), degree of scientific recommendation and type of study, intervention, compliance with the use of care bundles, main results and conclusions was collected. Results: A total of 13 out of 20 publications analyzed were from different countries and in most studies (n=18) the use of care bundles was found to significantly reduce the incidence of ventilator-associated pneumonia, resulting in a reduction in mortality, length of hospital stay and costs. The main components chosen to put together care bundles included head of bed elevation and oral care. Conclusion: Although studies with a higher degree of recommendation are possible, data from several countries suggest that the use of care bundles had a positive effect on ventilator-associated pneumonia, as well as on improving institutional performance by reducing health care costs. [ABSTRACT FROM AUTHOR]

The article aims to investigate the main differences between high-flow cannula and non-invasive ventilation in the postoperative period of pediatric cardiac surgery. The research was carried out in the electronic databases VIRTUAL HEALTH LIBRARY (VHL) - SciELO, LILACS and MEDLINE, using the following keywords: Cardiac Surgery, Non-Invasive Ventilation and Oxygen Therapy, published in the year 2010 to 2020. A total of 54 possibly relevant studies were found, 24 selected for detailed analysis and only 7 were included in the review. The articles were organized as follows: Author/year, type of study, sample, objective and result for a better understanding. The present study shows that noninvasive ventilation is used mainly at two pressure levels, improving ventilation capacity, decreasing carbon dioxide levels, while the high-flow nasal cannula increases oxygen levels. The comparison between the two resources does not allow to regulate and measure the amount of positive pressure generated in the airways. [ABSTRACT FROM AUTHOR]

Introduction. In the context of the health emergency, there has been an increase in the number of critical cases of COVID-19 in the Intensive and Intermediate Care Units (ICU, IMCU), indicating the need to develop strategies for coordination. Objective. To describe the approach implemented in Bogotá for the bed occupancy coordination on the ICU and IMCU, facing an increase in critical COVID-19 cases. Methods. We conducted a descriptive study using Emergency Division databoards and SaluData indicators. Additionally, we made a comparison between the essential points of the Capital's strategy and the bed occupancy rate in ICU and IMCU services at 12-hour intervals. Results. We described the design and implementation of the strategy, the bed occupancy rate indicators for COVID-19 cases, the hospitalization indicators for COVID-19 and non-COVID-19 cases, and the parameters of high demand (adult ICU beds occupancy percentage 50% or highest) for more than 24 hours. Taking into account these percentages we determined the alerts levels. Procedures, instruments, and channels of communication necessaries for supplying beds were considered as well. Conclusion. Centralized management of ICU beds by the Regulation Center has been favorable for the health services provided to patients in a critical state. [ABSTRACT FROM AUTHOR]

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