ABSTRACT
Pressure between bony prominences and sleep surfaces, as well as pressure from the use of medical devices, put children admitted to pediatric intensive care units (PICUs) at risk of developing pressure ulcers (PUs). To assess the effect of two pediatric-specific, continuous and reactive low-pressure mattresses on the incidence of PUs, an observational, descriptive, prospective, longitudinal (2009-2011) study was conducted among PICU patients. The two pediatric mattresses - one for children weighing between 500 g and 6 Kg and another for children weighing more than 6 Kg - were provided to patients at risk for PUs (Braden-Q ≤16, Neonatal Skin Risk Assessment Scale [NSRAS] ≤13, or per nurse assessment of clinical need). Between 2009 and 2011, 30 children (13 [43.3%] girls and 17 [56.7%] boys), ages 0 to 10 years, at risk of developing PUs (NSRAS risk: n = 14 [13.2 ± 3.03] and Braden-Q risk: n = 10 [10.4 ± 2.4]) were placed on the study mattresses for a median of 4 (range 1 to 25) days. Primary reasons for PICU admission included disorders of the respiratory system (40%), infectious and parasitic diseases (23.3%), and illnesses of the musculoskeletal system and connective tissue (10%). All other PU prevention strategies (eg, repositioning, specialty devices) used as part of standard care protocols also were implemented. Of the 30 participants, only one (3.3%) (confidence interval [CI] 95% = 0.08 -17.2%) developed a nondevice-related PU. No adverse events occurred. A 2008 incidence study in the same PICU, before use of these special surfaces, found a cumulative incidence of 20% nondevice-related PUs. The observed incidence rate of nonmedical device-related PUs in this high-risk population placed on these mattresses is encouraging and warrants future research.
Subject(s)
Beds , Intensive Care Units, Pediatric , Pressure Ulcer/prevention & control , Child , Female , Humans , Longitudinal Studies , Male , Pressure , Prospective StudiesABSTRACT
En las unidades de cuidados de pacientes críticos se dispone de multitudd e dispositivos que ayudan, complementan o sustituyen en aquellas funciones que el paciente es incapaz de realizar por sí mismo. La ventilación mecánica y todos sus elementos básicos de control, en especial, las alarmas,conforman un sistema mediante el que se trata de garantizar la seguridad del paciente y a la vez sirven de ayuda al profesional que le asiste.La correcta interpretación de las alarmas monitorizadas, el aprovechamiento de todos los recursos que ofrece el respirador y una actuación enfermera apropiada tras la confirmación de la causa son armas fundamentales en el restablecimiento y en el correcto funcionamiento del sistema (paciente, interfase, respirador).En el desarrollo de este artículo se trata de dar respuesta a las cuestiones que se pueden plantear en relación con el manejo de las alarmas de los respiradores relativas a la presión, el volumen y la frecuencia, se enuncian las causas más frecuentes de su activación y se indican las actuaciones enfermeras apropiadas en cada situación (AU)
In critical patient care units there are many systems that aid, complementor replace the functions that a patient is unable to carry out by him orherself. Mechanical ventilation and all of its basic control elements, especially alarms, comprise a system that aims to ensure the patient safety,while also helping the professional who is caring for patients using this system.The correct interpretation of monitored alarms, the good use of all of there sources offered by the respirator and an appropriate nursing intervention after confirming why the alarms went off are key tools in there establishment and correct operation of the system (patient, interphase,respirator).This article aims to address the issues that may present in the management of respirator alarms for pressure, volume and frequency, list the most frequent causes of their activation and describe the appropriate nursing interventions in each situation (AU)
