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Objective: To utilize Failure Mode and Effects Analysis (FMEA) to manage risks in prescribed drug therapy within an Intensive Care Unit (ICU). Methodology: This action research, integrating qualitative and quantitative methods, assesses medical prescriptions in a Coronary ICU (CECOR) in Fortaleza, Brazil, using FMEA. This study involves defining the process, forming a multidisciplinary team, conducting a situational diagnosis, evaluating failure modes (FMs) with Severity (S) and Detection (D) indices, monitoring FM Prevalence (P), and calculating the Prioritization Coefficient (PC). Each FM is accompanied by pharmaceutical recommendations (RF). Continuing education activities are designed based on the PC for CECOR professionals. Results: In the situational diagnosis, 170 prescriptions and 60 FMs were assessed, with primary categories being drug interactions (39.7 %) and incompatibilities (30.0 %). Causes are multifactorial. Regarding the team’s response to an FM, it was determined that 36,7 % of the FMs would be accepted with monitoring. During prevalence monitoring, 63.3 % of FM types occurred 837 times, with high severity (50.0 %) and low detection (55.3 %). Most frequent FMs were absence of pharmaceutical form (29.4 %) and dose (8.8 %). Conclusion: FMEA facilitates identifying, classifying, and prioritizing risks in drug therapy at CECOR, underlining its effectiveness as a quality tool for enhancing patient safety [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) 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 Argentina de Terapia Intensiva is the property of Sociedad Argentina de Terapia Intensiva (SATI) 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 Nursing Notes. Notas de Enfermería is the property of Sanatorio Allende 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 Portuguese Journal of Mental Health Nursing / Revista Portuguesa de Enfermagem de Saúde Mental is the property of Portuguese Society of Mental Health Nursing 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 Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) 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 Journal of Nursing & Health is the property of Journal of Nursing & Health (JONAH) 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.)

Objective: To characterize the clinical-epidemiological profile of patients admitted to the adult intensive care unit of a teaching hospital. Method: Descriptive epidemiological study, with a quantitative approach, cross-sectional and retrospective nature. The research was carried out at the teaching hospital, in an adult intensive care unit between January and December 2021. Results: 153 people were hospitalized. There was a predominance of males (68.6%). The average age was 53 years (standard deviation=20). Regarding the municipality of residence, Maringá predominated (39.9%). The average length of stay was 17 days (median=11; standard deviation=18). Regarding the primary cause of admission, it was noted that the most frequent causes were trauma (14.4%). Regarding the outcome of hospitalization, although the majority of participants were discharged from the sector (58.8%), there was an important proportion who died (37.3%). Conclusion: Predominance of males, with an average age of 53 years, from the city of Maringá, hospitalized for around 17 days due to trauma and/or fractures, which required intubation and without vasoactive drugs and hemodialysis, with a more rise in the sector is frequent, although the mortality rate was 37%, raising a warning for managers. [ABSTRACT FROM AUTHOR]

Objective: To explore, in scientific publications, the Nursing assistance provided to critically-ill or potentially serious adult patients hospitalized in wards. Method: An integrative review carried out in November 2022 in the Web of Science, PubMed, Biblioteca Virtual em Saúde, Scopus and EMBASE databases, using the following string: "nursing AND critical care AND patients' rooms OR ward OR infirmary AND adult OR middle aged OR aged OR aged, 80 and over". Results: Of the 4,596 studies found, 19 original articles published between 2017 and 2022 were included. Their contents were grouped into two categories: "Barriers for the care to be provided to acute patients in wards" and "Opportunities to improve care quality". Conclusion: From this review it was possible to extract possible barriers and potentialities for advancing care for critically-ill patients in wards, which can serve as a starting point for health teams to rethink the practice and create strategies aimed at solving barriers and at implementing care improvements. [ABSTRACT FROM AUTHOR]

Resumo Objetivo identificar a percepção de familiares e da equipe de enfermagem sobre a implementação de um diário de Unidade de Terapia Intensiva à rotina de cuidados do paciente crítico. Método estudo descritivo, qualitativo, realizado em uma Unidade de Terapia Intensiva (UTI) adulto, entre julho e outubro de 2022. Implementou-se um diário, com registros de familiares e da equipe de enfermagem. A percepção dos familiares foi identificada através de entrevistas, e a da equipe, por meio de roda de conversa. Utilizou-se análise temática de Minayo. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados participaram nove familiares; emergiram as seguintes categorias: Benefícios da utilização do diário de UTI e Fatores que podem influenciar no uso do diário de UTI”. A partir da roda de conversa, com cinco profissionais de enfermagem, evidenciaram-se as categorias: Melhora da conexão com paciente e família; O diário como fonte de informações e Aspectos éticos relacionados aos registros. Considerações finais e implicações para a prática os familiares e os profissionais de enfermagem consideraram o instrumento benéfico, tanto para familiares quanto para pacientes. Para sua implementação, fluxos bem estabelecidos sobre o uso e a aproximação da família são essenciais para subsidiar o processo e obter a adesão das partes envolvidas.

Introducción. La Colangitis Aguda Severa (CAS) o Colangitis III, se caracteriza por la obstrucción biliar total e infección de la bilis que puede evolucionar a una falla orgánica por infección sistémica, shock o muerte, su letalidad se incrementa en el retraso del tratamiento médico y su principal causa es por coledocolitiasis (1) Objetivo. Describir el efecto del Proceso de Atención de Enfermería (PAE) en un paciente en estado crítico con el diagnóstico médico de colangitis III. Materiales y métodos. Diseño cuantitativo, cuasi experimental, de corte transversal y se realizó una revisión bibliográfica en diversas plataformas como, Google Académico, PubMed y Elsevier así mismo, la organización de los datos se realizó con base a los patrones funcionales de salud, la redacción de diagnóstico se realizó con la taxonomía NANDA, los planes de cuidados con NOC y NIC. Resultados. El efecto de las intervenciones en los diagnósticos de mayor prioridad fue: limpieza ineficaz de las vías aéreas pre y postintervención 15-20, disminución del gasto cardiaco pre y postintervención 19-23 e hipertermia pre y postintervención 5-8. Conclusión. El efecto de las intervenciones de enfermería mediante la metodología del PAE asegura la calidad de la atención, y también nos permiten medir las respuestas humanas que indican una mejora del paciente, ayudando a identificar las áreas de oportunidad del cuidado.

La alta prevalencia de enfermedades crónicas, puede requerir el tratamiento en la Unidad de Cuidados Intensivos (UCI) y desde las Universidades es indispensable formar a enfermeras como especialistas en cuidado crítico, que con sus conocimientos y aplicación del cuidado contribuyan a disminuir las tasas de morbilidad y mortalidad de estas enfermedades. Objetivo: Identificar la percepción sobre la formación académica en la especialización en enfermería para el cuidado del paciente en estado crítico en la Universidad Mariana. Métodos: La investigación se basó en el enfoque cuantitativo, de tipo descriptivo y corte transversal, en el cual se aplicó un cuestionario electrónico con preguntas estructuradas a una muestra no probabilística conformada por docentes, egresados y estudiantes de la especialización en enfermería para el cuidado del paciente en estado crítico. Resultados: El 60% de los docentes, el 64,7% de los egresados y el 63,2% de los estudiantes consideran importante manejar el código deontológico en enfermería para el ejercicio del cuidado crítico, al igual que la aplicación de gestión y gerencia, los modelos y teorías de enfermería. Conclusión: Estudiantes, docentes y egresados de la especialización en cuidado critico indican que es importante incluir actividades académicas en el proceso formativo que permitan fortalecer el conocimiento, el desarrollo de nuevas habilidades, la vinculación del campo de trabajo y entorno social.

During the past two decades, the videolaryngoscope (VDL) has become a valuable and effective tool for the management of the airway, not just in the realm of anesthesiology, but also in other medical specialties in clinical scenarios requiring tracheal intubation. In countries such as the United States, this represents over 15 million cases in the operating room and 650,000 outside the OR. The overall accumulated incidence of difficult airway is 6.8% events in routine practice and between 0.1 and 0.3 % of failed intubations, both associated with complications such as desaturation, airway injury, hemodynamic instability and death. Notwithstanding the fact that the VDL has proven advantages such as improved visualization of the glottis, higher first attempt success rates, and a shortened learning curve, most of the time its use is limited to rescue attempts or as a secondary option. The aim of this article is to comment the advantages and limitations of the VDL vs. the direct laryngoscope in a wide range of clinical settings, including the operating room, intensive care units, emergency departments, pediatrics, obstetrics, and Covid-19 to consider its routine use. [ABSTRACT FROM AUTHOR]

Background: Nurses need not only practical knowledge to apply Advanced Life Support (ALS) but also theoretical knowledge. Objectives: To assess nurses' theoretical knowledge of ALS in the care of critically ill people and to examine the relationship between nurses' theoretical knowledge of ALS in the care of critically ill people and their sociodemographic, academic, and professional variables. Methodology: A quantitative and descriptive-correlational study was conducted on 36 nurses selected through non-probabilistic convenience sampling. Results: In the applied questionnaire, the nurses achieved a correct answer rate of 73.53%. Statistically significant differences were found between specialist nurses and their knowledge of emergency drug administration [amiodarone (t = 4.292; p = 0.038); and atropine (t = 4.912; p = 0.027)] and capnography monitoring (t = 4.788; p = 0.029). Conclusion: Nurses showed good levels of theoretical knowledge of ALS, and practical refresher training every 3 months is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Family members of patients admitted to an Intensive Care Unit present high uncertainty level due to not knowing what is happening and to not having clear details about the related events; therefore, interventions are required to allow modulating those levels. Objective: To evaluate the effect of an educational Nursing intervention compared to conventional care on the uncertainty of family members of patients hospitalized in an ICU. Materials and methods: An experimental study with a sample comprised by 132 relatives of patients admitted to an ICU, randomly distributed in four Solomon groups (33 in each group). The Nursing intervention based on the concepts of the Uncertainty in Illness Theory was applied to both experimental groups and devised under the Whittemore and Grey parameters with three moments: assessment; education about the relative's hospitalization in the ICU; and accompaniment. This was done with pre-assessments for two groups and post-assessments for the four groups, using the PPUS-FM Uncertainty Scale. The data were analyzed by means of descriptive statistics and respective non-parametric analyses. The study took into account the ethical principles in research. Results: The family members in the experimental groups presented a lower final uncertainty level when compared to the control groups, with a difference of 73.04 points and a p-value of 0.001. Discussion: Standardized interventions and under a theoretical model allow reducing uncertainty in relatives of patients in ICUs. Conclusions: The Nursing intervention based on the Uncertainty theory allows reducing uncertainty in relatives of patients hospitalized in an Intensive Care Unit. [ABSTRACT FROM AUTHOR]

Introduction: International Organizations recognize that, for the health professions, the development of their specialties is transcendental since it allows them to deepen knowledge and skills for a more qualified professional practice that allows improving the quality of care. Objective: To explore the state of the art, application of nursing models and theories in intensive care units and trends in the training of nursing specialists for critically ill patients. Method: Documentary research whose object of study were 17 research articles related to the subject, the articles were captured in international databases Scielo, Elsevier, ScienceDirect, published between 2011-2021. A matrix for the selection of investigations and the Investigation Analytical Sheet were used as information collection instruments. The analysis was oriented based on the evolution of the training process, theoretical-disciplinary approaches and training trends and challenges Results: Articles from documentary reviews were found and, to a lesser extent, from qualitative or quantitative research studies. Conclusions: The study allowed us to recognize the progress of the training process and the evolution of teaching-learning strategies typical of traditional educational models to others that stimulate reflective and critical thinking. The literature that accounts for the application of nursing models and theories in critical care units is scarce; novel perspectives related to nursing training for critical care were found. [ABSTRACT FROM AUTHOR]

Copyright of Online Brazilian Journal of Nursing is the property of Fundacao Euclides da Cunha de Apoio Institucional a UFF 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 Online Brazilian Journal of Nursing is the property of Fundacao Euclides da Cunha de Apoio Institucional a UFF 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.)

Enquadramento: A prevalência do acidente vascular cerebral continua elevada, sendo recomendada a existência de procedimentos clínicos. Objetivo: Validar, através da técnica Delphi, intervenções de enfermagem na abordagem ao doente com suspeita de acidente vascular cerebral em fase aguda, com um painel de especialistas. Metodologia: Realizou-se uma pesquisa Survey, com base num estudo quantitativo-descritivo, sendo que uma revisão sistemática de literatura foi realizada previamente. Resultados: Amostra composta por seis especialistas. Realizadas duas rondas da técnica Delphi, foram validadas intervenções de Enfermagem ao doente com suspeita de acidente vascular cerebral, em fase aguda, nomeadamente: correto encaminhamento tendo em conta o tempo de evolução dos sintomas; abordagem em sala de emergência (baseada na avaliação ABCDEFGH); vigilância e resposta a reações adversas durante e após trombólise. Conclusão: A validação das intervenções de enfermagem na abordagem ao doente com suspeita de acidente vascular cerebral em fase aguda levou à elaboração de uma instrução de trabalho sólida, direcionada aos enfermeiros.

Introducción: la determinación del gasto energético es fundamental en los pacientes críticos debido a que la subalimentación o sobrealimentación aumenta su morbimortalidad. Objetivo: determinar la exactitud y concordancia de la medición del gasto energético en reposo (GER) por calorimetría indirecta (CI) y tres fórmulas predictivas (Harris-Benedict, Regla del pulgar y Penn State) en pacientes ventilados de una UCI de Manizales, Colombia. Métodos: se incluyeron 31 pacientes hospitalizados en el S.E.S. Hospital Universitario de Caldas, con ventilación mecánica ≥48 horas. El GER se calculó para todas las variaciones de peso corporal. Como una medida de precisión de las ecuaciones, se calculó la distribución de pacientes con GER por debajo del 80 % del medido por CI (subestimación), entre 80 % y 110 % (adecuado) y >110 % (sobreestimación), y a partir de análisis con Bland- Altman se evaluó la concordancia. Resultados: el GER promedio por CI fue de 1441,1 (IC del 95 % 1205,7-1616,5) kcal/kg para mujeres y 1624,5 (IC del 95 % 1414,7–1834,2) para hombres. El análisis de exactitud mostró que la ecuación Penn State calculada con el peso actual tuvo una concordancia del 44,4 % y fue la que más subestimó con peso ideal y ajustado (51,9 %), la regla del pulgar calculada con el peso actual fue la que más sobreestimó (64,6 %) y el análisis con gráficos Bland-Altman mostró sesgos positivos y negativos. Conclusiones: se encontró una mala concordancia entre las diferentes ecuaciones predictivas y los valores de GER por CI en pacientes críticamente enfermos de una UCI.

Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension 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 Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura 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 Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia 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.)

Objetivo: resumir y analizar la evidencia más reciente sobre el efecto de la administración de vitamina C en el paciente con sepsis. Métodos: revisión narrativa. Se realizó una búsqueda bibliográfica, utilizando los términos de búsqueda “Vitamina C” y “Sepsis”, además de sinónimos, los cuales fueron combinados con los operadores “AND” y “OR”, en las bases de datos PubMed, ScienceDirect, Web of Science, y MEDLINE. Resultados: basados en los últimos estudios celulares y moleculares, se ha evidenciado que la vitamina C posee propiedades antioxidantes, antiinflamatorias, y microbicidas, pudiéndose obtener cierto beneficio de su uso en sepsis. Mientras algunos ensayos controlados aleatorizados han encontrado un incremento del riesgo de hasta el 20% de morir o presentar falla orgánica persistente, otros han observado una disminución de la mortalidad de hasta un 40%, además de la estancia hospitalaria y duración de ventilación mecánica. Conclusión: a la fecha, la evidencia es heterogénea respecto al posible beneficio en el uso de vitamina C intravenosa como terapia sola o combinada en el manejo del paciente con sepsis o shock séptico. Mientras los ensayos controlados aleatorizados parecieran demostrar ausencia de beneficio, principalmente respecto a mortalidad o persistencia de falla orgánica a los 28 días, algunos meta-análisis tienden a mostrar una reducción del riesgo de muerte. Por lo tanto, sigue faltando evidencia que amplíe este panorama.

Enquadramento: Os conhecimentos dos enfermeiros sobre suporte avançado de vida (SAV) implicam não só a aplicação de conhecimentos práticos, mas igualmente a mobilização dos conhecimentos teóricos. Objetivos: Avaliar o nível dos conhecimentos teóricos dos enfermeiros sobre SAV na prática de cuidados à pessoa em situação crítica (PSC) e relacionar o nível dos conhecimentos teóricos dos enfermeiros sobre SAV na prática de cuidados à PSC e as variáveis sociodemográficas, académicas e profissionais dos enfermeiros. Metodologia: Estudo quantitativo, descritivo-correlacional, onde participaram 36 enfermeiros selecionados através de uma técnica de amostragem não probabilística por conveniência. Resultados: Os enfermeiros apresentaram uma percentagem de respostas corretas de 73,53% no questionário aplicado. Evidenciaram-se diferenças estatisticamente significativas entre ser enfermeiro especialista e o conhecimento sobre a administração de fármacos de emergência [amiodarona (t = 4,292; p = 0,038); e atropina (t = 4,912; p = 0,027)] e a monitorização com capnografia (t = 4,788; p = 0,029). Conclusão: Os enfermeiros revelaram bons níveis de conhecimentos teóricos sobre SAV, sugerindo-se uma atualização da formação prática a cada 3 meses.

Introdução: Pacientes com câncer apresentaram risco de desenvolver quadros respiratórios graves quando acometidos por covid-19, com necessidade de suporte intensivo e de ventilação mecânica invasiva (VMI). Objetivo: Avaliar os fatores associados ao óbito em pacientes oncológicos que tiveram covid-19 e evoluíram com insuficiência respiratória e necessidade de VMI. Método: Estudo de coorte retrospectivo de pacientes com câncer em uma unidade de terapia intensiva (UTI) oncológica, com covid-19 e em VMI de abril de 2020 a dezembro de 2021. Foram incluídos de forma sequencial todos os pacientes com câncer admitidos na UTI em VMI ou que evoluíram com VMI por agravamento da covid-19, sendo excluídos aqueles em controle da doença oncológica há mais de cinco anos. Para a análise estatística, foram utilizadas medidas de tendência central e dispersão, assim como frequências absolutas e relativas. A regressão logística múltipla foi aplicada para a avaliação dos fatores associados à mortalidade, considerando estatisticamente significantes valores de p < 0,05. Resultados: Foram incluídos no estudo 85 pacientes. O óbito foi maior entre os pacientes com tumores sólidos (OR = 3,64; IC 95%: 1,06-12,52; p = 0,04), entre os que necessitaram de suporte renal durante a internação na UTI (OR = 6,88; IC 95%: 1,82-25,98; p = 0,004), os que não puderam ser extubados (OR = 8,00; IC 95%: 2,16-29,67; p = 0,002) e os que apresentaram o valor de pressão de distensão alveolar maior do que 15cmH2O por pelo menos um dia (OR = 5,9; IC 95%: 1,76-19,80; p = 0,004). Conclusão: Características clínicas e de VMI estavam associadas à morte de pacientes oncológicos com covid-19 e em VMI.

Introduction: Jean Watson's theory of caring is committed to holistic care through a helping relationship between patient and caregiver. The "bedside shift report" methodology actively involves the patient in the transfer of information between health professionals, especially in hostile contexts (such as intensive care units) for communication and humanization of care. Objective: to explore the perceptions of patients who participated in the transfer of information at the bedside in an intensive care unit, from Jean Watson's theory of caring. Methodology: narrative analysis of the interviews carried out through the conceptual-theoretical-empirical system (CTES) based on Jean Watson's caring theory. The empirical-rational method was combined through an inductive approach. Results: The four patients interviewed expressed perceptions inherent to the assumptions and care factors of the caring Theory: interpersonal relationship and health promotion (they facilitate trust and empowerment); adequate environment for personal development (improve transparency and satisfaction); patient as the central axis of nursing (increases the effectiveness and safety of care). Conclusions: The importance of including the patient in the transfer of information allows him to be the central axis of her care. This allows you to grow and promote your health, thanks to the environment of trust created and/or the communicative symbiosis between the participants.

La disfagia post extubación (DPE) es una complicación frecuente en pacientes sometidos a intubación orotraqueal (IOT). Actualmente, existe gran heterogeneidad en los reportes de su incidencia, fluctuando entre un 3 y un 81%. Tampoco existe consenso en relación con sus factores de riesgo. El objetivo del presente estudio fue determinar la incidencia y los factores de riesgo de DPE en pacientes adultos no neurológicos. Se realizó un estudio longitudinal retrospectivo. Se revisaron registros clínicos de pacientes sometidos a IOT en un hospital público de Chile entre junio del 2018 y junio del 2019. Se estimó la incidencia acumulada y se estimaron modelos de regresión logística univariados y multivariados para determinar los factores de riesgo. Se consideró la presencia/ausencia de DPE como variable respuesta, y edad, sexo, días de IOT, tiempo de la evaluación y diagnóstico de ingreso a UPC como variables predictoras. Se recopiló información de 141 pacientes, 72 hombres y 69 mujeres, con una edad promedio de 59 años. De los pacientes, el 73,05% presentó DPE. Tanto la edad como los días de IOT evidenciaron ser factores de riesgo de DPE. El sexo, el tiempo transcurrido hasta la evaluación y la causa de ingreso a la UPC no se asociaron a la presencia de DPE. En el periodo estudiado, se obtuvo una incidencia de un 73,05% de DPE. El principal factor de riesgo para DPE fue el tiempo de IOT, seguido por la edad. El resto de las variables estudiadas no evidenciaron ser factores de riesgo.

Introduction: In critically ill patients, nutritional support is a challenge in terms of both estimating their requirements and ensuring adherence to the prescribed treatment. Objective: To assess the association between requirements, prescription and adherence to energy and protein supplementation based on the phase of disease in critically ill patients. Sample and methods: We conducted a prospective, observational and analytical study in patients aged 0–18 years admitted to the paediatric intensive or intermediate care unit in 2020–2021. We collected data on demographic and anthropometric characteristics and the phase of disease (acute phase [AP] vs. non-acute phase [nAP]), in addition to prescribing (P) (indication of nutritional support), basal metabolic rate (BMR, Schofield equation), adherence to nutritional support (A) and protein requirements (R), and calculated the following ratios: P/BMR, P/R, A/BMR, A/R, and A/P. Results: The sample included 131 participants with a median age of 16 (4.5) months, of who 128 (97.7%) had comorbidities and 13 (9.9%) were in the AP. Comparing the phases of disease (AP vs. nAP), the median values for energy supplementation were P/BMR, 0.5 (IQR, 0.1–1.4) vs. 1.3 (IQR, 0.9–1.8) (P = 0.0054); A/BMR, 0.4 (IQR, 0–0.6) vs. 1.2 (IQR, 0.8–1.7) (P = 0.0005); A/P, 0.7 (IQR, 0–0.9) vs. 1 (IQR, 0.8–1) (P = 0.002), and for protein were P/R, 0.7 (IQR, 0–1.1) vs. 1.2 (0.9–1.6) (P = 0.0009); A/R 0.3 (IQR, 0–0.6) vs. 1.1 (IQR, 0.8–1.5) (P = 0.0002); A/P 0.7 (IQR, 0–1) vs. 1(IQR, 0.8–1) (P = 0.002). We found AP/nAP ratios greater than 110% for energy in the P/BMR (4 patients [30.8%]/72 patients [61%]; P = 0.007), A/BMR (3 [23%]/63 [53.4%]; P = 0.009) and A/P (1 [7%]/3 [2.5%]; P = 0.007). As for protein, more than 1.5 g/kg/day was prescribed in 3 patients (23.1%) in the AP and 71 (60.1%) in the nAP. We found adherence to the prescribed intake in 2 (15.4%) patients in the AP and 66 (56%) in the nAP. We found a correlation coefficient of 0.6 between the energy P/R and the protein P/R. Prescribed support was discontinued in 7 patients (53.8%) in the AP and 31 (26.3%) in the nAP (P = 0.002). Conclusions: The proportion of adherence to prescribed nutritional support was high in patients in the nAP of the disease. Overfeeding was frequent, more so in the nAP. We identified difficulties in adhering to prescribed support, chief of which was the discontinuation of feeding. Resumen: Introducción: El soporte nutricional en el paciente crítico es un desafío tanto en la estimación de requerimientos como en el cumplimiento de su prescripción. Objetivo: Evaluar las relaciones entre la prescripción, el requerimiento y el cumplimiento del soporte nutricional de energía y proteínas según la fase de la enfermedad en el paciente crítico. Pacientes y método: Estudio observacional, analítico, de datos obtenidos a través de reclutamiento prospectivo (2020–2021), pacientes de 0–18 años hospitalizados en la unidad de cuidados intensivos o intermedios pediátrica. Se obtuvieron datos demográficos, antropométricos y del estado agudo (FA)/no agudo (FNA) de la enfermedad. Se determinaron la prescripción (P) (indicación nutricional), el gasto energético basal (GEB) (fórmula de Schofield), el cumplimiento (C) de soporte nutricional, el requerimiento (R) proteico, creándose las siguientes relaciones: P/GEB, P/R, C/GEB, C/R, C/P. Resultados: Se incluyeron 131 sujetos con una mediana de 16 (4,5) meses; el 97,7% presentaban alguna comorbilidad y el 9,9% cursaban en FA. Al comparar FA/FNA tuvieron mediana (RIC) de energía: P/GEB 0,5 (0,1–1,4)/1,3 (0,9–1,8) (p = 0,0054); C/GEB 0,4 (0–0,6)/1,2 (0,8–1,7) (p = 0,0005); C/P 0,7 (0–0,9)/1 (0,8–1) (p = 0,002). Y proteínas: P/R 0,7 (0–1,1)/1,2 (0,9–1,6) (p = 0,0009); C/R 0,3 (0–0,6)/1,1 (0,8–1,5) (p = 0,0002); C/P 0,7 (0–1)/1 (0,8–1) (p = 0,002). Se encontró para energía FA/FNA > 110% en P/GEB en 4 pacientes (30,8%)/72 (61%) (p = 0,007), C/GEB en 3 pacientes (23%)/63 (53,4%) (p = 0,009) y C/P en 1 (7%)/3 (2,5%) (p = 0,007). En proteínas se prescribió > 1,5 g/kg/día en 3 (23,1%) pacientes en FA y 71 (60,1%) en FNA. El cumplimiento de este aporte fue de 2 (15,4%) pacientes en FA y 66 (56%) en FNA. Se encontró un coeficiente de correlación de 0,6 entre P/GEB de energía con P/R proteico. La suspensión fue de 7 (53,8%) pacientes en FA y 31 (26,3%) en FNA (p = 0,002). Conclusiones: La relación de cumplimiento de la prescripción fue alta en pacientes en FNA de la enfermedad. La sobrealimentación fue frecuente, siendo mayor en FNA. Se observó dificultad para cumplir la prescripción, siendo la causa principal la suspensión de la alimentación.

Introduction: The new SARS-CoV-2 coronavirus disease (COVID-19) spread rapidly throughout the world, which created a great challenge. The appearance of coinfections is among the most serious complications that these patients can develop. Pulmonary aspergillosis has been identified as a complication of COVID-19 pneumonia among ventilated patients in intensive care. Objective: To present an unusual clinical case of pulmonary aspergillosis. Clinical case: It is presented the case of a patient with a recent history of COVID-19, with an enteral clinical picture of diarrhea and vomiting plus respiratory failure, in which the evolution of colon cancer and ventilator-associated pneumonia caused by Aspergillus niger are concomitant. Conclusions: Pulmonary aspergillosis associated with COVID-19 is a complication that should be considered and sought in patients with a recent history of this disease.

Analisar o conhecimento que os profissionais de uma equipe que trabalha em Unidade de Terapia Intensiva possuem sobre comunicação de notícias difíceis. Método: estudo de caráter qualitativo e exploratório realizado em um hospital regional do estado do Maranhão no período de maio a novembro de 2019. Participaram do estudo 29 profissionais de nível superior. As informações obtidas foram coletadas por entrevista semiestruturada e tratadas pela análise de conteúdo. Resultados: os dados foram distribuídos em três categorias: percebendo a si durante a comunicação da notícia difícil; percebendo o contexto do processo de comunicação; e percebendo o outro como receptor da notícia difícil. Conclusão: os entrevistados realizavam a comunicação de notícias difíceis de maneira instintiva e sem a adoção de protocolos. Todavia ressaltaram alguns passos do protocolo ao destacarem os cuidados com essa comunicação, e reconheceram a necessidade de preparo adicional da comunicação de notícias difíceis para melhoria do serviço.

Objetivo: evaluar la asociación entre la clasificación de riesgo y el tiempo puerta-antibiótico en pacientes con sospecha de sepsis. Método: estudio de cohorte retrospectivo, con una muestra de 232 pacientes con sospecha de sepsis atendidos en el departamento de emergencias. Se dividieron en 2 grupos: con y sin clasificación de riesgo. Una vez identificado el tiempo puerta-antibiótico, se realizó un análisis de varianza de un factor con la prueba post hoc de Bonferroni o la prueba t de Student independiente para variables cuantitativas continuas; pruebas de correlación de Pearson, correlación biserial puntual o correlación biserial para análisis de asociación; y procedimiento de bootstrap cuando no había distribución normal de variables. Para el análisis de los datos se utilizó el software Statistical Package for the Social Sciences. Resultados: el tiempo puerta-antibiótico no difirió entre el grupo que recibió clasificación de riesgo en comparación con el que no fue clasificado. El tiempo puerta-antibiótico fue significativamente más corto en el grupo que recibió una clasificación de riesgo de alta prioridad. Conclusión: no hubo asociación entre el tiempo puerta-antibiótico y si se realizó o no la clasificación de riesgo, ni con la hospitalización en enfermería y en unidad de cuidados intensivos, ni con la duración de la estancia hospitalaria. Se observó que cuanto mayor era la prioridad, más corto era el tiempo puerta-antibiótico.

Objetivo: descrever as boas práticas realizadas pela equipe multiprofissional durante a aspiração de vias aéreas inferiores em pacientes adultos, internados na Unidade de Terapia Intensiva. Método: estudo quantitativo, observacional, descritivo e prospectivo, norteado pela ferramenta STROBE, realizado em uma Unidade de Terapia Intensiva adulto, entre maio e agosto de 2022. A amostra foi composta por 25 observações e a coleta de dados através de checklist, incluídos os profissionais de enfermagem, fisioterapia e medicina. Os dados foram processados no Statistical Package for the Social Sciences, sendo calculadas as frequências absolutas e relativas. Resultados: a maioria das aspirações foram realizadas pela equipe de enfermagem, 20 (80%) profissionais não regularam a fração inspirada de oxigênio antes e após o procedimento, 06 (60%) profissionais não clampearam a sonda durante a sua inserção. O uso de máscara (100%), capote (92%) e luva (100%) foram as boas práticas com maior aderência entre os participantes. Conclusão: reforça-se a necessidade de incentivar os treinamentos abordando as boas práticas durante a aspiração endotraqueal. Descritores: Unidades de Terapia Intensiva. Cuidados Críticos. Sucção. Manuseio das Vias Aéreas. Recomendação de Boas Práticas.

Objetivo: analizar la respuesta emocional de pacientes conscientes en estado crítico durante la higiene diaria en una unidad de cuidados intensivos cardiológicos y compararla en función de experiencias previas o no. Método: estudio prospectivo y descriptivo. Encuesta ad hoc de 30 ítems realizada a 148 pacientes y basada en la higiene del primer día. Se formulan preguntas sobre los sentimientos durante la higiene y aspectos positivos y negativos de la experiencia. Se compara a los pacientes en función de si se los había higienizado con anterioridad. Resultados: el 67,6% fueron hombres y la media de edad fue de 67±15 años. El 45,9% presentó conformismo, el 27% sintió vergüenza y el 86,3% agradeció que le hablaran durante la higiene. Al 33,1% de los pacientes nunca les habían realizado higiene en la cama, eran significativamente más jóvenes y solteros, y tenían menor sensación de limpieza. El 32% expresó que le gustaría que un familiar colaborase en la higiene. Conclusión: los pacientes no sienten que se invade su intimidad cuando se los higieniza y aprecian la comunicación con el personal sanitario durante estos cuidados. Los pacientes a quienes no les habían realizado higiene en la cama previamente son más jóvenes, sienten mayor vergüenza y les molestan más las interrupciones, siendo más conscientes de ellas.

Objective: To understand the perception of the nurses who work in the Shock Unit about care during fibrinolytic therapy. Method: Qualitative study, Ethnographic approach, according to ethno-nursing, of Leininger's theory. Thirty-four nurse practitioners participated in a shock unit for adults of a Mexican general hospital. The data were obtained through a semi-structured interview, participant observation, it opted for the content analysis that allowed the elaboration of the categories that facilitated the understanding the data. Results: The analysis revealed the themes: An experience in the time of the other, the scientific and humanistic with a light on the paradigmatic path; opportunity from the nature of life and care from the sensitive vision of my human side. Conclusion: human care is perceptible by belief, motivated from the experiences lived in intensive care units, in this scenario it is necessary to promote hospital cross-cultural studies, due to the scientific wealth of nursing interventions in the shock unit, that strengthens cares like a light on the road. [ABSTRACT FROM AUTHOR]

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Copyright of Dilemas Contemporáneos: Educación, Política y Valores is the property of Dilemas Contemporaneos: Educacion, Politica y Valores 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.)

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Objective: To analyze the knowledge of professionals working in an Intensive Care Unit regarding the communication of bad news. Method: A qualitative and exploratory study conducted in a regional hospital in the state of Maranhão from May to November 2019. The study involved 29 higher-level professionals. Data were collected through semi-structured interviews and analyzed using content analysis. Results: The data were categorized into three groups: self-perception during the communication of bad news, perception of the context of the communication process, and perception of the other as the recipient of bad news. Conclusion: The interviewees communicated bad news instinctively and without following protocols. However, some steps of the protocol were highlighted, emphasizing the importance of careful communication in these situations. They recognized the need for additional training in delivering bad news to enhance the service. [ABSTRACT FROM AUTHOR]

Introduction: The Intensive Care Unit (ICU) is an environment where critical patients must be treated by a multidisciplinary team. What becomes extremely important to recognize the clinical epidemiological profile to evaluate individually. Objective: To analyze the epidemiological profile of patients admitted to an ICU of a University Hospital and its relationship with the Fugulin scale. Method: This is a retrospective, descriptive study with a quantitative approach, which carried out an analysis of the epidemiological profile, outcomes and variables associated with morbidity and mortality, through reports of patients hospitalized from March to August 2020. Results: It was observed that most of these hospitalized patients were male, referred by the Emergency Medical Care Service, were diagnosed more frequently: acute respiratory failure, sepsis and acute renal failure, with a prevalent outcome in deaths, having been observed correlation of the Fugulin scale with the mortality and severity scores of these patients. Conclusion: In view of the complexity in the care of critically ill patients, the study demonstrates that the Fugulin scale can be an alternative in clinical practice, relating the need for care with severity and mortality to patients in an ICU. [ABSTRACT FROM AUTHOR]

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Objetivo. Esta investigación tiene como objetivo describir la población atendida y los beneficios del programa “Lineamiento de atención integral por Cuidados Paliativos en el Área de Salud de Palmares, para pacientes con SARS-CoV-2 severo” con ventilación mecánica asistida, hospitalizados en unidades de cuidados intensivos de la Caja Costarricense del Seguro Social durante la pandemia en Costa Rica, del 10 de junio al 31 de octubre del 2021. Métodos. Estudio descriptivo mixto de la población y los beneficios del programa por medio de indicadores cuantitativos obtenidos del informe de aplicación y cualitativos a través de la realización de una encuesta de satisfacción a usuarios en el período de estudio. Resultados. El programa atendió a 13 pacientes, brindó apoyo en manejo del duelo a los familiares de cinco pacientes que ya habían fallecido y a los cuidadores de ocho pacientes hospitalizados, también ofreció 70 consultas médicas en un período promedio de 62 días. La edad promedio de los pacientes fue de 55 años; doce pacientes presentaban algún factor de riesgo, siendo la obesidad y la falta de esquema de vacunación completo (dos dosis) los más frecuentes. Durante la implementación del programa fallecieron cinco pacientes más, obteniendo una tasa de mortalidad del 78%. A los pacientes que sobrevivieron se les atendió en promedio por 135 días. Con el apoyo del equipo, los pacientes lograron la recuperación clínica de las complicaciones respiratorias y funcionales. Lograron independencia total de actividades básicas de la vida diaria y reinserción social en menos de tres meses después del alta hospitalaria. En general, se documentó una percepción positiva del programa en el 100% de los usuarios, con cambios en el nivel de sufrimiento manifestado por las familias y el apoyo en el manejo del duelo. Conclusión. Con la optimización de uso de los recursos ya existentes en la Caja Costarricense del Seguro Social y la participación social, este programa abordó aspectos no atendidos previamente para los pacientes que sufrieron COVID 19 severo, como el manejo del sufrimiento y/o duelo durante la hospitalización y al egreso. Además, el programa colaboró en la recuperación clínica y funcional de los usuarios sobrevivientes y documentó múltiples beneficios percibidos por el paciente, sus familias, la institución y la sociedad, como el abordaje del sufrimiento, la adecuada atención al duelo, la organización de los recursos asistenciales y la pronta recuperación física, emocional y social del paciente sobreviviente.

Objetivo: determinar a incidência de lesões por pressão relacionadas a dispositivos médicos e os fatores associados em unidade de terapia intensiva adulta. Método: quantitativo, observacional, prospectivo. Os dados foram coletados entre setembro e novembro de 2020, em um hospital público. Utilizou-se instrumento para avaliações diárias da pele sob e peri os dispositivos. Resultados: foram analisados 1.579 dispositivos em 292 avaliações, em 47 pacientes. Identificando-se 233 lesões (14,9%). A incidência de lesões foi de 6,1%. Em 20,9% (n= 61) dos dispositivos utilizados, as lesões foram relacionadas ao tubo orotraqueal. Com relação às regiões acometidas por lesões, 10,4% (n= 24) ocorreram nas orelhas; 7,8% (n= 18), na face. As lesões estágio 1 foram as mais frequentes (n=147; 63,3%) nas avaliações realizadas. Conclusão: observou-se incidência de 6,1%. Ressalta-se a necessidade de manter a vigilância, em especial em pacientes com tubo endotraqueal. Medidas de prevenção devem ser adotadas para diminuir a ocorrência destas lesões.

Enquadramento: A escassez de estudos sobre complicações locais associadas ao cateterismo venoso periférico em doente crítico em Portugal compromete a implementação de medidas preventivas adequadas. Objetivo: Analisar as complicações locais associadas ao cateterismo venoso periférico no doente crítico num Serviço de Medicina Intensiva em Portugal. Metodologia: Estudo transversal analítico prospetivo, realizado através da aplicação de uma grelha de registo elaborada pelo investigador a uma amostra de 48 doentes. Resultados: Amostra maioritariamente masculina (54,2%), com média de idade de 70,13 anos, com cateter venoso periférico de calibre 20G (58,5%), colocados no membro superior (58,5%) e com diagnóstico na admissão de doenças infeciosas e parasitárias (33,3%). As complicações locais associadas ao cateterismo venoso periférico foram de 11,6%, sendo 6,4% flebites, 2,3% infiltrações e 2,9% obstruções. Estas associaram-se ao tempo de permanência do cateter (p < 0,05). Conclusão: A frequência de complicações foi significativa e o tempo de permanência do cateter influenciou a frequência de complicações. Recomendamos reduzir o tempo de permanência do cateter ou, quando possível, utilizar uma via alternativa.