Optimizing nursing workload in the intensive care unit during the COVID-19 pandemic: Planning prone positioning

Background Prone positioning is a complex, time-consuming task, involving significant intensive care unit staff. The increased workload during the COVID-19 pandemic and the reduced staffing boosted the burden of intensive care unit nurses, which might have a negative impact on patients’ safety and outcomes. Methods Retrospective chart review, analysing the hourly distribution of pronation and supination procedures in mechanically ventilated critically ill patients during the first and the second wave of the COVID-19 pandemic (March 2020–May 2021). Results 303 procedures were analysed: 77 pronation manoeuvres out of 156 (49.3%) and 82 supination out of 147 (55.8%) were performed in dedicated time slots in the afternoon (15.30–19.00) and in the morning (9.30–12.30) shifts, when the nursing staff was increased. At least five healthcare providers performed pronation manoeuvres. Six device displacements were registered. Conclusions Planning complex activities such as prone positioning needs an effective strategy to optimize nursing staff workload in the intensive care unit. This organization allowed to perform pronation cycles with a duration of at least 16 h, according to current clinical recommendations.

Nursing perspectives from an Italian ICU.

ABSTRACT: In Europe, the novel coronavirus outbreak started in the northern regions of Italy at the end of February 2020. Initially, resources were insufficient to deal with the abrupt influx of critically ill patients requiring respiratory support. This article recounts the authors' experiences caring for patients with COVID-19 in an Italian ICU during this period in order to help colleagues in the international critical care nursing community successfully manage similar circumstances in the ongoing pandemic.

Closed tracheal suctioning systems in the era of COVID-19: is it time to consider them as a gold standard?

Tracheal suctioning is one of the most common activities performed in intensive care units (ICU) and is recognised as a high-risk procedure by the World Health Organization (WHO) and Centers for Disease Control (CDC). Aerosol-generating procedures on critical patients with COVID-19 present an increased risk of contamination for medical workers. In the time of the Sars-Cov-2 pandemic, with a massive number of patients with COVID-19 admitted to the ICU, the open tracheal suction technique (OTST) represents a serious threat for medical workers, even if they are wearing full personal protective equipment. Closed tracheal suction systems (CTSS) allow the removal of tracheobronchial secretions without disconnecting ventilatory circuits, preventing alveolar derecruitment, gas exchange deterioration and hypoxia. CTSS reduce the risk of pathogens entering the respiratory circuit and appear to be a cost-effective solution. CTSS should be considered mandatory for patients in the ICU with an artificial airway, in order to reduce bioaerosol exposure risk for medical workers and contamination of the surrounding environment.