Prone Position in Acute Respiratory Distress Syndrome Patients: A Retrospective Analysis of Complications.

BACKGROUND: Early application of prolonged prone positioning has been shown to improve patient survival in moderate to severe adult respiratory distress syndrome (ARDS) patients. Prone position is a key component of lung protective mechanical ventilation in association with low tidal volume and neuromuscular blocking agents in patients with severe ARDS. Pressure sores are the major prone position complication. The rate of complication is lowering with the increase in center expertise. AIMS: The aim of this study was to examine the onset of pressure sores and other complications caused by the use of prone position in patients having ARDS. DESIGN: This is a single-center, retrospective, observational study. RESULTS: One hundred seventy patients were enrolled, with a median age of 49 years (interquartile range [IQR], 38-63). Of all participants, 58% (n = 98) survived the intensive care unit recovery. The total prone position maneuvers were 526, with a median of 2 prone position sessions for each patient (IQR, 1-3). The median length of the prone position session was 9 hours (IQR, 7-12). Twenty-three patients developed pressure sores after prone position (14%). The anatomical positions of pressure sores were as follows: face/chin, 5% (n = 8); face/cheekbones, 6% (n = 11); thorax, 2% (n = 3); trochanter, 1% (n = 1); and other sites, 5% (n = 8). Complications were observed in 1% (n = 6) of all pronation maneuvers (vomit, 2%; respiratory device removal, 0.4%). No removal of intravascular catheter was observed. CONCLUSIONS: The onset rate of complications given by the use of prone position in ARDS patients is similar to data reported by previous literature. The implementation of a dedicated protocol in specialized centers and the involvement of 5 trained and skilled professionals while moving the patient in the prone position are recommended to prevent the occurrence of similar adverse events.

[Number of nurses and adverse events: the results of a study]. / Fabbisogno assistenziale e insorgenza di eventi avversi in terapia intensiva: i risultati di un'indagine.

UNLABELLED: Number of nurses and adverse events: the results of a study. Introduction. Adverse events may be related to an higher workload and a lower nurse staffing level compared to patients needs. OBJECTIVE: To assess the association between adverse events and lower nurse staffing level compared to patients workload, measured with the Nursing Activity Score (NAS). METHOD: The daily workload of patients admitted to the Intensive Care Unit of San Gerardo Hospital (Monza) from December 15, 2009 to May 9, 2010 was measured with the NAS. The scores were correlated with the number of nurses on shift over 24 hours, the bed occupancy rate and the adverse events occurred. RESULTS: Out of a population of 240 patients for a follow-up period of 145 days, 45 adverse events were observed. In the days with events the difference between ideal and actual nurses requirement amounted to -7.68% (±8.84). On days without events, the difference was 0.44% (±7.96) (p value 0.0001). In the days with events patients received less minutes of care than needed -110.66 (±127), and on days without events an excess of minutes of care 6.40 (±115) minutes /patient. The average NAS score of patients with events was 81.88 (±10.00); 73.54 (±13.83) of those without events (p=0.001). CONCLUSIONS: In the period observed adverse events occurred mainly when the difference between patients workload according to NAS and minutes of care provided by nurses on shift was higher.

[Modifications of vital signs during hygiene care in intensive care patients: an explorative study]. / Alterazioni dei parametri vitali indotte dalle cure igieniche nel paziente critico: uno studio esplorativo.

UNLABELLED: Hygiene care in critical patients may alter vital signs. Aim of this paper is to measure vital signs and their modifications in critical patients during hygiene care and measure differences with pre and post hygiene values. METHOD: Vital signs of 6 patients two hours before, during and 90 minutes after hygienic care were measured. RESULTS: During and 2 hours after the end of hygiene a modification of vital signs was observed compared to basic values (mean values during/90 min after, compared to baseline): heart rate +11.20%/ +1.48; systolic blood pressure +22.68%/+1.56; arterial capillary saturimetry -4.31/+0.27, Respiratory frequency +8.10/+2.66, tidal volume +4,04/-7,51, CO2 min/vol +5,34/- 22.33, bladder temperature -0.85/-0.60. CONCLUSIONS: Hygiene care in critical care patients may significantly alter vital signs. Therefore a strict haemodinamic and respiratory monitoring is warranted as well as protocols for the management of sedation and of vasoactive support.