ABSTRACT
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Subject(s)
Humans , Exhalation , Physical Therapy Modalities , Critical Care , Critical Illness/therapy , Respiratory Therapy/nursingABSTRACT
Introducción y objetivos: Los pacientes ingresados en unidades de cuidados intensivos son susceptibles de complicaciones pulmonares por múltiples causas (enfermedad de base, inmovilización, riesgo de infección, etc.). La principal intervención para prevenirlas y tratarlas es la fisioterapia respiratoria (FR), práctica habitual en el día a día de enfermería. Por ello se realizó esta revisión bibliográfica, con el objetivo de describir los métodos de FR más eficaces para la prevención y tratamiento de las complicaciones pulmonares en los pacientes ingresados en unidades de cuidados intensivos, diferenciando paciente intubado y no intubado. Metodología: Se llevó a cabo una revisión narrativa de la literatura en las bases de datos Pubmed, Cinahl y Cochrane Library. Los límites fueron el idioma, la evidencia de los últimos 15 años y la edad. Resultados: Las técnicas de expansión pulmonar, tos, vibración, percusión, drenaje postural, espirometría incentivada y los sistemas oscilatorios y no oscilatorios presentan controversia en cuanto a la eficacia como método de fisioterapia respiratoria. En cambio, la ventilación mecánica no invasiva muestra clara evidencia de su beneficio. En el paciente intubado, la hiperinsuflación manual y la aspiración de secreciones son métodos eficaces para la prevención de complicaciones respiratorias. El resto de métodos de FR aplicados de forma aislada no han demostrado una clara eficacia. Discusión y conclusiones: Las técnicas de FR que han demostrado mejores resultados son la ventilación mecánica no invasiva para el paciente no intubado y la hiperinsuflación manual para el paciente intubado. Respecto al resto de técnicas existe mayor controversia. En ambos grupos de pacientes, la literatura muestra que la terapia combinada es la más eficaz
Introduction and aims: Patients in intensive care unit are susceptible to complications due to different causes (underlying disease, immobilisation, infection risk...) The current main intervention in order to prevent these complications is respiratory physiotherapy, a common practice for nurses on a daily basis. Therefore, we decided to carry out this bibliographic review to describe the most efficient respiratory physiotherapy methods for the prevention and treatment of lung complications in patients in intensive care, taking into account the differences between intubated and non-intubated patients. Methodology: The bibliographic narrative review was carried out on literature available in Pubmed, Cinahl and Cochrane Library. The established limits were language, evidence over the last 15 years and age. Results: Techniques involving lung expansion, cough, vibration, percussion, postural drainage, incentive inspirometry and oscillatory and non-oscillatory systems are controversial regarding their efficacy as respiratory physiotherapy methods. However, non-invasive mechanical ventilation shows clear benefits. In the case of intubated patients, manual hyperinflation and secretion aspirations are highly efficient methods for the prevention of the potential complications mentioned above. In this case, other RP methods showed no clear efficiency when used individually. DiscusSion and conclusions: Non-invasive mechanical ventilation (for non-intubated patients) and manual hyperinflation (for intubated patients) proved to be the respiratory physiotherapy methods with the best results. The other techniques are more controversial and the results are not so clear. In both types of patients this literature review suggests that combined therapy is the most efficient
Subject(s)
Humans , Critical Care/methods , Lung Diseases/therapy , Physical Therapy Modalities , Respiratory Therapy , Intensive Care Units , Spirometry/methods , Respiration, Artificial/methodsABSTRACT
INTRODUCTION AND AIMS: Patients in intensive care unit are susceptible to complications due to different causes (underlying disease, immobilisation, infection risk ) The current main intervention in order to prevent these complications is respiratory physiotherapy, a common practice for nurses on a daily basis. Therefore, we decided to carry out this bibliographic review to describe the most efficient respiratory physiotherapy methods for the prevention and treatment of lung complications in patients in intensive care, taking into account the differences between intubated and non-intubated patients. METHODOLOGY: The bibliographic narrative review was carried out on literature available in Pubmed, Cinahl and Cochrane Library. The established limits were language, evidence over the last 15 years and age. RESULTS: Techniques involving lung expansion, cough, vibration, percussion, postural drainage, incentive inspirometry and oscillatory and non-oscillatory systems are controversial regarding their efficacy as respiratory physiotherapy methods. However, non-invasive mechanical ventilation shows clear benefits. In the case of intubated patients, manual hyperinflation and secretion aspirations are highly efficient methods for the prevention of the potential complications mentioned above. In this case, other RP methods showed no clear efficiency when used individually. DISCUSSION AND CONCLUSIONS: Non-invasive mechanical ventilation (for non-intubated patients) and manual hyperinflation (for intubated patients) proved to be the respiratory physiotherapy methods with the best results. The other techniques are more controversial and the results are not so clear. In both types of patients this literature review suggests that combined therapy is the most efficient.
Subject(s)
Critical Care/methods , Lung Diseases/therapy , Physical Therapy Modalities , Respiratory Therapy , Humans , Intensive Care UnitsABSTRACT
Antecedentes: La adecuada prestación de cuidados paliativos por parte de las enfermeras en las unidades de cuidados intensivos es esencial para facilitar una «muerte buena» a los pacientes críticos. Objetivo: Conocer las percepciones, experiencias y conocimientos de las enfermeras de cuidados intensivos en el cuidado al paciente terminal. Metodología: Se realizó una revisión bibliográfica en las bases de datos Pubmed, Cinahl y PsicINFO utilizando como términos de búsqueda: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería, con sus respectivos sinónimos en inglés y combinados con los booleanos AND y OR. Asimismo, se revisaron 3 revistas especializadas en cuidados intensivos. Resultados: Se seleccionaron 27 artículos para revisión, la mayoría estudios de carácter cualitativo (n = 16). Tras el análisis de las publicaciones se ha identificado que, a pesar de que las enfermeras perciben la necesidad de respetar la dignidad del paciente, brindar cuidados dirigidos al bienestar y favorecer la inclusión de la familia en el cuidado, existe una falta de conocimientos de los profesionales de enfermería de intensivos en el cuidado al final de la vida. Conclusión: Esta revisión revela que para lograr unos cuidados de calidad al final de la vida es necesario fomentar la formación de las enfermeras en cuidados paliativos y favorecer su soporte emocional, llevar a cabo un trabajo multidisciplinar efectivo y la inclusión de la enfermera en la toma de decisiones
Background: Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a good death to critically ill patients. Objective: To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. Methodology: A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. Results: Twenty seven articles for review were selected, most of them qualitative studies (n = 16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units nurses. Conclusion: This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making
Subject(s)
Humans , Palliative Care/statistics & numerical data , Hospice and Palliative Care Nursing/education , Health Knowledge, Attitudes, Practice , Critical Care/methods , Intensive Care Units/statistics & numerical dataABSTRACT
BACKGROUND: Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. OBJECTIVE: To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. METHODOLOGY: A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. RESULTS: Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. CONCLUSION: This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making.
