Conocimiento y habilidades de enfermeras y médicos en ventilación mecánica no invasiva: equipamiento e influencias contextuales / Nurses' and physicians' knowledge and skills in non-invasive ventilation: Equipment and contextual influences

Objetivos: Evaluar el conocimiento y habilidades de enfermeras y médicos en ventilación mecánica no invasiva en diferentes contextos: equipamiento e influencias contextuales. Método: Estudio descriptivo transversal en 4 unidades de cuidados intensivos (una quirúrgica, 3 polivalentes), una reanimación posquirúrgica, 2 áreas de urgencias y 3 salas de hospitalización, de 4 hospitales (3 universitarios y uno general) con 407 profesionales. Se administró una encuesta con 13 ítems, evaluando la validez del contenido (índice de Kappa 0,97 [95% IC: 0,965-0,975]). Resultados: Respondieron el 63,7% de las enfermeras y el 39% de los médicos. El porcentaje de respuestas correctas fue del 50%. Con una puntuación del 1 al 5, en la que a menor puntuación más conocimiento, las enfermeras puntuaron 3,27 ± 0,5 vs. 2,62 ± 0,5 los médicos (diferencia de la media 0,65 [IC 95%: 0,48-0,82; p < 0,001]). No hubo diferencias entre hospitales o unidades (p = 0,07 y p = 0,09). Un porcentaje notable de profesionales identificó como estrategia para mejorar la sincronización paciente-ventilador «tapar el puerto espiratorio» (fugas intencionadas) y apretar la máscara a la cara del paciente (fugas no intencionadas) (28,2% unidad de cuidados intensivos, 22,5% urgencias, 8,3% reanimación posquirúrgica, 61,5% hospitalización), sin diferencia entre enfermeras y médicos (27,9% vs. 23,4%, p = 0,6). El 50% de las enfermeras respondieron correctamente cómo seleccionar el tamaño adecuado de máscara y el 11,7% conocía que la máscara debe ajustarse permitiendo el paso de 2 dedos. Conclusiones: No hubo diferencias en el conocimiento por unidades entre enfermeras y médicos. La falta de conocimiento relacionada con la terapia de la ventilación mecánica no invasiva es dependiente de la formación recibida y del material disponible en la unidad. Para reducir la confusión entre fugas intencionadas y no intencionadas se recomienda usar un solo tipo de ventilador y mantener un entrenamiento regular de las enfermeras

Objectives: To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences. Method: Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]). Results: Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27 ±.5 vs 2.62 ±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P < .001). There were no differences between hospitals or units (P = .07 and P = .09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P = .6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment. Conclusions: There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended

Nurses' and physicians' knowledge and skills in non-invasive ventilation: Equipment and contextual influences. / Conocimiento y habilidades de enfermeras y médicos en ventilación mecánica no invasiva: equipamiento e influencias contextuales.

OBJECTIVES: To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences. METHOD: Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]). RESULTS: Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27±.5 vs 2.62±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P<.001). There were no differences between hospitals or units (P=.07 and P=.09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P=.6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment. CONCLUSIONS: There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended.

Optimising non-invasive mechanical ventilation: Which unit should care for these patients? A cohort study.

BACKGROUND: Use of noninvasive ventilation (NIV) has extended beyond intensive care units (ICUs), becoming usual practice in emergency departments (EDs) and general wards. OBJECTIVE: To analyse the relationship between nursing care and NIV outcome in different hospital units. DESIGN AND SETTINGS: Three university hospitals and one community hospital participated in a prospective observational cohort study. PARTICIPANTS: Ten units participated: 4 ICUs (1 surgical, 3 medical-surgical), 3 recovery (1 postsurgical, 2 EDs, 3 general wards). METHOD: Treatment success/failure, interface intolerance and complications were evaluated according to patient characteristics, nursing care provided, and procedures used. Complications analysed included bronchoaspiration, pneumothorax, skin lesions, inability to manage secretions, eye irritations, deteriorating level of consciousness, gastric distension, and excessive air losses around the mask. RESULTS: Of 387 patients, 194 (50.1%) were treated in ICU, 121 (31.3%) in ED, 38 (9.8%) postsurgery, and 34 (8.8%) in general wards. Regression analysis, adjusted for APACHE score and NIV indication, showed 3.3 times greater risk of NIV failure (95% CI [1.2-9.2]) in a university-hospital ICU with <50 NIV cases/year, compared to a community hospital ICU. In ICUs and general wards, NIV was suspended in 12% of patients due to interface intolerance. Acute-on-chronic lung diseases (ACLD) had lower risk of NIV failure (OR 0.2 [95% CI 0.06-0.69]) and lack of humidification was not associated with treatment failure (OR 0.2 [95% CI 0.1-0.4]). Poor secretion management was linked to pneumonia (OR 2.5 [95% CI 1.1-5.9]) and early weaning/extubation (OR 3.3 [95% CI 1.2-8.9]). Interface intolerance was associated with conventional ICU ventilators (OR 4.4 [95% CI 2.1-9.2]) and nasal skin lesions with excessive air losses (OR 2.4 [95% CI 1.1-5.3]), especially with oronasal masks (OR 3.5 [95% CI 1.1-11.3]). CONCLUSIONS: Acute respiratory failure patients with pneumonia admitted to general wards had increased interface intolerance and NIV failure. Rotating mask types could improve NIV success in any unit administering this therapy.

Análisis comparativo de los conocimientos en ventilación mecánica no invasiva de profesionales de cuidados intensivos / Intensive care unit profesionals's knowledge about non invasive ventilation comparative analysis

Objetivo: La bibliografía destaca la falta de protocolos de ventilación mecánica no invasiva (VNI) y la variabilidad de conocimientos entre unidades y hospitales, por lo que se pretende comparar los conocimientos en VNI en enfermeras de 4 UCI polivalentes y una quirúrgica. Métodos: Estudio descriptivo multicéntrico en hospitales universitarios de nivel 3. Se diseñó una encuesta ad-hoc, con fiabilidad interobservador Kappa = 0,9. Contestar la encuesta era indicación de consentimiento informado. Análisis con Chi cuadrado. Resultados: Respondieron 117 (65%) enfermeras, con 11 ± 9,7 años de experiencia en UCI y 9,2 ± 7,2 en uso de VNI. Una de las UCI polivalentes había iniciado la VNI una media de 6 años más tarde que las otras (IC 95% [3,3 a 8,6], P <0,001).Solo el 23,1% de las enfermeras colocaría una mascarilla sin puerto espiratorio en respirador convencional, el resto cualquier mascarilla buconasal. El 12,7% cree que la mascarilla debe permitir el paso de 2 dedos mientras que el 29% apretaría la máscara a la cara del paciente y taparían el puerto espiratorio para facilitar la sincronización con el respirador. En la UCI quirúrgica se identifica mayoritariamente la agitación como una complicación de la VNI comparado con las polivalentes (31,6 vs. 1,8%, P < 0,001).El 56,4% de las enfermeras no consideran la fisioterapia respiratoria como un cuidado enfermero, sin diferencia entre unidades. Conclusiones: El conocimiento en tipos de interfase es muy dependiente del material de la unidad. Falta formación para detectar complicaciones de VNI como la agitación y el manejo de secreciones

Aims: The literature highlights the lack of noninvasive vntilation (NIV) protocols and the variability of the knowledge of NIV between intensive care units (ICU) and hospitals, so we want to compare NIV nurses's Knowledge from 4 multipurpose ICU and one surgical ICU. Methods: Multicenter, crosscutting, descriptive study in three university hospitals. The survey instrument was validated in a pilot test, and the calculated Kappa index was 0.9. Returning a completed survey is an indication of informed consent. Analysis by Chi square test. Results: 117 responded (65%) nurses, 11 ± 9.7 years of experience in ICU and 9.2 ± 7.2 in use of NIV. One of the multipurpose ICU, was initiated NIV an average of 6 years later than the others (95% CI [3.3 to 8.6], P < .001). Only 23.1% of nurses would place a non-vented mask (with no exhalation port) by conventional ventilator, the rest any kind of face mask. 12.7% believed that the mask must be adjusted to the '2-finger' fit while 29% would seal the mask to the patient's face and cover the mask opening where air escapes to facilitate patient/ventilator synchronization. In the surgical ICU agitation identifies mostly as a complication of NIV compared with multipurpose UCIs (31.6% vs 1.8%, P < .001). 56.4% of nurses do not consider respiratory physiotherapy as nursing care, with no difference between units. Conclusions: Knowledge about types of interface is very dependent on the material of the unit. More training for complications of NIV as agitation and handling secretions it is necessary

[Intensive care unit profesionals's knowledge about non invasive ventilation comparative analysis]. / Análisis comparativo de los conocimientos en ventilación mecánica no invasiva de profesionales de cuidados intensivos.

AIMS: The literature highlights the lack of noninvasive ventilation (NIV) protocols and the variability of the knowledge of NIV between intensive care units (ICU) and hospitals, so we want to compare NIV nurses's Knowledge from 4 multipurpose ICU and one surgical ICU. METHODS: Multicenter, crosscutting, descriptive study in three university hospitals. The survey instrument was validated in a pilot test, and the calculated Kappa index was 0.9. Returning a completed survey is an indication of informed consent. Analysis by Chi square test. RESULTS: 117 responded (65%) nurses, 11±9.7 years of experience in ICU and 9.2±7.2 in use of NIV. One of the multipurpose ICU, was initiated NIV an average of 6 years later than the others (95% CI [3.3 to 8.6], P<.001). Only 23.1% of nurses would place a non-vented mask (with no exhalation port) by conventional ventilator, the rest any kind of face mask. 12.7% believed that the mask must be adjusted to the "2-finger" fit while 29% would seal the mask to the patient's face and cover the mask opening where air escapes to facilitate patient/ventilator synchronization. In the surgical ICU agitation identifies mostly as a complication of NIV compared with multipurpose UCIs (31.6% vs 1.8%, P<.001). 56.4% of nurses do not consider respiratory physiotherapy as nursing care, with no difference between units. CONCLUSIONS: Knowledge about types of interface is very dependent on the material of the unit. More training for complications of NIV as agitation and handling secretions it is necessary.

[Comparative study of maintenance of patency of triple lumen central venous catheter]. / Estudio comparativo del mantenimiento de la permeabilidad de los catéteres venosos centrales de tres luces.

OBJECTIVE: Establish an action protocol for the maintenance of patency of the three lumen central venous catheters (CVC) when any of them are not used. The main variable of interest was evaluate it 24 hours. MATERIAL AND METHOD: This is a blind, randomized clinical trial. Phase 1: Comparison of efficacy, for maintenance of patency of the lumen at 24 hours and on discharge of the patient, of sodium heparin 500 IU (control 1), versus sodium heparin 100 IU (study 1). Phase 2: Once efficacy of sodium heparin 100 IU (control 2) was confirmed, we compared it with saline solution (SS) (study 2). POPULATION: multiple diseased patients admitted to eight critical care unit who were carriers of 3 lumen CVC without previous coagulation disorders. ANALYSIS: quantitative variables with mean (SD) analyzed with Student's t test and qualitative ones with -2. ANALYSIS: SPSS 12.0 program. RESULTS: Phase 1: 128 catheters (control 1: 49, study 1: 79). Mean days of permanency with CVC: 5.4 (SD 6). At 24h, 100% of the CVC of both groups were patent. On discharge of the patient (n = 107) were not patent and 4.9% of the control group and 4.5% of the study group 1. Phase 2: 95 catheters (control 2: 38, study 2: 57) Mean days of permanency: 4.87 (SD 5). At 24h (n = 95), at 72 h (n = 66) and on discharge (n = 43), 100% of the CVC of both groups were patent. No significant difference was established in the two study phases between the groups studied with days of permanence, laboratory values and anticoagulant treatment. CONCLUSIONS: SS is as effective as 100 or 500 IU of heparin for maintenance of patency of CVC.

Estudio comparativo del mantenimiento de la permeabilidad de los catéteres venosos centrales de tres luces / Comparative study of maintenance of patency of triple lumen central venous catheter

Objetivo. Establecer un protocolo de actuación para el mantenimiento de la permeabilidad de los catéteres venosos centrales (CVC) de tres luces cuando alguna de ellas no se utilice. La variable principal de interés se evaluó a las 24 horas. Material y método. Se trata de un ensayo clínico ciego aleatorizado. Fase1: Comparación de la eficacia para el mantenimiento de la permeabilidad de la luz a las 24 horas y al alta del paciente, de la heparina sódica 500 UI (control 1), frente a la heparina sódica 100 UI (estudio 1). Fase 2: una vez confirmada la eficacia de la heparina sódica 100 UI (control 2) la comparamos con suero salino fisiológico (SF) (estudio 2). Población: enfermos pluripatológicos ingresados en una unidad de cuidados críticos portadores de CVC de tres luces sin trastornos de coagulación previos. Análisis: variables cuantitativas con media (desviación estándar [DE]) analizadas con la «t» de Student y las cualitativas con Chi2. Análisis: programa SPSS 12.0©. Resultados. Fase 1: 128 catéteres (control 1: 49; estudio 1: 79). La media de días de permanencia de los CVC: 5,4 (DE 6). A las 24 horas el 100% de los CVC de ambos grupos eran permeables. Al alta del paciente (n = 107) fueron no permeables el 4,9% grupo control 1 y el 4,5% grupo estudio 1. Fase 2: 95 catéteres (control 2: 38; estudio 2: 57) La media de días de permanencia: 4,87 (DE 5) a las 24 horas (n = 95), a las 72 horas (n = 66) y al alta (n = 43); el 100% de los CVC de ambos grupos eran permeables. No se estableció ninguna diferencia significativa en las dos fases del estudio entre los grupos estudiados con los días de permanencia, valores analíticos y tratamiento anticoagulante. Conclusiones. El SF es igualmente eficaz que 100 o 500 UI de heparina para el mantenimiento de la permeabilidad de los CVC

Objective. Establish an action protocol for the maintenance of patency of the three lumen central venous catheters (CVC) when any of them are not used. The main variable of interest was evaluate it 24 hours. Material and methods. This is a blind, randomized clinical trial. Phase 1: Comparison of efficacy, for maintenance of patency of the lumen at 24 hours and on discharge of the patient, of sodium heparin 500 IU (control 1), versus sodium heparin 100 IU (study 1). Phase 2: Once efficacy of sodium heparin 100 IU (control 2) was confirmed, we compared it with saline solution (SS) (study 2). Population: multiple diseased patients admitted to eight critical care unit who were carriers of 3 lumen CVC without previous coagulation disorders. Analysis: quantitative variables with mean (SD) analyzed with Student's t test and qualitative ones with ¯2. Analysis: SPSS 12.0 program®. Results. Phase 1: 128 catheters (control 1: 49, study 1: 79). Mean days of permanency with CVC: 5.4 (SD 6). At 24h, 100% of the CVC of both groups were patent. On discharge of the patient (n = 107) were not patent and 4.9% of the control group and 4.5% of the study group 1. Phase 2: 95 catheters (control 2: 38, study 2: 57) Mean days of permanency: 4.87 (SD 5). At 24h (n = 95), at 72h (n = 66) and on discharge (n = 43), 100% of the CVC of both groups were patent. No significant difference was established in the two study phases between the groups studied with days of permanence, laboratory values and anticoagulant treatment. Conclusions. SS is as effective as 100 or 500 IU of heparin for maintenance of patency of CVC