Nursing care and prevalence of adverse events in prone position: Characteristics of mechanically ventilated patients with severe SARS-CoV-2 pulmonary infection.

BACKGROUND: Because of the coronavirus disease 2019 (COVID-19) pandemic, the use of prone positioning has dramatically increased in the intensive care unit (ICU). Because this manoeuvre is related to several complications, it must be performed in a protocolized manner by the appropriate personnel. AIM: To determine the prevalence of adverse events (AEs) in patients admitted to the ICU with a diagnosis of COVID-19-related acute respiratory distress syndrome (C-ARDS) undergoing mechanical ventilation in prone position (PP). DESIGN: Descriptive ambispective study of patients admitted to the ICU diagnosed with C-ARDS undergoing mechanical ventilation who were in the PP at least once. The number of PP manoeuvres and the time spent in the PP were recorded for each subject. AEs proportions and frequencies were calculated, and analysis of variance was used to assess mean differences in the number of manoeuvres and total hours in PP stratified by the number of facial pressure ulcers. IBM SPSS Statistics v.25.0. and EPIDAT 4.1 software were used. RESULTS: Forty-four patients were analysed, and 130 PP manoeuvres were performed. The most frequently observed AEs were facial oedema in 26 patients (80.3%) and facial pressure ulcers in 20 (60.6%). There was a significant positive association between the time spent in PP and the development of facial pressure ulcers (P < .001). Enteral nutrition was well tolerated, and no serious AEs or sentinel events were noted. CONCLUSION: Despite the stressful, demanding situation during the peak of the pandemic, the large number of PP manoeuvres, and long duration spent in this position, no serious AEs occurred. This study highlights the need to implement preventive measures to avoid the development of pressure ulcers secondary to prone positioning. RELEVANCE TO PRACTICE: Prone positioning requires a nursing protocol to prevent the occurrence of AEs that may reduce the quality of nursing care.

Flash Glucose Monitoring and Patient Satisfaction: A Meta-Review of Systematic Reviews.

Flash glucose monitoring (FGM) systems have been suggested to have clinical beneficial effects in patients with diabetes mellitus, although their improvements in terms of quality of life (QoL) and patients' satisfaction are not always addressed or are considered a secondary outcome. Thus, the aim of this meta-review is to establish the benefits of FGM in terms of patients' satisfaction and QoL in both type 1 and type 2 diabetes patients using evidence from past systematic reviews and meta-analyses. Major databases were searched for systematic reviews (with or without meta-analyses) that assessed the satisfaction or QoL of type 1 or 2 diabetes patients using FGM compared with other glucose monitoring systems. The quality of the included systematic reviews was addressed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Six systematic reviews (including two meta-analyses) were included in the meta-review. Evidence suggests that FGM systems seem to improve patients' satisfaction and QoL compared with self-monitoring of blood glucose, although the high variability in the measurement tools, the clinical significance and the quality of the systematic reviews included do not allow us to state FGM benefits with any certainty. Further research, including high-quality randomised clinical trials, differentiating the needs of both type 1 and type 2 diabetes patients and focusing on psychosocial benefits for these patients is needed to optimise clinical decisions between patients and professionals by developing the right health technology assessment for FGM systems.

An informative nursing intervention for families of patients admitted to the intensive care unit regarding the satisfaction of their needs: The INFOUCI study.

AIM: To evaluate whether an informative intervention by nursing professionals through Short Message Service (SMS) improved patients' family members' satisfaction with the intensive care experience. METHODS/DESIGN: This was an exploratory, two-armed, randomised, non-pharmacological, prospective study. The intervention consisted of providing information to the contact persons of patients admitted to the ICU of the University Hospital La Princesa (Madrid, Spain) through SMS based on the patient's nursing assessment. Nursing diagnoses established by NANDA and based on the Virginia Henderson model were used as a reference. The main result was the satisfaction levels of the contacts of patients admitted to the intensive care unit, which was evaluated with the Critical Care Family Needs Inventory. RESULTS: The total score on the Critical Care Family Needs Inventory was significantly better in the intervention group (16.6 ±â€¯3.3 vs. 19.1 ±â€¯4.7; p = 0.012) compared with the control group. All participants included in the intervention considered it useful to some degree. Even when the contact person received negative information, there was no demand for information outside established hours, which was included as a possible adverse effect of the intervention. CONCLUSION: Support in the form of additional nursing information implied an increase in the satisfaction of the needs perceived by the contact persons of patients admitted to the intensive care unit, together with a better perception of the quality of intensive care unit care and a reassuring and beneficial effect.

The early diagnosis and management of mixed delirium in a patient placed on ECMO and with difficult sedation: A case report.

Delirium represents a serious problem that impacts the physical and cognitive prognosis of patients admitted to intensive care units and requires prompt diagnosis and management. This article describes the case and progress of a patient placed on Extracorporeal Membrane Oxygenation with difficult sedation criteria and an early diagnosis of mixed delirium. During the case report, we reflect on the pharmacological and non-pharmacological strategies employed to cope with delirium paying special attention to the non-use of physical restraint measures in order to preserve vital support devices (endotracheal tube or Extracorporeal Membrane Oxygenation cannula). The multimodal and multidisciplinary approach, focused on nursing interventions, strict Pain/Agitation/Delirium monitoring and pharmacological measures, as well as the implementation of measures according to the eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Human Care) concept, were effective, resulting in a relatively short admission considering the severity of the patient's condition and the associated complications. Early independent ambulation was achieved prior to transfer to a hospitalisation unit.

Healthy lifestyle habits for patients with systemic lupus erythematosus: A systemic review.

OBJECTIVES: To assess the effects of lifestyle habits on the disease activity and damage, the occurrence of flares and quality of life of people with systemic lupus erythematosus (SLE). METHODS: A systematic literature review was performed. MEDLINE, EMBASE, and SCI/SSCI were searched. Experimental and observational studies evaluating the effect of lifestyles for SLE patients were included. Two independent reviewers selected studies and extracted relevant data. Critical appraisal of the studies was assessed following SIGN criteria. RESULTS: Eligibility criteria were met by 21 studies, five analyzed the effect of tobacco consumption, nine the effect of physical exercise and seven the effect of diet. Three studies on tobacco observed an association with increased SLE activity and the onset of cutaneous damage. The studies on physical exercise, of heterogeneous quality, reported that aerobic activity is safe for SLE patients, leading to an increase of tolerance to exercise, physical and functional capacity for those with moderate or low activity. A reduction in fatigue, anxiety and depression, as well as improved quality of life, is also suggested though evidence for these outcomes is limited. Better-quality studies on diet analyzed the effect of polyunsaturated fatty acids on disease activity. Three of the four randomized placebo-controlled trials revealed a positive effect both on overall SLE indices and individual symptoms that affect patients. CONCLUSIONS: Tobacco smoking increases the risk of skin damage and disease activity in patients with SLE. A diet rich in polyunsaturated fatty acids, avoiding a sedentary lifestyle and supervised exercise should be recommended for patients with stable SLE.