Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases.

OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS: A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION: Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.

Spinal cord ischemia as intraoperatory complication in shoulder surgery positioned in beach chair: case report.

Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.

Spinal cord ischemia as intraoperatory complication in shoulder surgery positioned in beach chair: case report

Abstract Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.

Risco para lesões por posicionamento cirúrgico decorrentes da posição supina / Riesgo de lesiones de posicionamiento quirúrgicoderivadas de la posición supina / Risk for surgical position injuries arising from the supine position

Objetivo: relacionar o escore de risco de lesões por posicionamento cirúrgico decorrentes da posição supina com aspectos sociodemográficos, clínicos, cirúrgicos e ocorrência de complicações. Método: estudo observacional longitudinal realizado com 89 pacientes em decúbito dorsal. Aplicadas variáveis ​​sociodemográficas e clínicas e a Escala de Risco para Desenvolvimento de Lesões por Posicionamento Cirúrgico. Adotadas análises descritivas, bivariadas e de regressão logística, considerando-se um nível de significância de α=0,05. Resultados: a idade aumentou em 1,11 vezes (p<0,001) e a obesidade em 13,77 vezes (p=0,01) a chance de aumento do risco de lesões. A proporção de dor (34,1%) e lesão por pressão na região sacrococcígea (91,7%) destacou-se nos pacientes de maior risco (p=0,05). Conclusão: obesos e idosos apresentaram maior risco de lesões. Dor e ocorrência de lesão por pressão na região sacrococcígea foram as complicações predominantes nos pacientes de maior risco (AU)

Objective:to relate the risk score for injuries due to surgical positioning resulting from the supine position with sociodemographic, clinical, surgical aspects and the occurrence of complications. Method: longitudinal observational study carried out with 89 patientsin the supine position. Sociodemographic and clinical variables and the Risk Scale for the Development of Surgical Positioning Injuries were applied. Descriptive, bivariate and logistic regression analyzes were adopted, considering a significance level ofα=0.05. Results: age increased by 1.11 times (p<0.001) and obesity by 13.77 times (p=0.01) the chance of increased risk of injury. The proportion of pain (34.1%) and pressure injury in the sacrococcygeal region (91.7%) stood out in patients at higher risk(p=0.05). Conclusion:obese and elderly people had a higher risk of injury. Pain and occurrence of pressure injury in the sacrococcygeal region were the predominant complications in patients at higher risk (AU)

Objetivo:relacionar el puntaje de riesgo de lesiones por posicionamiento quirúrgico derivado de la posición supina con aspectos sociodemográficos, clínicos, quirúrgicos y la ocurrencia de complicaciones. Método:estudio observacional longitudinal realizado con 89 pacientes en decúbito supino. Se aplicaron variables sociodemográficas, clínicas y la Escala de Riesgo para el Desarrollo de Lesiones de Posicionamiento Quirúrgico. Fueron adoptados análisis descriptivos, bivariados y de regresión logística, considerando un nivel de significancia de α=0,05. Resultados:La edad aumentó en 1,11 veces (p<0,001) y la obesidad en 13,77 veces (p=0,01) la probabilidad de mayor riesgo de lesión. La proporción de dolor (34,1%) y lesión por presión en la región sacrococcígea (91,7%) sedestacó en los pacientes de mayor riesgo (p=0,05).Conclusión:Las personas obesas y ancianas tenían mayor riesgo de lesiones. El dolor y la aparición de lesión por presión en la región sacrococcígea fueron las complicaciones predominantes en los pacientes de mayor riesgo (AU)

Risco de lesão relacionada ao posicionamento cirúrgico: avaliação em hospital universitário brasileiro / Riesgo de lesiones relacionadas a la posición quirúrgica: evaluación en un hospital universitario de brasil / Risk of injuries related to surgical positioning: an assessment in a brazilian university hospital

Objetivo: avaliar o risco para desenvolvimento de lesões relacionadas ao posicionamento cirúrgico. Método: estudo transversal com amostra (n=146) de adultos cirúrgicos eletivos do Paraná, Brasil. Aplicou-se a Escala de Avaliação de Risco para o Desenvolvimento de Lesões decorrentes do Posicionamento Cirúrgico e extração de variáveis sociodemográficas. Procedeu-se análise estatística descritiva e inferencial. Resultados: homens (49,3%) e mulheres (50,7%) tiveram distribuição equânime de atendimento majoritariamente pela ortopedia (39,7%). Pela escala aplicada, destacou-se: uso de colchão convencional+coxins de campo de algodão como superfície de suporte (100%); posição supina (78%); membros superiores com abertura inferior a 90º (70,5%); anestesia regional (54,1%) e tempo cirúrgico de 1-2h (46,6%). Constatou-se escore médio de 17,6±3,29 pontos e 75,3% da amostra apresentou baixo risco de desenvolver lesões do posicionamento cirúrgico. Conclusão: em torno de um quarto da amostra apresentou maior risco de lesão decorrente da posição cirúrgica.

Objetivo: evaluar el riesgo de desarrollar lesiones relacionadas con la posición quirúrgica. Método: estudio transversal con una muestra (n=146) de adultos sometidos a cirugías electivas en Paraná, Brasil. Se aplicó la Escala de Evaluación del Riesgo de Desarrollar Lesiones a raíz de la Posición Quirúrgica y se extrajeron variables sociodemográficas. Se realizó un análisis estadístico descriptivo e inferencial. Resultados: hubo distribución igualitaria entre hombres (49,3%) y mujeres (50,7%), atendidos mayoritariamente en la especialidad de Ortopedia (39,7%). Al aplicar la escala se destacó lo siguiente: utilización de colchón convencional + almohadones de campo de algodón como superficie de apoyo (100%); posición supina (78%); extremidades superiores con abertura de menos de 90º (70,5%); anestesia regional (54,1%) y duración de la cirugía de 1 a 2 horas (46,6%). Se verificó una puntuación media de 17,6±3,29 puntos y el 75,3% de la muestra presentó bajo riesgo de desarrollar lesiones a raíz de la posición quirúrgica. Conclusión: aproximadamente el 25% de la muestra presentó un riesgo más elevado de lesiones resultantes de la posición quirúrgica.

Objective: to assess the risk for the development of injuries related to surgical positioning. Method: a cross-sectional study with a sample comprised by adults undergoing elective surgeries (n=146) in Paraná, Brazil. The Risk Assessment Scale for the Development of Injuries arising from Surgical Positioning was applied, with extraction of sociodemographic variables. Descriptive and inferential analyses were performed. Results: men (49.3%) and women (50.7%) presented equal distribution of appointments, mostly in the Orthopedics specialty (39.7%). The following stood out as per the scale applied: use of conventional mattress + cotton field cushions as a support surface (100%); supine position (78%); upper limbs with opening less than 90º (70.5%); regional anesthesia (54.1%), and surgical time of 1h-2h (46.6%). A mean score of 17.6±3.29 points was found and 75.3% of the sample presented low risk for the development of injuries related to surgical positioning. Conclusion: around 25% of the sample presented a higher risk of injuries arising from surgical positioning.

Risk for surgical positioning injuries: scale validation in a rehabilitation hospital.

OBJECTIVE: to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital. METHOD: analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics. RESULTS: most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries. CONCLUSION: the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.

Risk assessment for the development of perioperative lesions due to surgical positioning. / Avaliação do risco para o desenvolvimento de lesões perioperatórias decorrentes do posicionamento cirúrgico.

OBJECTIVE: To evaluate the risk of developing perioperative lesions due to surgical positioning in patients submitted to elective surgeries. METHODS: This is an analytical and longitudinal study carried out with 45 patients in a public hospital of medium and high complexity in the state of Piauí. The following data was used: perioperative evaluation instrument, Numerical Visual Scale, Braden Scale and the Risk Assessment Scale for the Development of Injuries from Surgical Positioning (ELPO). RESULTS: Participants aged ≥ 46 years had a higher risk, and there were 33.4% of hypertensives among the 35.6% with comorbidities. The most prevalent position, with 64.5% was supine, with only 2.2% cases of pre-surgical injury. Regarding the risk for positional lesions, 68.9% presented low risk. CONCLUSIONS: 31.1% of the participants were at high risk for developing positional lesions, related to age and comorbidities.

Clinical indicators of nursing outcomes classification for patient with risk for perioperative positioning injury: A cohort study.

AIMS AND OBJECTIVES: To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis 'Risk for perioperative positioning injury'. BACKGROUND: Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. DESIGN: Longitudinal concept validation cohort study. METHODS: Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. RESULTS: A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes-Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation-and 13 clinical indicators. CONCLUSIONS: Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at 'Risk for perioperative positioning injury' are sensitive to patient states during the perioperative period. RELEVANCE TO CLINICAL PRACTICE: Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care.

Risk assessment for perioperative pressure injuries.

OBJECTIVES: to evaluate and classify patients according to the Risk Assessment Scale for Perioperative Pressure Injuries; verify the association between sociodemographic and clinical variables and the risk score; and identify the occurrence of pressure injuries due to surgical positioning. METHOD: observational, longitudinal, prospective and quantitative study carried out in a teaching hospital with 278 patients submitted to elective surgeries. A sociodemographic and clinical characterization questionnaire and the Risk Assessment Scale for Perioperative Pressure Injuries were used. Descriptive, bivariate and logistic regression analyses were applied. RESULTS: the majority of patients (56.5%) presented a high risk for perioperative pressure injury. Female sex, elderly group, and altered body mass index values were statistically significant (p < 0.05) for a higher risk of pressure injuries. In 77% of the patients, there were perioperative pressure injuries. CONCLUSION: most of the participants presented a high risk for development of perioperative decubitus ulcers. The female sex, elderly group, and altered body mass index were significant factors for increased risk. The Risk Assessment Scale for Perioperative Pressure Injuries allows the early identification of risk of injury, subsidizing the adoption of preventive strategies to ensure the quality of perioperative care.

Nursing Outcomes for Patients with Risk of Perioperative Positioning Injury.

PURPOSE: To select and refine the outcomes and indicators of Nursing Outcomes Classification for the diagnosis of risk for perioperative positioning injury. METHOD: Validation study on expert consensus and refinement through pilot study. FINDINGS: Eight outcomes and 35 indicators were selected in consensus. After clinical testing was performed, in which 10 patients were assessed at five different times. Eight outcomes and 33 indicators remained in the protocol. CONCLUSION: This study made it possible to select the most relevant outcomes and indicators to be measured for this diagnosis in clinical practice. IMPLICATIONS FOR NURSING PRACTICE: Validation studies by consensus and clinical testing are important to promote the accuracy, creating opportunities to legitimize, and improve the concepts of taxonomies.

Perfil clínico e complicações em pacientes pronados: uma coorte de um hospital universitário / Clinical profile and complications in prone patients: a cohort from a university hospital

Introdução: Este arquivo busca verificar a incidência de lesões por pressão (LP) e eventos adversos graves em pacientes submetidos à posição prona. Métodos: Estudo de coorte retrospectivo realizado entre 2015 a 2017 no Centro de Terapia Intensiva (CTI) de um Hospital Universitário de Porto Alegre. Os dados foram coletados no prontuário eletrônico por meio de um questionário estruturado e analisados através de estatística descritiva e analítica. Resultados: Foram avaliados 37 pacientes. A incidência de LP após prona foi 8 (21,6%). A ocorrência de eventos adversos durante posicionamento em prona foi 1 (2,7%), durante alternância da posição nadador foram 3 (8%) e nenhum no retorno à posição supina. Conclusões: A incidência de eventos adversos graves e de LP é menor comparados aos outros estudos. A hipótese é que o uso de coxins para o posicionamento, cuidados de enfermagem padronizados, aplicação do checklist e treinamento da equipe são responsáveis para esse resultado. (AU)

Introduction: This paper aims to determine the incidence of pressure ulcers (PUs) and serious adverse events in patients in the prone position. Methods: A retrospective cohort study was conducted from 2015 to 2017 in the intensive care unit of a university hospital in Porto Alegre, southern Brazil. Data were collected from electronic medical records using a structured questionnaire and analyzed by descriptive and analytical statistics. Results: Thirty-seven patients were evaluated. Of these, 8 (21.6%) had PUs after prone positioning. One (2.7%) adverse event occurred during prone positioning, 3 (8%) when patients were alternately placed in the swimmer's position, and none when patients were returned to the supine position. Conclusions: The incidence of serious adverse events and PUs was lower than that reported in previous studies. A hypothesis is that the use of cushions for positioning, standardized nursing care, checklists, and team training are responsible for this outcome. (AU)

Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones

ABSTRACT Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan. Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases. Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.

Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones.

PURPOSE: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. MATERIAL AND METHODS: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan. RESULTS: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases. CONCLUSION: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.

Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report / Reflexo de Bezold-Jarisch em paciente submetida à simpatectomia endoscópica para tratamento de angina pectoris refratária: relato de caso

Abstract Background and objectives Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. Case report A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold- Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure. Conclusion Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease.

Resumo Justificativa e objetivos A cardiomiopatia isquêmica caracteriza-se pelo desbalanço entre a oferta e o consumo de oxigênio pelo miocárdio. A simpatectomia transtorácica endoscópica é uma opção terapêutica indicada nos casos refratários. Contudo, a posição do paciente na mesa cirúrgica pode favorecer eventos coronarianos isquêmicos e deflagrar o reflexo de Bezold-Jarisch. Relato de caso Paciente do sexo feminino, 47 anos, portadora de cardiomiopatia isquêmica refratária, admitida na sala de cirurgia para simpatectomia transtorácica endoscópica, deflagrou o reflexo de Bezold-Jarisch e desenvolveu bradicardia e hipotensão graves logo após colocação em posição semissentada para o procedimento. Conclusão Bradiarritmia, hipotensão e assistolia são complicações potencialmente associadas à colocação do paciente em posição semissentada, especialmente nos casos em que há prévio comprometimento isquêmico do coração.

[Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report]. / Reflexo de Bezold­Jarisch em paciente submetida à simpatectomia endoscópica para tratamento de angina pectoris refratária: relato de caso.

BACKGROUND AND OBJECTIVES: Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. CASE REPORT: A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold-Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure. CONCLUSION: Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease.

Elevation of the head during intensive care management in people with severe traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) is a major public health problem and a fundamental cause of morbidity and mortality worldwide. The burden of TBI disproportionately affects low- and middle-income countries. Intracranial hypertension is the most frequent cause of death and disability in brain-injured people. Special interventions in the intensive care unit are required to minimise factors contributing to secondary brain injury after trauma. Therapeutic positioning of the head (different degrees of head-of-bed elevation (HBE)) has been proposed as a low cost and simple way of preventing secondary brain injury in these people. The aim of this review is to evaluate the evidence related to the clinical effects of different backrest positions of the head on important clinical outcomes or, if unavailable, relevant surrogate outcomes. OBJECTIVES: To assess the clinical and physiological effects of HBE during intensive care management in people with severe TBI. SEARCH METHODS: We searched the following electronic databases from their inception up to March 2017: Cochrane Injuries' Specialised Register, CENTRAL, MEDLINE, Embase, three other databases and two clinical trials registers. The Cochrane Injuries' Information Specialist ran the searches. SELECTION CRITERIA: We selected all randomised controlled trials (RCTs) involving people with TBI who underwent different HBE or backrest positions. Studies may have had a parallel or cross-over design. We included adults and children over two years of age with severe TBI (Glasgow Coma Scale (GCS) less than 9). We excluded studies performed in children of less than two years of age because of their unfused skulls. We included any therapeutic HBE including supine (flat) or different degrees of head elevation with or without knee gatch or reverse Trendelenburg applied during the acute management of the TBI. DATA COLLECTION AND ANALYSIS: Two review authors independently checked all titles and abstracts, excluding references that clearly didn't meet all selection criteria, and extracted data from selected studies on to a data extraction form specifically designed for this review. There were no cases of multiple reporting. Each review author independently evaluated risk of bias through assessing sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and other sources of bias. MAIN RESULTS: We included three small studies with a cross-over design, involving a total of 20 participants (11 adults and 9 children), in this review. Our primary outcome was mortality, and there was one death by the time of follow-up 28 days after hospital admission. The trials did not measure the clinical secondary outcomes of quality of life, GCS, and disability. The included studies provided information only for the secondary outcomes intracranial pressure (ICP), cerebral perfusion pressure (CPP), and adverse effects.We were unable to pool the results as the data were either presented in different formats or no numerical data were provided. We included narrative interpretations of the available data.The overall risk of bias of the studies was unclear due to poor reporting of the methods. There was marked inconsistency across studies for the outcome of ICP and small sample sizes or wide confidence intervals for all outcomes. We therefore rated the quality of the evidence as very low for all outcomes and have not included the results of individual studies here. We do not have enough evidence to draw conclusions about the effect of HBE during intensive care management of people with TBI. AUTHORS' CONCLUSIONS: The lack of consistency among studies, scarcity of data and the absence of evidence to show a correlation between physiological measurements such as ICP, CCP and clinical outcomes, mean that we are uncertain about the effects of HBE during intensive care management in people with severe TBI.Well-designed and larger trials that measure long-term clinical outcomes are needed to understand how and when different backrest positions can affect the management of severe TBI.

Safe prone checklist: construction and implementation of a tool for performing the prone maneuver. / Checklist da prona segura: construção e implementação de uma ferramenta para realização da manobra de prona.

OBJECTIVE: To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver. METHODS: This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane). RESULTS: We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice. CONCLUSION: The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.

OBJETIVO: Construir e implementar um instrumento (checklist) para melhoria do cuidado na manobra prona. MÉTODOS: Estudo aplicativo, qualitativo e descritivo. O instrumento foi desenvolvido a partir de ampla revisão da literatura, para construção de um protocolo de atendimento assistencial, utilizando as principais bases eletrônicas (MEDLINE, LILACS e Cochrane). RESULTADOS: Descrevemos a construção de uma ferramenta de segurança do paciente com suas inúmeras modificações e adaptações, a partir das observações da equipe multidisciplinar com seu uso na prática diária. CONCLUSÃO: A aplicação do checklist na manobra de prona acrescentou confiabilidade e segurança ao procedimento. O entendimento da importância da ferramenta na segurança do paciente, por parte da equipe, e sua capacitação são necessários para seu sucesso.

Checklist da prona segura: construção e implementação de uma ferramenta para realização da manobra de prona / Safe prone checklist: construction and implementation of a tool for performing the prone maneuver

RESUMO Objetivo: Construir e implementar um instrumento (checklist) para melhoria do cuidado na manobra prona. Métodos: Estudo aplicativo, qualitativo e descritivo. O instrumento foi desenvolvido a partir de ampla revisão da literatura, para construção de um protocolo de atendimento assistencial, utilizando as principais bases eletrônicas (MEDLINE, LILACS e Cochrane). Resultados: Descrevemos a construção de uma ferramenta de segurança do paciente com suas inúmeras modificações e adaptações, a partir das observações da equipe multidisciplinar com seu uso na prática diária. Conclusão: A aplicação do checklist na manobra de prona acrescentou confiabilidade e segurança ao procedimento. O entendimento da importância da ferramenta na segurança do paciente, por parte da equipe, e sua capacitação são necessários para seu sucesso.

ABSTRACT Objective: To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver. Methods: This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane). Results: We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice. Conclusion: The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.

Influence of seat tilt motion on discomfort perception during a simulated driving activity.

BACKGROUND: Discomfort perceived in activities where there is a prolonged sitting posture are normally compensated in a natural way by means of macro-repositioning movements in the seat. Nevertheless, evidence shows that such movements are not able to palliate discomfort due to lumbar pain. OBJECTIVE: This study involves research performed to demonstrate whether induced postural changes are able to mitigate this type of discomfort during a simulated driving activity. METHODS: Twenty-four subjects with lumbar pain (LBP) and without lumbar pain (WLBP) underwent 90 min of simulated driving activities while periodic variations of seat tilt (Tt) were implemented. RESULTS: Discomfort perception due to lumbar pain significantly decreased in the case of Tt compared with the case of WTt (without seat tilt), and significant differences were found (p = 0.02). However, treatments with Tt indicated that no substantial differences exist between LBP and WLBP subjects when considering discomfort perception due to lumbar pain and the erector spinae activity. CONCLUSIONS: This study revealed that periodic variations on seat tilt can help to reduce discomfort perception due to lumbar pain during driving activities, regardless of the health condition of the subject.

Influência do posicionamento do paciente sobre a qualidade das imagens ecocardiográficas em exames realizados no leito / Influence of patient’s positioning on the quality of bedside echocardiography images

Fundamento: O ecocardiograma é particularmente importante para a avaliação de pacientes instáveis hemodinamicamente. Apesar de sua realização à beira do leito eliminar o risco resultante do transporte, a obtenção de imagens pode ficar prejudicada; o posicionamento adequado poderia contribuir para uma melhor qualidade de imagem e consequentemente análise do exame. Objetivo: Avaliar se o posicionamento do paciente pela enfermagem poderia influenciar a qualidade das imagens ecocardiográficas obtidas no leito. Métodos: Foram estudados de maneira consecutiva os pacientes com solicitação de exame no leito. Durante a realização de ecocardiograma transtorácico foram adquiridos vídeos dos planos para esternal longitudinal (PEL) e apical 4-câmaras(Apical-4C) e a imagem estática do fluxo aórtico (FAo) em decúbito lateral esquerdo (DLE) e em decúbito dorsal (DD). As imagens digitalizadas foram analisadas cegamente por dois observadores em relação ao tipo de decúbito utilizado. A qualidade das imagens foi graduada como 1:boa/ótima; 2:inadequada/ruim; e comparadas com o teste de Kappa e correlação de Pearson. Resultados: Foram estudados 68 pacientes, com idade de 69 ± 24 anos, sendo 37 do sexo masculino e superfície corpórea 1,85 ± 0,09 m2. Em relação aos cortes, as imagens em DLE apresentam melhor qualidade (p < 0,001) quando comparadas ao DD tanto para os vídeos Apical-4C (Kappa 0,19) e PEL (Kappa 0,25) e FAo (Kappa 0,13); a concordância entre os avaliadores para a qualidade das imagens foi de 95%. Conclusão: O posicionamento adequado do paciente no leito em decúbito lateral esquerdo contribui significativamente para a aquisição de imagens de melhor qualidade.

Background: Echocardiography is particularly important for assessing hemodynamically unstable patients. Despite being carried out at the bedside to eliminate the risk resulting from patient’s transportation, the imaging maybe impaired. Proper patient’s positioning could contribute to enhancing both the image quality and analysis of the exam. Objective: To evaluate whether patient’s positioning by nurses could influence the quality of the echocardiographic images obtained at the bedside. Methods: Patients whose examinations were requested to be carried out at the bedside were studied in a consecutive manner. During transthoracic echocardiography, videos of the parasternal longitudinal view (PLV) and 4-chamber apical view (Apical-4C) were obtained, as well as the still image of the aortic flow (FAo), in the left lateral decubitus (LLD) and supine decubitus (SD). The scanned images were blindly analyzed by two observers comparing the type of decubitus used. The image quality was rated as 1: good/excellent quality; 2: inadequate/poor, and then submitted to Kappa agreement test and Pearson correlation. Results: 68 patients were studied, aged 69 ± 24 years, 37 males and body surface 1.85 ± 0.09 m2. When the distinct views were compared, LLD images showed better quality (p < 0.001) when compared to SD for both the Apical-4C videos (Kappa 0.19) and PLV (Kappa 0.25) and FAo (Kappa 0.13); interobserver agreement of the quality of the images was 95%. Conclusion: Patient’s proper positioning in bed in left lateral decubitus contributes significantly to the acquisition of better quality images.