ABSTRACT
Introducción: En las 2 últimas décadas la ventilación mecánica no invasiva (VNI) se ha consolidado como estrategia inicial para el abordaje de la insuficiencia respiratoria en el paciente crítico adulto y pediátrico. Objetivos: Identificar los factores de riesgo y estrategias preventivas para disminuir la incidencia de lesiones cutáneas asociadas a dispositivos clínicos (LESADIC) relacionadas con la VNI, así como el tratamiento más eficaz para las lesiones que no se han podido evitar. Metodología: Revisión en las bases de datos MEDLINE, CINAHL y Cochrane de estudios publicados en los últimos 10años para llegar al consenso mediante panel de expertos. Resultados: Los conocimientos acerca de cómo medir la talla correcta de máscara y la protección de la piel con apósitos de espuma o hidrocoloides son factores relacionados con la incidencia de LESADIC, pues condiciona el grado de presión-fricción y cizalla que la interfaz ejerce sobre la piel. La interfaz que menos LESADIC causa y es mejor tolerada es la máscara facial. Cuando hay lesiones, lo primero es retirar la interfaz que provoca presión sobre la piel dañada, recomendando como alternativa el casco Helmet(R), tratar la infección, gestionar el exudado y estimular piel perilesional. Conclusiones: La máscara de elección es la facial, siempre con uso de apósitos de espuma o hidrocoloides en el puente nasal. Evaluar el estado de la piel debajo la interfaz y arnés entre las 4 h (recomendable) y 11 h (máximo). Valorar la estrategia de rotación de la interfase a las 24 h si la VNI sigue siendo necesaria de forma continuada
Introduction: In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. Objectives: To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. Methodology: Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10 years to reach consensus through an expert panel. Results: Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet(R) hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. Conclusions: The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4 hours (recommended) and 11 hours (maximum). Evaluate the rotation strategy of the interface at 24 hours if the NIV is still needed on an ongoing basis
Subject(s)
Humans , Noninvasive Ventilation/adverse effects , Skin Diseases/etiology , Masks/adverse effects , Risk Factors , Respiratory Insufficiency/therapy , Critical Care , Nursing Care/methodsABSTRACT
INTRODUCTION: In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. OBJECTIVES: To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. METHODOLOGY: Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel. RESULTS: Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet® hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. CONCLUSIONS: The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis.
Subject(s)
Noninvasive Ventilation/instrumentation , Skin Diseases/etiology , Skin Diseases/therapy , Humans , Practice Guidelines as Topic , Skin Diseases/prevention & controlABSTRACT
Objetivo. Determinar el grado de conocimientos de las guías de prevención de la neumonía asociada a ventilación de los profesionales de enfermería de la unidad de cuidados intensivos (UCI) de tres hospitales españoles de nivel asistencial II y III y relacionar el grado de conocimiento con los años trabajados en UCI. Método. Estudio descriptivo, prospectivo, transversal, y multicéntrico. Para llevarlo a cabo, se facilitó un cuestionario validado y fiable que constaba de 9 preguntas con respuestas cerradas extraídas del estudio EVIDENCE, a los enfermeros de UCI de los tres hospitales universitarios, en el periodo comprendido entre enero y abril del 2014. Siendo la muestra del hospital A la más representativa, y por el contrario, la del B la de menor participación. Para determinar la relación entre los años trabajados en UCI de los enfermeros y el grado de conocimientos se calculó la correlación de Pearson. Resultados. Se recogieron un total de 98 cuestionarios. La mejor puntuación media de los test obtenida fue en el hospital A con una media de 6,33 puntos DE 1,4, seguida del C con 6,21 DE 1,4. Y por último, el hospital B con 6,06 DE 1,5. Al relacionar años trabajados y grado de conocimiento p=0,08. Conclusiones. Los resultados obtenidos indicaron un grado de conocimiento medio-alto comparándolo con otros estudios, y una tendencia entre los años trabajados en la unidad y el grado de conocimiento de prevención de la neumonía asociada a ventilación
Objective. To determine the level of knowledge of the prevention of ventilator-associated pneumonia guidelines of nurses working in three intensive care units (ICU) in 3 university hospitals in a Spanish region, and evaluate the relationship between this level of knowledge and years worked in the ICU. Method. A descriptive, prospective, cross-sectional, multicentre study was conducted using a validated and reliable questionnaire, made up by 9 questions with closed answers drawn from the EVIDENCE study. A total of 98 questionnaires were collected from ICU nurses of the three university hospitals (A, B, and C) from January to April 2014. The sample from hospital A responded the most, in contrast with the sample from hospital B, which was the one with the less participation. The Pearson correlation was calculated in order to determine the relationship between nurse years worked in ICU and level of knowledge. Results. Hospital A obtained in the best mean score in the questionnaire, 6.33 (SD 1.4) points, followed by hospital C with 6.21 (SD 1.4), and finally, the hospital B with 6.06 (SD 1.5) points. A p=.08 was obtained on relating years worked with the level of knowledge. Conclusion. The results showed a high level of knowledge compared other studies. There was a tendency between the years worked in the unit and the level of knowledge in ventilator-associated pneumonia prevention
Subject(s)
Humans , Male , Female , Critical Care Nursing , Critical Care Nursing/organization & administration , Pneumonia/nursing , Health Knowledge, Attitudes, Practice , Patient Safety/standards , Pneumonia/prevention & control , Critical Care Nursing/education , Respiration, Artificial/adverse effects , Ventilation/methods , Prospective Studies , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To determine the level of knowledge of the prevention of ventilator-associated pneumonia guidelines of nurses working in three intensive care units (ICU) in 3 university hospitals in a Spanish region, and evaluate the relationship between this level of knowledge and years worked in the ICU. METHOD: A descriptive, prospective, cross-sectional, multicentre study was conducted using a validated and reliable questionnaire, made up by 9 questions with closed answers drawn from the EVIDENCE study. A total of 98 questionnaires were collected from ICU nurses of the three university hospitals (A, B, and C) from January to April 2014. The sample from hospital A responded the most, in contrast with the sample from hospital B, which was the one with the less participation. The Pearson correlation was calculated in order to determine the relationship between nurse years worked in ICU and level of knowledge. RESULTS: Hospital A obtained in the best mean score in the questionnaire, 6.33 (SD 1.4) points, followed by hospital C with 6.21 (SD 1.4), and finally, the hospital B with 6.06 (SD 1.5) points. A p=.08 was obtained on relating years worked with the level of knowledge. CONCLUSION: The results showed a high level of knowledge compared other studies. There was a tendency between the years worked in the unit and the level of knowledge in ventilator-associated pneumonia prevention.
