Escala de alerta precoce na identificação de pacientes com risco de deterioração clínica / Early warning scale for identifying patients at risk of clinical deterioration / Escala de alerta temprana en la identificación de pacientes con riesgo de deterioro clínico

Objetivo: avaliar pontuação da National Early Warning Score (NEWS) em relação ao tipo de desfecho e perfil dos pacientes da enfermaria clínica médica de um hospital em Teresina, Piauí, Brasil. Método: estudo quantitativo realizado num hospital público, em Teresina, com 150 prontuários de pacientes internados no setor clínica médica de fevereiro de 2022 a dezembro de 2022, a partir de registros demográficos, clínicos e valores da escala na admissão e desfecho. Resultados: houve associação dos valores da escala com a faixa etária (p=0,029), tempo de internação (p=0,023) e tipo de desfecho (p < 0,001). Alto risco clínico prevaleceu entre pacientes do sexo masculino (13%), na faixa etária de 60 a 94 anos (13%), com permanência de 21 a 57 dias (19,2%) e óbito como desfecho (100%). Conclusão: implementação da referida escala evidenciou ser fundamental para prever agravos clínicos e melhorar qualidade da assistência.

Objective: to evaluate the National Early Warning Score (NEWS) in relation to the type of outcome and profile of patients in the medical clinical ward of a hospital in Teresina, Piauí, Brazil. Method: a quantitative study conducted in a public hospital in Teresina, with 150 medical records of patients admitted to the medical clinic sector from February 2022 to December 2022, based on demographic and clinical records and scale values at admission and outcome. Results: there was an association between the scale values and the age group (p=0.029), length of stay (p=0.023) and type of outcome (p < 0.001). High clinical risk prevailed among male patients (13%), aged between 60 and 94 years (13%), with a stay of 21 to 57 days (19.2%), and death as an outcome (100%). Conclusion: implementation of the aforementioned scale proved to be fundamental for predicting clinical problems and improving care quality.

Objetivo: evaluar el puntaje de la National Early Warning Score (NEWS) con respecto al tipo de desenlace y el perfil de los pacientes de la enfermería clínica médica de un hospital en Teresina, Piauí, Brasil. Método: estudio cuantitativo realizado en un hospital público en Teresina, con 150 historiales médicos de pacientes internados en el sector de clínica médica desde febrero de 2022 hasta diciembre de 2022, a partir de registros demográficos, clínicos y valores de la escala en la admisión y desenlace. Resultados: hubo asociación de los valores de la escala con la edad (p=0,029), tiempo de internación (p=0,023) y tipo de desenlace (p < 0,001). El alto riesgo clínico prevaleció entre los pacientes del sexo masculino (13%), en la franja de edad entre 60 y 94 años (13%), con una estancia de 21 a 57 días (19,2%) y fallecimiento como desenlace (100%). Conclusión: la implementación de dicha escala demostró ser fundamental para prever agravios clínicos y mejorar la calidad de la asistencia.

Evaluación de signos vitales mediante una aplicación móvil en pacientes con insuficiencia cardiaca: ¿una oportunidad para la titulación remota? / Evaluation of vital signs through a mobile application in patients with heart failure: a opportunity for remote titration?

Resumen Antecedentes: Las consultas virtuales aumentaron exponencialmente, pero presentan como limitación la imposibilidad de valorar los signos vitales (SV), siendo especialmente útiles en los pacientes con insuficiencia cardiaca (IC) para titular medicación que modifica pronóstico. Este problema podría potencialmente solucionarse mediante una herramienta que pueda medir la presión arterial (PA) y frecuencia cardiaca (FC) de manera precisa, accesible y remota. Los teléfonos móviles equipados con tecnología de imágenes ópticas transdérmicas podrían cumplir con estos requisitos. Objetivo: Evaluar la precisión de una app basada en imagen óptica transdérmica para estimar SV en relación con la valoración clínica en pacientes con IC. Métodos: Estudio de cohorte prospectivo, se incluyeron pacientes evaluados en una unidad ambulatoria de IC de febrero a abril del 2022. Se valoró simultáneamente la PA y FC mediante la app y el examen clínico (PA con un esfigmomanómetro automatizado y FC por palpación braquial). Se realizaron tres mediciones por app y clínica en cada paciente, por dos médicos independientes, encontrándose ciegos a los resultados. Resultados: Se incluyeron 30 pacientes, con 540 mediciones de TA y de FC. Edad media de 66 (± 13) años, el 53.3% de sexo masculino. La fracción de eyección del ventrículo izquierdo media fue de 37 ± 15, con hospitalizaciones previas por IC el 63.3%, en CF II-III el 63.4%. La diferencia media entre la medición de la app y su medición de referencia clínica fue de 3.6 ± 0.5 mmHg para PA sistólica (PAS), 0.9 ± -0.2 mmHg para PA diastólica (PAD) y 0.2 ± 0.4 lpm para FC. Cuando se promedian las diferencias medias emparejadas para cada paciente, la media entre los 30 pacientes es de 2 ± 6 mmHg para PAS, -0.14 ± 4.6 mmHg para PAD y 0.23 ± 4 lpm para FC. Conclusión: La estimación de PA y FC por una app con tecnología de imagen óptica transdérmica fue comparable a la medición no invasiva en pacientes con IC, y cumple los criterios de precisión de la medición de PA en este estudio preliminar. La utilización de esta nueva tecnología de imagen óptica transdérmica brinda datos prometedores, que deberán ser corroborados en cohortes de mayor tamaño.

Abstract Background: Virtual consultations have increased exponentially, but a limitation is the inability to assess vital signs (VS). This is particularly useful in patients with heart failure (HF) for titrating prognosis-modifying medication. This issue could potentially be addressed by a tool capable of measuring blood pressure (BP) and heart rate (HR) accurately, remotely, and conveniently. Mobile phones equipped with transdermal optical imaging technology could meet these requirements. Objective: To evaluate the accuracy of a transdermal optical imaging-based app for estimating VS compared to clinical assessment in patients with HF. Methods: A prospective cohort study included patients evaluated in an HF outpatient unit between February and April 2022. BP and HR were simultaneously assessed using the app and clinical examination (BP with an automated sphygmomanometer and HR by brachial palpation). Three measurements were taken by both the app and clinic for each patient, by two independent blinded physicians. Results: Thirty patients were included, with 540 measurements of BP and HR. The mean age was 66 (± 13) years, 53.3% were male. The mean left ventricular ejection fraction was 37 ± 15, with 63.3% having previous hospitalizations for HF, and 63.4% in NYHA class II-III. The mean difference between the app measurement and its clinical reference measurement was 3.6 ± 0.5 mmHg for systolic BP (SBP), 0.9 ± -0.2 mmHg for diastolic BP (DBP), and 0.2 ± 0.4 bpm for HR. When averaging the paired mean differences for each patient, the mean across the 30 patients was 2 ± 6 mmHg for SBP, -0.14 ± 4.6 mmHg for DBP, and 0.23 ± 4 bpm for HR. Conclusion: The estimation of BP and HR by an app with transdermal optical imaging technology was comparable to non-invasive measurement in patients with HF and met the precision criteria for BP measurement in this preliminary study. The use of this new transdermal optical imaging technology provides promising data, which should be corroborated in larger cohorts.

Evaluation of Anxiety and Vital Signs in Adults Undergoing Different Dental Procedures: A Prospective Study

The aim of this study was to evaluate the vital signs related with different dental treatments, and correlate with demographic data and participants' anxiety level. This is a prospective clinical study with 60 participants, divided into 3 groups of dental procedures: (1) restorative treatment, (2) extractions and biopsies, and (3) gingival treatment. A level of anxiety questionnaire before dental procedure proposed by Corah's Dental Anxiety Scale was collected. Respiratory rate, systolic and diastolic pressure, temperature and oxygenation were measured before, during and after the procedures. 31 (51.7 %) women and 29 (48.3 %) men were included, with mean age of 41.75 years old. Most participants (50 %) were classified as very little anxious. Diastolic pressure before the procedure was higher for slightly anxious patients when compar ed with very little anxious patients (p=0.028). Systolic pressure before, during and after the procedure was higher for participan ts above 40 years old (p=0,001). Heart rate (p=0,050) and temperature (p=0,041) was higher before the restorative treatment. Anxiety can promote changes in vital signs in the dental environment. Vital signs, sex, age and level of anxiety do influence the blood pressure at different clinical moments. Dental procedures have association with variations in temperature, heart and respiratory rate.

El objetivo de este estudio fue evaluar los signos vitales relacionados con diferentes tratamientos dentales y correlacionarlos con datos demográficos y el nivel de ansiedad de los participantes. Este es un estudio clínico prospectivo con 60 participantes, divididos en 3 grupos de procedimientos dentales: (1) tratamiento restaurador, (2) extracciones y biopsias, y (3) tratamiento gingival. Se recogió un cuestionario de nivel de ansiedad antes del procedimiento odontológico propuesto por la Escala de Ansiedad Dental de Corah. Se midieron la frecuencia respiratoria, la presión sistólica y diastólica, la temperatura y la oxigenación antes, durante y después de los procedimientos. Se incluyeron 31 (51,7 %) mujeres y 29 (48,3 %) hombres, con edad media de 41,75 años. La mayoría de los participantes (50 %) fueron clasificados como muy poco ansiosos. La presión diastólica antes del procedimiento fue mayor en los pacientes ligeramente ansiosos en comparación con los pacientes muy poco ansiosos(p=0,028). La presión sistólica antes, durante y después del procedimiento fue mayor para los participantes mayores de 40 años (p=0,001). La frecuencia cardíaca (p=0,050) y la temperatura (p=0,041) fueron mayores antes del tratamiento restaurativo. La ansiedad puede promover cambios en los signos vitales en el entorno dental. Los signos vitales, el sexo, la edad y el nivel de ansiedad sí influyen en la presión arterial en los diferentes momentos clínicos. Los procedimientos dentales tienen asociación con variaciones de temperatura, frecuencia cardíaca y respiratoria.

Análise do perfil clínico e epidemiológico das internações por asma no período de 2020 a 2021 em um hospital do sul de Santa Catarina / Analysis of the clinical and epidemiological profile of hospitalizations due to asthma in the period 2020­2021 in a hospital in southern Santa Catarina, Brazil

INTRODUÇÃO: A asma brônquica é uma doença crônica inflamatória de alta frequência mundialmente, e em especial no Brasil, onde ocorreram mais de 100.000 internações por ano, segundo dados do DATASUS. Identificar pacientes em admissão hospitalar que poderão necessitar de leito em UTI ou uso de ventilação mecânica por conta de crises asmáticas é um desafio ao profissional de saúde, portanto, faz-se importante analisar variáveis clínicas que possam predispor agravos e avaliar pacientes mais vulneráveis, para que as condutas realizadas sejam efetivas e rápidas. OBJETIVO: Analisar o perfil clínico e epidemiológico de pacientes internados em um hospital do sul do Brasil e avaliar os preditores relacionados ao maior tempo de internação. MÉTODOS: Estudo epidemiológico observacional, do tipo transversal, que utilizou como fonte de informação dados secundários, os quais foram obtidos através de prontuários de pacientes internados em um hospital do sul do Brasil. RESULTADOS: Foram analisados 261 prontuários. Verificou-se que a população menor de 40 anos de idade teve maior prevalência, representando 57% das internações. Além disso, em relação a gênero e etnia, mulheres e caucasianos foram as populações com maiores taxas de hospitalização, sendo 63% e 87% das admissões hospitalares, respectivamente.A necessidade de internação em UTI foi encontrada em 1,1% dos casos (3 pacientes), cerca de 6,9% tiveram internações prolongadas (maiores de 3 dias), e 0,8% vieram à óbito (2 pacientes). Identificou-se que a baixa saturação de oxigênio e a alta frequência cardíaca tiveram relação significativa com internação prolongada. CONCLUSÃO: É importante analisar sinais vitais no momento das admissões hospitalares e o perfil epidemiológico dos pacientes para que as populações mais prevalentes e os fatores preditivos de desfechos mais graves possam ser acompanhados e a conduta a ser tomada seja adequada e efetiva.

INTRODUCTION: Bronchial asthma is a chronic inflammatory disease with a high worldwide frequency, especially in Brazil, where more than 100,000 asthma-related hospitalizations occur annually according to DATASUS data. Identifying patients upon hospital admission who may require an ICU bed or mechanical ventilation due to an asthma attack is a challenge for healthcare professionals. It is important to analyze clinical variables that may predispose to deterioration and evaluate more vulnerable patients to ensure that effective interventions are instituted promptly. OBJECTIVE: To analyze the clinical and epidemiological profile of patients admitted due to asthma in a hospital in southern Brazil and evaluate predictors of longer hospital stay. METHODS: Observational epidemiological study with a cross-sectional design.The source of information were secondary data obtained from medical records of patients admitted to a hospital in southern Brazil. RESULTS: Overall, 261 medical records were analyzed.Patients were predominantly under the age of 40, representing 57% of hospitalizations. In terms of gender and ethnicity, most patients were female (63%) and white (87%).Three patients (1.1%) required ICU admission, approximately 6.9% had prolonged hospitalizations (>3 days), and 2 (0.8%) died. Low oxygen saturation and elevated heart rate correlated significantly with prolonged hospitalization. CONCLUSION: Vital signs at the time of hospital admission and the epidemiological profile of patients should be analyzed, so that the most prevalent populations and predictors of severe outcomes can be monitored, and appropriate and effective measures can be taken.

Clinicalstudy on the effect of pentatone therapy on perioperative anxiety state / 现代医院

Objective To explore the effect of pentatone therapy in surgical patients.Methods A prospective random-ized controlled trial was used to select 100 surgical patients admitted to our hospital from January 2022 to September 2022 as the study object.They were divided into two groups according to the time of operation:50 surgical patients admitted from January to June 2022 who did not participate in the traditional Chinese medicine pentatone therapy were selected as the control group;From July to December 2022,50 surgical patients who were treated with pentatone therapy of traditional Chinese medicine were selected as the intervention group.The perioperative vital signs,anxiety,patient satisfaction and operation time were compared between the two groups.Results There was no significant difference in vital signs and anxiety between the two groups 60 minutes before admission(P＞0.05);The levels of heart rate,systolic blood pressure and diastolic blood pressure in the intervention group were(74.57±5.39)beats/min,(110.92±4.03)mmHg and(79.73±4.10)mmHg,respectively,lower than those in the control group,and the satisfaction was higher than that in the control group,the difference was statistically significant(P＜0.05).Conclusion The pentatone therapy of traditional Chinese medicine can improve the anxiety state of patients during peri-operative period,maintain the stability of vital signs and improve the satisfaction of patients.

Continuous vital signs monitoring using wireless wearable devices in patients after video-assisted thoracoscopic surgery for lung cancer: A prospective self-control study / 中国胸心血管外科临床杂志

@#Objective To explore the reliability and safety of continuous monitoring of vital signs in patients using wireless wearable monitoring devices after video-assisted thoracoscopic surgery (VATS) for lung cancer. Methods The patients undergoing VATS for lung cancer in West China Hospital, Sichuan University from May to August 2023 were prospectively enrolled. Both wireless wearable and traditional wired devices were used to monitor the vital signs of patients after surgery. Spearman correlation analysis, paired sample t test and ratio Bland-Altman method were used to test the correlation, difference and consistency of monitoring data measured by the two devices. The effective monitoring rate of the wireless wearable device within 12 hours was calculated to test the reliability of its continuous monitoring. Results A total of 20 patients were enrolled, including 15 females and 5 males with an average age of 46.20±11.52 years. Data collected by the two monitoring devices were significantly correlated (P<0.001). Respiratory rate and blood oxygen saturation data collected by the two devices showed no statistical difference (P>0.05), while heart rate measured by wireless wearable device was slightly lower (=−0.307±1.073, P<0.001), and the blood pressure (=1.259±5.354, P<0.001) and body temperature(=0.115±0.231, P<0.001) were slightly higher. The mean ratios of heart rate, respiratory rate, blood oxygen saturation, blood pressure and body temperature collected by the two devices were 0.996, 1.004, 1.000, 1.014, and 1.003, respectively. The 95% limits of agreement (LoA) and 95% confidence interval of 95%LoA of each indicator were within the clinically acceptable limit. The effective monitoring rate of each vital signs within 12 hours was above 98%. Conclusion The wireless wearable device has a high accuracy and reliability for continuous monitoring vital signs of patients after VATS for lung cancer, which provides a security guarantee for subsequent large-scale clinical application and further research.

Relação entre os sinais vitais e as concentrações plasmáticas de óxido nítrico / Relationship between vital signs and plasma nitric oxide concentrations

A sepse e o choque séptico são as principais preocupações globais de saúde no mundo e um grave problema de saúde no Brasil, sendo uma das principais causas de mortalidade nas unidades de terapia intensiva. O óxido nítrico na fisiopatologia da sepse tem sido usado como um biomarcador de gravidade em pacientes sépticos devido as alterações hemodinâmicas microvascular e sistêmicas, refletindo em alterações dos sinais vitais, causadas pelo excesso de óxido nítrico. O objetivo deste trabalho, foi demonstrar a relevância da verificação dos sinais vitais e análise de exames laboratoriais mais comuns na sepse, correlacionado os mesmos com as concentrações plasmáticas de óxido nítrico, no sentido de monitorar o paciente com sepse e choque séptico. O estudo foi realizado em dois hospitais brasileiros, sendo o hospital A localizado no sul de minas gerais e o hospital B na região noroeste paulista, constituídos de 166 pacientes maiores de 18 anos, sendo 104 pacientes do hospital A e 62 do hospital B, que apresentaram diagnóstico de sepse e choque séptico confirmados e internados nas unidades de clínica médica/cirúrgica, urgência/emergência, maternidade e terapia intensiva. As orientações e aceite em participar do estudo foram realizadas no próprio leito do paciente após sua estabilização clínica e a abordagem aos familiares e/ou responsável legal para aqueles pacientes com instabilidade hemodinâmica. Os dados demográficos, clínicos e laboratoriais foram coletados por meio do prontuário eletrônico, a aferição dos sinais vitais e coleta de sangue após a confirmação do diagnóstico de sepse ou choque séptico, entre março de 2021 a janeiro de 2022. As amostras contendo 3 ml de sangue, identificadas e rotuladas, foram centrifugadas em rotação de 3.500 rpm, por 10 minutos a temperatura de 23ºC a 25ºC. Ao final, o sobrenadante contendo plasma sanguíneo foi desproteinizado por incubação com etanol absoluto 4ºC, mantido por 30 minutos em freezer (-20ºC). Posteriormente submetidas à centrifugação 10.000 rpm por 10 minutos à 23ºC e realizado a técnica de quimiluminescência NO/ozônio. Os resultados evidenciaram maiores concentrações plasmáticas de nitrato em pacientes com piores prognósticos e desfechos, e correlação com sinais vitais e exames laboratoriais da sepse que evidenciam a presença de disfunção orgânica. Quanto maior o nitrato maior foram os níveis de lactato plasmático, ureia, creatinina, potássio e tempo de protrombina, e menores a contagem das plaquetas no sangue. Dentre os sinais vitais, os valores da temperatura corporal, a pressão diastólica e a pressão arterial média foram menores quando evidenciado maiores concentrações de nitrato. Em conjunto, os resultados encontrados mostram que o aumento da concentração do nitrato se associa com a gravidade da sepse e entre as alterações dos sinais vitais, a hipotermia mostrou-se um dado vital de alerta à gravidade clínica dos pacientes. As alterações da frequência respiratória e a pressão sistólica são componentes de escores de gravidade utilizados na prática clínica atual, porém esses sinais vitais não foram evidenciados como sinalizadores de alerta à gravidade de pacientes sépticos.

Sepsis and septic shock are the main global health concerns in the world and a serious health problem in Brazil, being one of the main causes of mortality in intensive care units. Nitric oxide in the pathophysiology of sepsis plays as a biomarker of severity in septic patients due to microvascular and systemic hemodynamic changes, reflecting changes in vital signs caused by excess nitric oxide. The objective of this work was to demonstrate the relevance of checking vital signs and analyzing the most common laboratory tests in sepsis, correlating them with plasma nitric oxide concentrations, in order to monitor patients with sepsis and septic shock. The study was carried out in two Brazilian hospitals - hospital A located in the south of Minas Gerais and hospital B in the northwestern region of São Paulo - consisting of 166 patients over 18 years old, 104 patients from hospital A and 62 from hospital B, which had had a confirmed diagnosis of sepsis and septic shock and were admitted to medical/surgical, urgency/emergency, maternity and intensive care units. The instructions and acceptance to participate in the study were carried out at the patient's own bed after clinical stabilization and the approach to family members and/or legal guardians for those patients with hemodynamic instability. Demographic, clinical and laboratory data were collected through electronic medical records, measurement of vital signs and blood collection after confirmation of the diagnosis of sepsis or septic shock, between March 2021 and January 2022. Samples containing 3 ml of blood, identified and labeled, were centrifuged at 3,500 rpm for 10 minutes at a temperature of 23ºC to 25ºC. Finally, the supernatant containing blood plasma was deproteinized by incubation with absolute ethanol at 4ºC, kept for 30 minutes in a freezer (-20ºC). Subsequently, they were subjected to centrifugation at 10,000 rpm for 10 minutes at 23ºC and the NO/ozone chemiluminescence technique was performed. The results showed higher plasma nitrate concentrations in patients with worse prognoses and outcomes, and correlation with vital signs and sepsis laboratory tests that demonstrate the presence of organic dysfunction. The higher the nitrate, the higher the levels of plasma lactate, urea, creatinine, potassium and prothrombin time, and the lower the blood platelet count. Among vital signs, body temperature, diastolic pressure and mean arterial pressure values were lower when there was higher nitrate concentrations. Altogether, the results found show that the increase in nitrate concentration is associated with the severity of sepsis and among the changes in vital signs, hypothermia proved to be a vital indicator of the clinical severity of patients. Respiratory rate and systolic pressure are components of severity scores used in current clinical practice, but these vital signs have not been demonstrated as warning signs of the severity of septic patients.

Development of Human Vital Signs and Body Posture Monitoring and Positioning Alarm Systems / 中国医疗器械杂志

In view of the high incidence of malignant diseases such as malignant arrhythmias in the elderly population, accidental injuries such as falls, and the problem of no witnesses when danger occurs, the study developed a human vital signs and body posture monitoring and positioning alarm system. Through the collection and analysis of electrocardiogram (ECG), respiration (RESP) and acceleration (ACC) signals, the system monitors human vital signs and body posture in real time, automatically judges critical states such as malignant arrhythmias and accidental falls on the local device side, and then issues alarm information, opens the positioning function, and uploads physiological information and patient location information through 4G communication. Experiments have shown that the system can accurately determine the occurrence of ventricular fibrillation and falls, and issue position and alarm information.

Effects of dexmedetomidine on stress response and postoperative recovery in children undergoing laparoscopic surgery / 中国基层医药

Objective:To investigate the effects of dexmedetomidine on stress response and postoperative recovery in children undergoing laparoscopic surgery.Methods:A total of 200 pediatric patients undergoing laparoscopic surgery who received treatment in Jinhua Maternal and Child Health Hospital from May 2021 to December 2022 were included in this prospective randomized controlled study. These patients were randomly divided into Group A and Group B. Group A ( n = 100) received an intravenous infusion of physiological saline before anesthesia induction, while Group B ( n = 100) received an intravenous infusion of 0.5 μg/kg dexmedetomidine, and the other anesthesia methods were the same as the Group A. Vital signs (mean arterial pressure, heart rate), stress reactions (norepinephrine, cortisol, blood glucose), postoperative recovery status (eye-opening time, time to orientation, extubation time), the occurrence of restlessness (restlessness score, duration of restlessness), and adverse reactions (nausea, vomiting, tachycardia, laryngeal spasm, respiratory depression) were compared between different time points [before infusion (T0), 10 minutes after infusion (T1), postoperative wakefulness (T2), and 5 minutes after extubation (T3)]. Results:At T1, T2, T3, the mean arterial pressure and heart rate in Group B [(81.53 ± 7.45) mmHg (1 mmHg = 0.133 kPa), (78.32 ± 8.23) mmHg, (85.73 ± 7.28) mmHg, (109.43 ± 7.78) beats/minute, (106.22 ± 7.25) beats/minute, and (112.34 ± 6.74) beats/minute] were significantly higher than those in Group A [(76.39 ± 7.21) mmHg, (73.54 ± 7.41) mmHg, (80.34 ± 6.81) mmHg, (102.58 ± 7.34) beats/minute, (99.14 ± 6.90) beats/minute, (107.76 ± 6.38) beats/minute, t = 4.95, 4.31, 5.40, 6.40, 7.07, 4.93, all P < 0.001]. At 1 day after surgery, the levels of norepinephrine, cortisol, and blood glucose in Group B [(352.73 ± 60.32) ng/L, (310.85 ± 67.61) nmol/L, (4.89 ± 0.97) mmol/L ] were significantly lower than those in Group A [(427.82 ± 72.95) ng/L, (375.33 ± 74.97) nmol/L, (5.53 ± 1.10) mmol/L, t = 7.93, 6.38, 4.36, P < 0.001]. The time to eye-opening, time to orientation, and time to extubation in Group B were (10.06 ± 1.93) minutes, (10.54 ± 2.10) minutes, and (11.92 ± 2.06) minutes, respectively, which were significantly shorter than (11.88 ± 2.14) minutes, (12.43 ± 2.65) minutes, and (14.46 ± 2.43) minutes ( t = 6.31, 5.59, 7.97, all P < 0.001). The pediatric anesthesia emergence delirium score in Group B was (8.19 ± 2.10) points, which was significantly lower than (11.56 ± 2.62) points in Group A ( t = 10.03, P < 0.001). The duration of restlessness in Group A was (7.41 ± 1.27) minutes, which was significantly shorter than (9.33 ± 1.65) minutes in Group B ( t = 9.22, P < 0.001). There was no significant difference in the incidence of adverse reactions between Group A and Group B [8.00% (8/100) vs. 6.00% (6/100), χ2 = 0.30, P > 0.05]. Conclusion:Dexmedetomidine has a good application effect in pediatric laparoscopic surgery. It can stabilize the vital signs of children, reduce stress reactions, facilitate postoperative recovery, and reduce restlessness and adverse reactions.

Features of the triggering of the yellow code and factors associated with the occurrence of adverse events / Características de la activación del código amarillo y factores relacionados a la ocurrencia de eventos adversos / Características do acionamento do código amarelo e fatores associados à ocorrência de eventos adversos

ABSTRACT Objective: to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team. Methods: a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo. Results: among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014). Conclusions: decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.

RESUMEN Objetivo: analizar características de la activación del código amarillo en unidades de internación e identificar factores relacionados a ocurrencia de eventos adversos después de la atención del Equipo de Respuesta Rápida. Métodos: estudio transversal con análisis retrospectivo de prontuarios de adultos internados en enfermerías de Clínica Médica o Quirúrgica de hospital universitario de São Paulo. Resultados: entre 91 pacientes, los signos más frecuentes de las activaciones (n=107) fueron saturación periférica de oxígeno inferior a 90% (40,2%) y hipotensión arterial (30,8%). Cuanto a factores relacionados, identificado que cada minuto de atención del Equipo de Respuesta Rápida en enfermerías aumentó en 1,2% la chance de ocurrencia de eventos adversos (24 admisiones no planeadas en Unidad de Cuidado Intensivo y un paro cardíaco) en la amuestra (p=0,014). Conclusiones: caída de saturación de oxígeno e hipotensión arterial fueron los principales motivos de activación, y tiempo de ateción fue relacionado a ocurrencia de eventos adversos.

RESUMO Objetivo: analisar as características do acionamento do código amarelo em unidades de internação e identificar os fatores associados à ocorrência de eventos adversos após o atendimento do Time de Resposta Rápida. Métodos: estudo transversal com análise retrospectiva de prontuários de adultos internados em enfermarias de Clínica Médica ou Cirúrgica de hospital universitário de São Paulo. Resultados: entre os 91 pacientes, os sinais mais frequentes dos acionamentos (n=107) foram saturação periférica de oxigênio inferior a 90% (40,2%) e hipotensão arterial (30,8%). Quanto aos fatores associados, identificou-se que cada minuto de atendimento do Time de Resposta Rápida nas enfermarias aumentou em 1,2% a chance de ocorrência de eventos adversos (24 internações não planejadas em Unidade de Terapia Intensiva e uma parada cardiorrespiratória) na amostra (p=0,014). Conclusões: queda da saturação de oxigênio e hipotensão arterial foram os principais motivos de acionamento, e o tempo de atendimento foi associado à ocorrência de eventos adversos.

Arquitectura de información para indicaciones médicas de signos vitales y ventilación

Introducción: La Historia Clínica es el documento principal en el sistema de información hospitalaria, imprescindible en sus vertientes asistencial y administrativa. Las nuevas tecnologías de la Informática y las comunicaciones han permitido informatizar todos los procesos del sistema de salud. Desde el punto de vista técnico, la informatización de los registros médicos, debe tener en cuenta la correcta descripción de las indicaciones médicas, más aún en los pacientes hospitalizados en las unidades de cuidados intensivos, por su estado de gravedad. Objetivo: desarrollar el prototipo de la aplicación informática que permitirá la gestión de la información del registro de las indicaciones médicas de signos vitales y ventilación de las historias clínicas en el Hospital Clínico-Quirúrgico Docente León Cuervo Rubio de la provincia de Pinar del Río. Métodos: la investigación que se describe obedeció a un estudio de desarrollo tecnológico, para su desarrollo se emplearon métodos teóricos y empíricos. Resultados: la investigación permite a los programadores desarrollar la aplicación informática para el registro de las indicaciones médicas de signos vitales y ventilación en la historia clínica tradicional, por una solución informatizada, a partir de la descripción del negocio, sus requisitos e interacciones. Conclusiones: se alcanzó un gran impacto social en nuestro sistema de salud tanto a nivel provincial como nacional, ya que no existe este sitema y beneficiaria tanto al paciente, como a los profesionales y a la misma institución al abaratar los costos.

Introduction: The Clinical History is the main document in the hospital information system, essential in its care and administrative aspects. The new information technology and communications have made it possible to computerize all the processes of the health system. From a technical point of view, the computerization of medical records must take into account the correct description of medical indications, especially in patients hospitalized in intensive care units, due to their state of seriousness. Objective: to develop the prototype of the computer application that will allow the management of the information of the registry of the medical indications of vital signs and ventilation of the medical records at the León Cuervo Rubio Teaching Clinical-Surgical Hospital in the province of Pinar del Río. Methods: the research that is described obeyed a study of technological development, for its development theoretical and empirical methods were used. Results: the research allows the programmers to develop the computer application for the registration of the medical indications of vital signs and ventilation in the traditional clinical history, by a computerized solution, based on the description of the business, its requirements and interactions. Conclusions: a great social impact was achieved in our health system both at the provincial and national level, since this system does not exist and it would benefit patient, professional and the institution itself by reducing costs.

Más allá de los límites de la disciplina con niños prematuros: una reflexión holística / Beyond the Limits of Discipline with Premature Children: A Holistic Reflection / Além dos limites da disciplina com bebés prematuros: uma reflexão holística

Introducción. En este artículo se presenta una reflexión sobre la necesidad de tener una visión holística en la problemática de la prematurez, para que los equipos del área de salud puedan tener una comprensión de la multiplicidad de factores presentes en el parto prematuro, y sus consecuencias para el menor, la madre, los familiares y el personal de salud involucrado. Tema de reflexión. El tema se sustenta en dos investigaciones realizadas con las madres, los padres y los niños beneficiarios del Programa Madre Canguro en un hospital del Estado, en dos momentos, 2012 y 2014, con algunos de los autores del presente artículo. Conclusiones. Además de la revisión de la literatura científica relacionada con el tema y la problemática, se concluye que, bajo una mirada holística, se comprende de manera integral la problemática y se propicia una mejor comunicación con los padres; con el equipo de la atención en salud, se logra un manejo transdisciplinario, superando los objetos de estudios aislados. Se da así un abordaje integrador y significativo en la cotidianidad de cada actor, desde la piel, con el Programa Madre Canguro, hasta la racionalidad de la ciencia.

Introduction. This article presents a reflection on the need for a holistic view of the problem of premature births, so that healthcare teams can understand the multiplicity of factors present in premature births, and its consequences for the minor, the mother, the family members, and the healthcare staff involved. Topic of reflection. The topic is based on two investigations carried out with mothers, fathers, and children's beneficiaries of the Mother Kangaroo Program in a State hospital, at two moments, 2012 and 2014, with some of the authors of this article. Conclusions. In addition to the review of the scientific literature related to the topic and the problem, it is concluded that, under a holistic view, the problem is understood in a comprehensive way and better communication with the parents is encouraged. With the healthcare team, cross-disciplinary handling is achieved, overcoming the objects of isolated studies. As such, there is an integrative and significant approach in the daily life of each actor, from the skin, with the Mother Kangaroo Program, to the rationality of science.

Introdução. Este artigo apresenta uma reflexão sobre a necessidade de se ter uma visão holística da problemática da prematuridade, para que as equipes da área da saúde possam ter uma compreensão da multiplicidade de fatores presentes no parto prematuro, e suas consequências para a criança, a mãe, os familiares e o pessoal de saúde envolvido. Tópico de reflexão. O tema é baseado em duas pesquisas realizadas com mães, pais e filhos beneficiários do Programa Mãe Canguru em um hospital estadual, em dois momentos, 2012 e 2014, com alguns dos autores deste artigo. Conclusões. Além da revisão da literatura científica relacionada ao tópico e ao problema, conclui-se que, sob uma visão holística, o problema é plenamente compreendido e incentiva-se uma melhor comunicação com os pais; com a equipe de saúde, consegue-se uma gestão transdisciplinar, superando os objetos de estudos isolados. Isto proporciona uma abordagem integradora e significativa no cotidiano de cada ator, desde a pele, com o Programa Mãe Canguru, até a racionalidade da ciência.

Documentação automatizada de parâmetros vitais em enfermarias utilizando estações portáteis - Efeito no acionamento adequado do time de resposta rápida: um protocolo de um ensaio clínico randomizado em clusters / Automated documentation of vital parameters in wards using portable stations - Effect on proper triggering of the rapid response team: a study protocol of a cluster randomized clinical trial

RESUMO Objetivo: Avaliar a eficácia da solução Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ em acionar o time de resposta rápida em tempo hábil, em comparação com o acionamento manual. Métodos: O estudo Hillrom é um ensaio clínico unicêntrico, aberto, de superioridade, randomizado em clusters em paralelo (taxa de alocação 1:1) realizado em um hospital terciário. Serão incluídos dois grupos de três enfermarias com 28 leitos (um grupo intervenção e um grupo controle). As enfermarias serão distribuídas aleatoriamente para utilizar a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ (grupo intervenção) ou para manter a rotina habitual (grupo controle) em relação ao acionamento do time de resposta rápida. O desfecho primário será o número absoluto de ocorrências de acionamento do time de resposta rápida em tempo hábil. Como desfechos secundários, características clínicas como mortalidade, parada cardíaca, necessidade de internação em unidade de terapia intensiva e duração da hospitalização serão avaliadas de forma exploratória de acordo com os grupos. Estimou-se uma amostra de 216 acionamentos de time de resposta rápida, para identificar uma possível diferença entre os grupos. O protocolo foi aprovado pelo Comitê de Ética em Pesquisa institucional. Resultados esperados: Espera-se que a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ seja mais eficaz no acionamento do sistema de chamada de enfermeiros, para acionar o time de resposta rápida em tempo hábil e de maneira adequada, em comparação com o acionamento manual (prática habitual). ClinicalTrials.gov: NCT04648579

ABSTRACT Objective: To evaluate the effectiveness of the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ solution in activating the rapid response team in a timely manner compared to manual activation. Methods: The Hillrom study is a single-center, open-label, superiority, cluster-randomized, parallel-group (1:1 allocation ratio) clinical trial that will be conducted in a tertiary hospital. Two sets of three wards with 28 beds will be included (one as the intervention cluster and the other as the control). The wards will be randomly assigned to use the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution (intervention cluster) or to maintain the usual routine (control cluster) regarding rapid response team activation. The primary outcome will be the absolute number of episodes of rapid response team triggering in an appropriate time; as secondary outcomes, clinical features (mortality, cardiac arrest, need for intensive care unit admission and duration of hospitalization) will be assessed according to clusters in an exploratory way. A sample size of 216 rapid response team activations was estimated to identify a possible difference between the groups. The protocol has been approved by the institutional Research Ethics Committee. Expected results: The Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution is expected to be more effective in triggering the nurse call system to activate the rapid response team in a timely and adequate manner compared to manual triggering (usual practice). ClinicalTrials.gov: NCT04648579

Application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation and its effects on pulmonary infection in patients with craniocerebral trauma / 中国基层医药

Objective:To investigate the application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation and its effects on pulmonary infection in patients with craniocerebral trauma.Methods:A total of 105 patients with craniocerebral trauma who received treatment in Yiwu Central Hospital from January 2020 to December 2020 were included in this study. They were randomly allocated to undergo endotracheal intubation with a video laryngoscope (control group, n = 50) or a video laryngoscope combined with a fiberoptic bronchoscope (observation group, n = 55). Glottic exposure, intubation, vital signs, lung infection rate during hospitalization, and incidence of complications were monitored/determined in each group. Results:Glottic exposure in the observation group was superior to that in the control group ( Z = 4.29, P < 0.001). First-pass success rate was significantly higher in the observation group than in the control group [96.36% (53/55) vs. 82.00% (41/50), χ2 = 5.76, P < 0.05]. The number of intubation attempts and the time to successful intubation were (1.07 ± 0.53) times and (85.12 ± 15.36) seconds, respectively in the observation group, which were significantly less or shorter than those in the control group [(1.92 ± 0.74) times, (106.13 ± 16.34) seconds, t = 6.81, 6.79, both P < 0.001). The changes in mean arterial pressure and heart rate during intubation were less in the observation group than in the control group (both P < 0.05). The amplitude of increase in blood oxygen saturation after intubation was greater in the observation group than in the control group ( P < 0.05). Lung infection rate was significantly lower in the observation group than in the control group [10.91% (6/55) vs. 30.00% (15/50), χ2 = 5.96, P < 0.05]. The incidence of complications was significantly lower in the observation group than in the control group [5.45% (3/55) vs. 18.00% (9/50), χ2 = 4.07, P < 0.05]. Conclusion:Application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation can increase the first-pass success rate, reduce repeated intubation attempts, shorten time to successful intubation, help to maintain stable vital signs, prevent lung infection and complication. Therefore, the combined method is of clinical application value.

Blood transfusion and prognostic factors of extracorporeal membrane pulmonary oxygenation for the treatment of respiratory and circulatory failure / 中国基层医药

Objective:To analyze blood transfusion and prognostic factors of extracorporeal membrane pulmonary oxygenation (ECMO) for the treatment of respiratory and circulatory failure.Methods:The clinical data of 80 patients with respiratory and circulatory failure who received treatment in Huangshi Central Hospital from March 2016 to July 2021 were retrospectively analyzed. According to 28-day prognosis, these patients were divided into death group ( n = 44) and survival group ( n = 36). The general data, blood transfusion during the process of ECMO, vital signs, laboratory indicators, ventilation time, and length of hospital stay were compared between the two groups. The factors affecting death during the process of ECMO were analyzed. Results:There were no significant differences in sex, age, body mass index, complications, the cause of respiratory and circulatory failure, and the mode of ECMO between the two groups (all P > 0.05). Preoperative Acute Physiology and Chronic Health Evaluation II score, creatinine, procalcitonin and lactic acid levels in the survival group were (22.36 ± 3.71) points, (79.17 ± 9.29) μmol/L, (2.77 ± 0.79) ng/L, (2.74 ± 0.36) mmol/L, respectively, which were significantly lower than (34.27 ± 4.98) points, (94.16 ± 10.23) μmol/L, (3.69 ± 1.10) ng/L, (5.18 ± 0.42) mmol/L, respectively in the death group ( t = -11.89, -6.79, -5.62, -27.53, all P < 0.001). There were no significant differences in preoperative respiratory frequency, diastolic pressure, systolic pressure, heart rate, oxygenation index (PaO 2/FiO 2) and C-reactive protein between the two groups (all P > 0.05). The volume of blood transfused on the day of undergoing ECMO, the volume of blood transfused on the day of withdrawing ECMO, the volume of blood transfused during the whole process of ECMO, duration of ventilation, and the incidence of complications related to ECMO were(98.74 ± 16.28) mL, (37.23 ± 10.36) mL, (398.79 ± 67.81) mL, (210.39 ± 20.21) hours, 38.89% (14/36), respectively, which were significantly lower than (160.17 ± 23.14) mL, (48.26 ± 12.25) mL, (600.23 ± 70.12) mL, (320.14 ± 18.21) hours, 79.55% (35/44), respectively in the death group ( t = -13.43, -4.29, 4.94, 25.25, χ2 = 13.79, all P < 0.001). The length of hospital stay in the survival group was longer than that in the death group [(20.14 ± 5.36) days vs. (14.17 ± 4.23) days, t = 5.56, P < 0.001). Acute Physiology and Chronic Health Evaluation II score, procalcition level, the volume of blood transfused on the day of ECMO, duration of ventilation, and the volume of blood transfused during the whole process of ECMO are risk factors for death after ECMO, while length of hospital stay is a protective factor for ECMO. Conclusion:Preoperative evaluation of Acute Physiology and Chronic Health Evaluation II score, continuous blood transfusion during the whole process of ECMO, grasping the opportunity of ventilation and preventing against complications of ECMO are the keys to increasing the survival rate of patients with respiratory and circulatory failure.

Prevention of vasovagal response by applied muscle tension at different time points during blood donation / 中国输血杂志

【Objective】 To explore the role and value of applied muscle tension (AMT) in preventing vasovagal nerve reaction (VVR) in blood donors. 【Methods】 A total of 2 992 people, susceptible to suffer VVR from May 2020 to may 2022, were randomly divided into control group (1406 cases) and observation group (1 586 cases). The control group was not given AMT intervention, while the observation group received AMT intervention at different periods during blood donation. The changes of systolic blood pressure, diastolic blood pressure, heart rate and psychological state of anxiety (self-rating anxiety scale, SAS) of blood donors were monitored in the two groups at each period to compare the occurrence of VVR. 【Results】 There were no statistically significant differences in blood pressure and heart rate between the two groups before blood donation (P>0.05). The parameters were relatively stable in observation group during and after donation, but significantly different from that of the controls(P>0.05). SAS score was similar in two groups before blood donation(P>0.05), while decreased in observation group during and after donation in comparison with the controls(P<0.05). The incidence of VVR in the observation group was 3.09%, which was significantly lower than that in the control group (7.97%)(P<0.05). The incidence of VVR was 2.18% after AMT exercise during blood donation. 【Conclusion】 AMT intervention in different periods of blood donation can significantly reduce the occurrence of VVR.

O uso de aplicativo de celular para medir frequência cardíaca e saturação periférica de oxigênio / The use of cellular application to measure heart rate and peripheral oxygen saturation

Avaliar a associação da medida de frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2 ) utilizando um aplicativo de celular e um monitor multiparamétrico. Métodos: Estudo experimental e randomizado entre participantes saudáveis. Investigou o aplicativo Samsung Health® e o monitor multiparamétrico da marca Midway®, modelo: PM-60. O estudo foi estruturado em quatro etapas. Para análise estatística, aplicou correlação de Pearson e Spearman, com nível de significância de 5%. Resultados: Dos 150 participantes a idade média foi de 22,3±4,5 anos, o sexo feminino foi predominante (71,3%). Verificouse forte correlação da FC medida pelo monitor com a FC do aplicativo de celular (r=0,93) indicando correlação positiva (p<0,001). A SpO2 medida por monitor multiparamétrico e pelo aplicativo de celular revelou um r=0,05 (p=0,51), o que atesta uma correlação nula e não significativa. Conclusão: Não houve correlação entre a medida da SpO2 do monitor multiparamétrico e do aplicativo Samsung Health®, não sendo confiável a utilização deste aplicativo para monitorar e gerenciar o sinal vital SpO2 em pessoas saudáveis. A FC medida com o aplicativo é significativa, e pode ser utilizada para monitorar e gerenciar esse sinal vital.

Assess the association of the measure of heart rate (HR) and oxygen saturation (SpO2 ) using a mobile application and a multiparameter monitor. Methods: Study experimental and randomized healthy participants. Investigated the application Samsung Health® and multiparameter monitor Midway® make, model: PM-60. The study was divided into four stages. Statistical analysis was applied Pearson and Spearman correlation with 5% significance level. Results: Of the 150 participants average age was 22.3±4.5 years, females were predominant (71.3%). There was a strong correlation HR measured by the monitor application to cell FC (r=0.93) indicating a positive correlation (p<0.001). SpO2 measured by multiparameter monitor and the mobile application revealed r=0.05 (p=0.51), which demonstrates a zero and no significant correlation. Conclusion: There was no correlation between the SpO2 measurement of the multiparameter monitor and the Samsung Health® app, not being trusted to use this application to monitor and manage the vital sign SpO2 in healthy people. The HR measured with the application is significant, and can be used to monitor and manage this vital sign.

Effect of the national early warning score on monitoring the vital signs of patients in the emergency room / Efecto del national early warning score en el monitoreo de los signos vitales de los pacientes en urgencias / Efeito do national early warning score no monitoramento dos sinais vitais de pacientes no pronto-socorro

ABSTRACT Objective: To verify the effect of using the National Early Warning Score (NEWS) system on the compliance of the vital signs monitoring interval with those recommended for patients in the emergency room. Methods: This is a quasi-experimental, before-and-after study, performed in an emergency room with 280 adult patients selected by convenience. The effect of NEWS on the compliance of the vital signs monitoring interval with those recommended by the system was analyzed by linear regression. Results: In the Pre-NEWS phase, 143 patients were analyzed (mean age ± standard deviation: 54.4 ± 20.5; male: 56.6%) and, in the Post-NEWS phase, 137 patients (mean age ± standard deviation: 55.5 ± 20.8; male: 50.4%). There was compliance of the vital signs monitoring interval with what is recommended by NEWS in 92.6% of vital signs records after adopting this instrument. This compliance was 9% (p < 0.001) higher in the Post-NEWS phase. Conclusion: The use of the NEWS system increased the compliance of the vital signs monitoring intervals with the ones recommended, but this compliance decreased when the NEWS score pointed to a shorter interval in the monitoring of vital signs.

RESUMEN Objetivo: Verificar el efecto del uso del sistema National Early Warning Score (NEWS) sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado a pacientes en urgencias. Método: Estudio casi experimental, de tipo antes y después, realizado con 280 pacientes adultos seleccionados por conveniencia en un servicio de urgencias. Con el uso de la regresión lineal se analizó el efecto del NEWS sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el sistema. Resultados: En la fase Pre-NEWS se analizaron 143 pacientes (edad media ± desviación estándar: 54,4 ± 20,5; sexo masculino: 56,6%) y, en la fase Post-NEWS, 137 pacientes (edad media ± desviación estándar: 55,5 ± 20,8; sexo masculino: 50,4%). El 92,6% de los registros de signos vitales después de la adopción de este instrumento presentaron cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el NEWS. Este cumplimiento fue mayor en la fase Post-NEWS con un 9% (p < 0,001). Conclusion: El uso del sistema NEWS tuvo un incremento del cumplimiento de los intervalos de monitoreo de los signos vitales conforme a lo recomendado, pero este cumplimiento disminuyó cuando el puntaje NEWS apuntó a un intervalo más corto en el monitoreo de los signos vitales.

RESUMO Objetivo: Verificar o efeito do uso do sistema National Early Warning Score (NEWS) na conformidade do intervalo de monitoramento dos sinais vitais com o recomendado em pacientes no pronto-socorro. Método: Estudo quasi-experimental, do tipo antes e depois, realizado em um pronto-socorro com 280 pacientes adultos selecionados por conveniência. O efeito do NEWS na conformidade do intervalo de monitoramento dos sinais vitais com o recomendado pelo sistema foi analisado por regressão linear. Resultados: Na fase Pré-NEWS, foram analisados 143 pacientes (idade média ± desvio-padrão: 54,4 ± 20,5; sexo masculino: 56,6%) e, na fase Pós-NEWS, 137 pacientes (idade média ± desvio-padrão: 55,5 ± 20,8; sexo masculino: 50,4%). Houve conformidade do intervalo de monitoramento dos sinais vitais com o recomendo pelo NEWS em 92,6% dos registros de sinais vitais após adoção desse instrumento. Essa conformidade foi maior na fase Pós-NEWS em 9% (p < 0,001). Conclusão: O uso do sistema NEWS aumentou a conformidade dos intervalos de monitorização dos sinais vitais com o recomendado, porém essa conformidade diminuiu quando o escore NEWS apontou para intervalo menor no monitoramento dos sinais vitais.

Effects of guided imagery relaxation in hematopoietic stem-cell transplantation patients: a quasi-experimental study / Efecto de la relajación con imagen guiada en trasplantados de células madre hematopoyéticas: estudio cuasi experimental / Efeito do relaxamento com imagem guiada em transplantados de células-tronco hematopoéticas: estudo quase experimental

ABSTRACT Objective: To analyze the effects of the technique of virtual reality guided imagery in the vital signs of hematopoietic stem-cell transplantation patients. Method: Quasi-experimental study with 35 participants who received an intervention using virtual reality guided imagery with progressive muscle relaxation, applied three times a week for four weeks in a referral hospital for transplants in the south of Brazil. Data collected included: temperature, arterial pressure, respiratory rate, heart rate, pain, and oxygen saturation, before and after each intervention. The comparisons were analyzed using Wilcoxon's test. Results: There was a clinical significance between the mean measurements before and after for respiratory rate (p=0.00) in all stages, and for the variables Heart rate, Temperature, and Oxygen saturation from the 1st to the 12th measurements (p=0.05). Conclusion: The intervention was low cost, easy to apply, and showed positive effects, presenting itself as an option for patient-focused care.

RESUMEN Objetivo: Analizar efectos de técnica de imagen guiada por realidad virtual en los signos vitales de trasplantados de células madre hematopoyéticas. Método: Estudio cuasi experimental con 35 participantes que recibieron intervención de imagen guiada por realidad virtual con relajación muscular progresivo, aplicada tres veces por semana durante cuatro semanas, en hospital de referencia en trasplante del Sur de Brasil. Los datos recolectados fueron: temperatura, presión arterial, respiración, frecuencia cardíaca, dolor y saturación de oxígeno, antes y después de cada intervención. Las comparaciones analizadas por test de Wilcoxon. Resultados: Hubo significación clínica entre las medianas de los contrastes de antes y después para Frecuencia respiratoria (p=0,00) en todas etapas; y en las variables Frecuencia cardíaca, Temperatura y Saturación de oxígeno, entre la 1ª hasta 12ª evaluación (p=0,05). Conclusión: Los efectos de la intervención mostrados favorables, bajo costo y fácil realización, siendo una opción de acción de cuidado centrado en el paciente.

RESUMO Objetivo: Analisar os efeitos da técnica de imagem guiada por realidade virtual nos sinais vitais de transplantados de células-tronco hematopoéticas. Método: Estudo quase experimental com 35 participantes que receberam intervenção de imagem guiada por realidade virtual com relaxamento muscular progressivo, aplicada três vezes por semana durante quatro semanas, em um hospital de referência em transplante no Sul do Brasil. Os dados coletados foram: temperatura, pressão arterial, respiração, frequência cardíaca, dor e saturação de oxigênio, antes e depois de cada intervenção. As comparações foram analisadas pelo teste de Wilcoxon. Resultados: Houve significância clínica entre as médias das aferições de antes e depois para Frequência respiratória (p=0,00) em todas as etapas; e nas variáveis Frequência cardíaca, Temperatura e Saturação de oxigênio, entre a 1ª até 12ª avaliação (p=0,05). Conclusão: Os efeitos da intervenção se mostraram favoráveis, de baixo custo e fácil realização, sendo uma opção de ação de cuidado centrado no paciente.

Efeitos da musicoterapia nas respostas fisiológicas dos recém-nascidos pré-termos em ventilação não invasiva: estudo quase-experimental / Effects of music therapy on the physiological responses of preterm newborns on non-invasive ventilation: a quasi-experimental study / Efectos de la musicoterapia sobre las respuestas fisiológicas de los recién nacidos prematuros con ventilación no invasiva: estudio cuasiexperimental

OBJETIVO: Avaliar os efeitos da musicoterapia nas respostas fisiológicas do recém-nascido pré-termo (RNPT) em ventilação não invasiva. MÉTODO: Estudo quase-experimental, de grupo único, do tipo antes e depois, com trinta prematuros, hospitalizados em uma Unidade de Terapia Intensiva Neonatal. RESULTADOS: Em relação à frequência respiratória (FR), observou-se redução de até seis incursões por minuto (p=<0,001) e em relação à frequência cardíaca (FC), de até sete batimentos por minuto (p=<0,002). Na saturação de oxigênio, identificou-se o aumento em média de 2% (p=0,003). A temperatura axilar apresentou aumento de 0,1ºC após a intervenção (p=0,05). Na escala de dor, identificou-se uma redução de um ponto (p=0,001). DISCUSSÃO: A musicoterapia apresenta efeitos benéficos em relação a redução da FR, da FC e do nível de dor, bem como, aumento da saturação de oxigênio e da temperatura axilar. CONCLUSÃO: A musicoterapia interfere positivamente nas respostas fisiológicas do RNPT em ventilação não invasiva.

OBJECTIVE: To evaluate the effects of music therapy on the physiological responses of preterm newborns (PTNBs) on non-invasive ventilation. METHOD: A quasi-experimental study, with a single group and of the before-and-after type, conducted with thirty premature infants in a Neonatal Intensive Care Unit. RESULTS: As for respiratory frequency (RF), a reduction of up to six breaths per minute was observed (p=<0.001) and, in relation to heart rate (HR), the reduction was up to seven beats per minute (p=<0.002). In oxygen saturation, a 2% (p=0.003) mean increase was identified. Axillary temperature presented a 0.1ºC increase after the intervention (p=0.05). In the pain scale, a one-point reduction (p=0.001) was identified. DISCUSSION: Music therapy presents beneficial effects in relation to reductions in RF, HR and pain level, as well as an increase in oxygen saturation and axillary temperature. CONCLUSION: Music therapy interferes positively with the physiological responses of PTNBs on non-invasive ventilation.

OBJETIVO: Evaluar los efectos de la musicoterapia sobre las respuestas fisiológicas de los recién nacidos prematuros (RNP) con ventilación no invasiva. MÉTODO: Estudio cuasiexperimental, de un solo grupo, del tipo antes y después, con treinta prematuros, hospitalizados en una Unidad de Terapia Intensiva Neonatal. RESULTADOS: Se observó una reducción de la frecuencia respiratoria (FR) de hasta seis respiraciones por minuto (p=<0,001) y de la frecuencia cardíaca (FC) de hasta siete latidos por minuto (p=<0,002). Se detectó un aumento del 2% (p=0,003) en la saturación de oxígeno. La temperatura axilar aumentó 0,1ºC tras la intervención (p=0,05). Se identificó la reducción de un punto (p=0,001) en la escala de dolor. DISCUSIÓN: La musicoterapia tiene efectos beneficiosos en cuanto a la reducción de la FR, FC y el nivel de dolor, así como también, un aumento de la saturación de oxígeno y temperatura axilar. CONCLUSIÓN: La musicoterapia interfiere positivamente en las respuestas fisiológicas del RNP con ventilación no invasiva.