O enfermeiro está preparado frente às complicações ocasionadas pela ventilação mecânica? / Is the nurse prepared for complications caused by mechanical ventilation? / El enfermero está preparado frente a las complicaciones ocasionadas por la ventilación mecánica?

Avaliar o conhecimento de enfermeiros sobre as complicações relacionadas à Ventilação Mecânica. Método: Estudo descritivo, exploratório e de abordagem quantitativa. A coleta de dados foi realizada por meio questionário aplicado a enfermeiros de um hospital de nível terciário no município de Fortaleza/CE, entre fevereiro e julho de 2017 e os resultados foram submetidos à análise estatística simples. Resultados: Dos enfermeiros entrevistados, 50% era especialista, 86,36% informou não ter recebido durante a academia informações suficientes para cuidar de um paciente sob ventilação mecânica e 77,52% dos pesquisados alegou não saber reconhecer as complicações relacionadas à Ventilação Mecânica. Conclusão: Infere-se a necessidade de capacitação e treinamento dos profissionais enfermeiros sobre as complicações relacionadas à ventilação mecânica, para que assim, esses profissionais participem efetivamente da construção do seu processo de práticas baseada em evidências, propagando um cuidado seguro e holístico ao paciente.(AU)

To evaluate nurses' knowledge regarding complications related to mechanical ventilation. Method: Descriptive, exploratory study and using a quantitative approach. The data collection was performed through a questionnaire applied to nurses of a tertiary level hospital in the city of Fortaleza/CE, between February and July 2017 and the results were submitted to simple statistical analysis. Results: Of the nurses interviewed, 50% were specialists, 86.36% reported not having received enough information during college to care for a patient under mechanical ventilation, and 77.52% of the participants claimed that they would not know the complications related to mechanical ventilation. Conclusion: It is inferred the need for training of nurses on complications related to mechanical ventilation, so that these professionals effectively participate in the construction of their process of evidence-based practices, propagating a safe and holistic care to the patient.(AU)

Evaluar el conocimiento de enfermeros sobre las complicaciones relacionadas a la ventilación mecánica. Método: Estudio descriptivo, exploratorio y de abordaje cuantitativo. La recolección de datos fue realizada por medio de un cuestionario aplicado a los enfermeros de un hospital de nivel terciario en el municipio de Fortaleza / CE, entre febrero y julio de 2017 y los resultados fueron sometidos al análisis estadístico simple. Resultados: De los enfermeros entrevistados, 50% eran especialistas, 86,36% informaron no haber recibido durante la academia informaciones suficientes para cuidar de un paciente bajo ventilación mecánica y el 77,52% de los encuestados alegaron que no sabían reconocer las complicaciones relacionadas a la Ventilación Mecánica . Conclusión: Se infiere la necesidad de capacitación y entrenamiento de los profesionales enfermeros sobre las complicaciones relacionadas con la ventilación mecánica, para que así, participen efectivamente de la construcción de su proceso de prácticas basada en evidencias, propagando un cuidado seguro y holístico hacia el paciente.(AU)

Índices prognósticos na prática clínica de enfermagem em terapia intensiva: revisão integrativa / Prognostic indices of clinical nursing practice in intensive care: an integrative review / Índices pronósticos en la práctica clínica de enfermería en terapia intensiva: revisión integrativa

Trata-se de revisão integrativa objetivando analisar a produção científica de Enfermagem sobre índices prognósticos na prática clínica em Terapia Intensiva. Realizou-se busca nas bases de dados Medline (Sistema Online de Busca e Análise de Literatura Médica), PubMed (National Library of Medicine)eScopus (Elsevier). Selecionaram-se 12 artigos para análise, nas seguintes categorias temáticas: Índices prognósticos para avaliação da gravidade de pacientes assistidos em UTI; e Índices prognósticos como instrumentos norteadores da prática clínica e do gerenciamento do cuidado de Enfermagem em UTI. Inferiu-se que o uso de índices prognósticos na prática clínica e no gerenciamento do cuidado é incipiente, porém crescente na Enfermagem. Entretanto, há maior apropriação dos índices que lhe são próprios (TISS-28; NAS). Estes constituem ponto de partida para quantificar e qualificar os cuidados prestados e são ferramentas úteis para a gestão de recursos humanos e materiais, permitindo a incorporação de evidências científico-tecnológicas requeridas para a assistência a pacientes intensivos.

The objective of this integrative review was to analyze the scientific production in nursing on prognostic indices in clinical practice in intensive care. A search of Medline (Retrieval System Online and Medical Literature Analysis), PubMed (National Library of Medicine)andScopus (Elsevier) resulted in 12 articles, which were analyzed considering the following thematic categories: Prognostic indices for severity assessment in critical patients; and Prognostic indices as guiding instruments of clinical practice and nursing care management in the ICU. It was inferred that using prognostic indices in clinical practice and in care management remains incipient, but is growing in nursing. Nevertheless, there is a greater utilization of indices particular of nursing (TISS-28; NAS). The latter are a starting point to quantify and qualify the delivered care, and are useful tools for material human resource management, as they allow for incorporating scientific-technological evidence that are required for delivering care to critical patients.

Revisión integrativa objetivando analizar la producción científica de Enfermería sobre índices pronósticos en la práctica clínica en Terapia Intensiva. Datos relevados de las bases Medline (Sistema Online de Búsqueda y Análisis de Literatura Médica), PubMed (National Library of Medicine) y SCOPUS (Elsevier). Fueron seleccionados 12 artículos para análisis, en las categorías: Índices pronósticos para evaluación de la gravedad de pacientes atendidos en UTI; Índices pronósticos como instrumentos orientadores de la práctica clínica y del gerenciamiento del cuidado de Enfermería en UTI. Se infirió que el uso de índices pronósticos en práctica clínica y en gerenciamiento del cuidado es incipiente, aunque creciente en Enfermería. No obstante, existe mayor utilización de los índices propios (TISS-28; NAS). Estos constituyen punto de partida para cuantificar y calificar los cuidados ofrecidos, constituyendo herramientas útiles para gestión de recursos humanos y materiales, permitiendo la incorporación de evidencias científico-tecnológicas, necesarias para la atención de pacientes intensivos.

Influence of parenteral nutrition delivery system on the development of bloodstream infections in critically ill patients: an international, multicenter, prospective, open-label, controlled study--EPICOS study.

BACKGROUND: Parenteral nutrition (PN) is associated with an increased risk of developing bloodstream infections (BSIs) but the impact of the PN delivery system upon BSI rates remains unclear. This was an international, multicenter, prospective, randomized, open-label, controlled trial that investigated the differences of BSIs associated with 2 different PN systems. METHODS: Patients were randomly allocated in a 2:1:1 ratio to receive either PN delivered by a multichamber bag (MCB group), or by compounded PN made with olive oil (COM1 group) or with MCT/LCT (COM2 group). Blood cultures were performed to evaluate the incidence of BSIs, and catheter use data was collected to calculate CLAB and central venous catheter device use ratio (CVC-DUR). Secondary outcomes included the development of severe sepsis/septic shock, number of intensive care unit (ICU) and hospital days, and all-cause mortality at Day 28. RESULTS: 406 patients were included: 202 in the MCB group, 103 in the COM1 group, and 101 in the COM2 group. Baseline characteristics were well balanced between the 3 groups, BSIs were significantly higher in patients receiving compounded PN (46 BSIs for COM1+COM2 vs 34 BSIs for MCB; p = 0.03).CLAB was higher in patients receiving compounded PN (13.2 for COM1+COM2 vs 10.3 for MCB; p < 0.0001). No differences were observed for the secondary outcomes. CONCLUSION: Compounded PN was associated with a higher incidence of BSIs and CLABs, suggesting that the use of MCB PN may play a role in reducing the incidence of BSIs in patients who receive PN. TRIAL REGISTRATION NUMBER: NCT00798681.

Enteral nutrition with eicosapentaenoic acid, γ-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT study.

INTRODUCTION: Enteral nutrition (EN) with eicosapentaenoic acid (EPA)/γ-linolenic acid (GLA) is recommended for mechanically ventilated patients with severe lung injury. EPA/GLA has anti-inflammatory benefits, as evidenced by its association with reduction in pulmonary inflammation, improvement in oxygenation and improved clinical outcomes in patients with severe forms of acute lung injury. This study was a prospective, multicenter, randomized, double-blinded, controlled trial designed to investigate whether EPA/GLA could have an effective role in the treatment of patients with early sepsis (systemic inflammatory response syndrome with confirmed or presumed infection and without any organ dysfunction) by reducing the progression of the disease to severe sepsis (sepsis associated with at least one organ failure) or septic shock (sepsis associated with hypotension despite adequate fluid resuscitation). Secondary outcomes included the development of individual organ failure, increased ICU and hospital length of stay, need for mechanical ventilation and 28-day all-cause mortality. METHODS: Randomization was concealed, and patients were allocated to receive, for seven days, either an EPA/GLA diet or an isocaloric, isonitrogenous control diet not enhanced with lipids. Patients were continuously tube-fed at a minimum of 75% of basal energy expenditure × 1.3. To evaluate the progression to severe sepsis and/or septic shock, daily screening for individual organ failure was performed. All clinical outcomes were recorded during a 28-day follow-up period. RESULTS: A total of 115 patients in the early stages of sepsis requiring EN were included, among whom 106 were considered evaluable. Intention-to-treat (ITT) analysis demonstrated that patients fed the EPA/GLA diet developed less severe sepsis and/or septic shock than patients fed the control diet (26.3% versus 50%, respectively; P = 0.0259), with similar results observed for the evaluable patients (26.4% versus 50.9% respectively; P = 0.0217). The ITT analysis demonstrated that patients in the study group developed cardiovascular failure (36.2% versus 21%, respectively; P = 0.0381) and respiratory failure (39.6% versus 24.6%, respectively; P = 0.0362) less often than the control group. Similarly, when considering only the evaluable patients, fewer patients developed cardiovascular failure (20.7% versus 37.7%, respectively; P = 0.03) and respiratory failure (26.4% versus 39.6%, respectively; P = 0.04). The percentage of patients fed the EPA/GLA diet requiring invasive mechanical ventilation was reduced compared with controls (ITT patients: 18.9% versus 33.9%, respectively; P = 0.394; evaluable patients: 17.5% versus 34.5%, respectively; P = 0.295). Patients nourished with the EPA/GLA diet remained in the ICU fewer days than the control population (ITT patients: 21.1 ICU-free days versus 14.7 ICU-free days, respectively; P < 0.0001; evaluable patients: 20.8 ICU-free days versus 14.3 ICU-free days, respectively; P < 0.0001) and fewer days at the hospital (ITT patients: 19.5 hospital-free days versus 10.3 hospital-free days, respectively; P < 0.0001; evaluable patients: 19.1 hospital-free days versus 10.2 hospital-free days, respectively; P < 0.001) (all numbers expressed as means). No significant differences in 28-day all-cause mortality were observed (ITT patients: 26.2% EPA/GLA diet versus 27.6% control diet, respectively; P = 0.72; evaluable: 26.4 EPA/GLA diet versus 30.18 control diet, respectively; P = 0.79). CONCLUSIONS: These data suggest that EPA/GLA may play a beneficial role in the treatment of enterally fed patients in the early stages of sepsis without associated organ dysfunction by contributing to slowing the progression of sepsis-related organ dysfunction, especially with regard to cardiovascular and respiratory dysfunction. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00981877.