Enfermeria intensiva最新文献_第7页

Incidence of unscheduled removal of invasive devices in patients with COVID-19 in intensive care 重症监护COVID-19患者有创装置意外移除的发生率

Enfermeria intensiva

Pub Date : 2025-03-21 DOI: 10.1016/j.enfie.2025.100507

Susana Arias-Rivera PhDc, MsN, RN , Raquel Jareño-Collado RN , María del Mar Sánchez-Sánchez MsN, RN , Fernando Frutos-Vivar MD

Introduction

The rate of unscheduled removal of invasive devices (ID) is an indicator of quality programmes in the critically ill. Our research group performed prevalence analyses since 2010 and another during the pandemic. The aim was to analyse the rates of use and non-planed removal of endotracheal tubes, catheters (central venous and arterial) and enteral catheters in the first wave of the COVID-19 pandemic comparing them with previous rates.

Methodology

Prevalence study in a polyvalente ICU. After 4 prospective observational analyses (2010, 2011, 2018, 2019) a retrospective analysis was performed (8 March–8 May 2020). Variables: diagnosis, stay and reason for removal of ID (endotracheal tubes (ET), central venous catheters, arterial catheters and enteral catheters) and rate of reintubation after self-removal of ET. Variables analysed and described as accidental removal rates per 1000 device-days and rates of ID use.

Results

2026 patients were included (631 in 2010, 724 in 2011, 210 in 2018, 361 in 2019 and 100 in 2020). Significant differences, between all periods, in diagnoses (p < 0.001), ICU stay (p < 0.001) and mortality (p = 0.016) and, between 2020 and all other periods, in rates of use per 100 days-stay (p < 0.010) and per 100 admissions (p < 0.001) in all devices except arterial catheter. In 2020, there was an increase in ET obstruction (36.0%; rate 20.27 per 1000 intubation-days, p < 0.010), decrease in ET self-removals (2020 rate: 0.00 per 1000 intubation-days; p < 0.050) and enteral catheters (14.33 per 1000 catheter-days). Overall reintubation (all periods) after self-extubation: 12.5%.

Conclusions

The rate of devices self-removal in COVID-19 patients in the first wave of the pandemic was lower than that observed in the previous four periods. The high incidence rate of ET obstruction in these patients was significant and relevant.

非计划移除侵入性装置（ID）的比率是危重病人质量规划的一个指标。我们的研究小组自2010年以来进行了患病率分析，另一次是在大流行期间进行的。目的是分析2019冠状病毒病第一波大流行期间气管内管、导管（中心静脉和动脉）和肠内导管的使用率和非计划拔除率，并将其与之前的使用率进行比较。方法多价ICU的患病率研究。经过4次前瞻性观察分析（2010年、2011年、2018年和2019年），进行了回顾性分析（2020年3月8日至5月8日）。变量：诊断、拔除ID（气管内管（ET）、中心静脉导管、动脉导管和肠内导管）的停留时间和原因，以及自行拔除ET后的再插管率。变量分析和描述为每1000个设备日的意外拔除率和ID使用率。结果共纳入2026例患者（2010年631例，2011年724例，2018年210例，2019年361例，2020年100例）。各时期诊断的显著差异(p <；0.001)， ICU住院时间(p <；0.001)和死亡率（p = 0.016），在2020年和所有其他时期，每100天住院的使用率(p <；0.010)，每100人收费(p <；0.001)，除动脉导管外。2020年，ET梗阻发生率增加了36.0%；比率：20.27 / 1000插管日，p <；0.010)， ET自清除减少(2020年比率：0.00 / 1000插管日；p & lt;0.050)和肠内导管（14.33 / 1000导管天）。自拔管后整体再插管（所有时期）：12.5%。结论第一波疫情中，COVID-19患者的器械自行取出率低于前四波疫情。这些患者ET梗阻的高发生率具有显著性和相关性。

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引用次数: 0

Efficacy of locally infiltrated amides as local anesthesia in arterial puncture for blood gas analysis: A systematic review 局部浸润酰胺作为局部麻醉在动脉穿刺血气分析中的应用效果综述

Enfermeria intensiva

Pub Date : 2025-03-05 DOI: 10.1016/j.enfie.2025.100506

Itxaso Nieves-Cámara RN , Sendoa Ballesteros-Peña RN, MPH, PhD

Aim

To assess the efficacy of infiltrated amides in reducing pain caused by arterial puncture for blood gas analysis.

Method

A search protocol was developed and applied across four databases (Medline, SCOPUS, Embase, and TRIP Database). Clinical trials published between January 2000 and May 2024, in either Spanish or English, were considered. Clinical trials comparing the analgesic efficacy of infiltrated amides in adult patients undergoing arterial puncture were selected.

Results

Five randomised clinical trials were selected, with sample sizes ranging from 10 to 133 adult patients per randomization group. The studies showed mixed results regarding the efficacy of infiltrated amides in reducing pain associated with arterial puncture. Two studies highlighted mepivacaine for its pain reduction efficacy, while the other three demonstrated variable efficacy of lidocaine.

Conclusions

The efficacy of infiltrated amides as local anaesthetics in arterial puncture for blood gas analysis varies. Mepivacaine appears promising; however, further studies are needed to establish clear recommendations. It is crucial to consider patient preferences and professional experience when deciding on the use of these anaesthetics.

目的探讨浸润酰胺对动脉穿刺血气分析疼痛的缓解作用。方法开发检索协议，并在Medline、SCOPUS、Embase和TRIP数据库中应用。2000年1月至2024年5月期间以西班牙语或英语发表的临床试验被纳入考虑范围。选择临床试验，比较浸润酰胺在成人动脉穿刺患者中的镇痛效果。结果选择5个随机临床试验，每个随机组的样本量为10 ~ 133例成人患者。研究显示浸润性酰胺在减轻动脉穿刺疼痛方面的疗效好坏参半。两项研究强调了甲哌卡因的镇痛效果，而另外三项研究表明利多卡因的疗效不同。结论浸润酰胺在动脉穿刺血气分析中作为局麻药的效果不同。甲哌卡因看起来很有希望；然而，需要进一步的研究来确定明确的建议。在决定使用这些麻醉剂时，考虑患者的偏好和专业经验是至关重要的。

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引用次数: 0

Management of critically ill patients difficult to sedate: Update and clinical strategies 难以镇静的危重病人的管理：最新和临床策略

Enfermeria intensiva

Pub Date : 2025-03-05 DOI: 10.1016/j.enfie.2025.100500

Diana Gil-Castillejos RN, MSN, PhD , Aaron Castanera-Duro RN, MSN, PhD , Gemma Via-Clavero RN, MSN, PhD , Alberto Sandiumenge-Camps MD, PhD

One in every three critically ill patients who receive prolonged analgosedation may experience difficult sedation, negatively influencing their evolution and prognosis. Difficult sedation includes situations of therapeutic failure, tolerance or deprivation of analgesic and sedative drugs. Its origin is multifactorial and depends on the patient’s characteristics, history of drug consumption, critical condition and the administration of drugs that alter the pharmacokinetics of the sedatives used. This update aims to describe the definition of difficult sedation, identify the group of critically ill sedated patients who can develop it, its etiology, and how it should be treated and managed. The difficulty in achieving an adequate level of sedation, increasing the dose of sedatives or adding new agents represents a challenge in daily practice in critical care units since it can increase the risks of toxicity and related complications. Prevention and early identification of difficult sedation situations are essential strategies to minimize their impact; hence nurses’ autonomy in the management of analgosedation represents a primary intervention.

每三名接受长时间镇痛镇静治疗的危重患者中就有一名可能难以镇静，这对他们的病情发展和预后产生了负面影响。镇静困难包括治疗失败，耐受或剥夺镇痛和镇静药物的情况。其起源是多因素的，取决于患者的特点、用药史、危重情况和使用改变所使用镇静剂药代动力学的药物。本更新旨在描述困难镇静的定义，确定可能发生这种情况的危重镇静患者群体，其病因以及应如何治疗和管理。难以达到足够的镇静水平，增加镇静剂的剂量或添加新的药物是在重症监护病房的日常实践中的一个挑战，因为它可以增加毒性和相关并发症的风险。预防和早期识别困难的镇静情况是尽量减少其影响的基本策略；因此，护士在麻醉管理中的自主权是主要的干预措施。

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引用次数: 0

Discriminatory ability of the current pressure ulcer risk assessment scale in critically ill patients in Quito, Ecuador 厄瓜多尔基多危重患者现行压疮风险评估量表的区分能力

Enfermeria intensiva

Pub Date : 2025-03-05 DOI: 10.1016/j.enfie.2025.100505

Fausto Marcos Guerrero-Toapanta MD, MSc, Mónica Jeanneth Sandoval-Cóndor RN, María Teresa Usuay-Usuay RN, Cristina Jeanneth Paida-Cañar RN, MSc, Elena Elizabeth Cuenca-Bermúdes RN

Introduction

Pressure ulcers are adverse events that increase morbidity, mortality and costs. Critically ill patients have several risk factors. There are scales that predict their occurrence; however, it is necessary to use specific scales in critically ill patients.

Objective

To evaluate the discriminative ability of the current pressure ulcer risk assessment scale in critically ill patients in Quito, Ecuador.

Method

Observational, longitudinal, prospective study. Patients hospitalized for more than 48 h without evidence of ulcers on admission were recruited. Demographic and clinical variables were recorded, as well as the current risk assessment scales, Norton, and the appearance of ulcers on a daily basis. Data were analyzed using the JAMOVI statistical package version 2.4. The significance level was P < .05.

Results

A total of 306 patients were enrolled, 5 developed ulcers, an incidence of 1.63%. Grade 2 ulcers and sites on the face and head were most common. For the current risk assessment scale, the ROC curve defined the best cut-off point of 13, at 48 h, Youden index 0.678, sensitivity 100%, specificity 67.77%, positive predictive value 4.9%, negative predictive value 100%, with an AUC of 0.855, with a relative risk of 1.05, with 95% confidence intervals of 1.01–1.10. For Norton, the ROC curve defined the best cut-off point as 9, at 48 h, Youden index 0.646, sensitivity 64.65%, specificity 100%, positive predictive value 100%, negative predictive value 4.55%, AUC 0.874, with a relative risk of 1.04, with 95% confidence intervals of 1.01–1.08.

Conclusions

The current risk assessment scale, similar to the Norton scale, can be used to discriminate the occurrence of pressure ulcers in critically ill patients. The best assessment may be at 48 h after admission, with a cut-off point of 13.

压疮是增加发病率、死亡率和成本的不良事件。危重病人有几个危险因素。有一些尺度可以预测它们的发生；但是，危重患者有必要使用特定的量表。目的评价厄瓜多尔基多地区现行压疮风险评估量表对危重患者压疮风险的鉴别能力。方法观察性、纵向、前瞻性研究。患者住院超过48小时，入院时无溃疡的证据。记录了人口统计学和临床变量，以及当前的风险评估量表、诺顿评分和每日溃疡的出现情况。使用JAMOVI统计软件包2.4版分析数据。显著性水平为P <；. 05。结果共纳入306例患者，5例发生溃疡，发生率为1.63%。2级溃疡和面部及头部部位最常见。对于现行的风险评估量表，ROC曲线定义的最佳截断点为13,48 h时，约登指数0.678，敏感性100%，特异性67.77%，阳性预测值4.9%，阴性预测值100%，AUC为0.855，相对风险为1.05,95%可信区间为1.01-1.10。对于Norton， ROC曲线定义的最佳截断点为9,48 h时，约登指数0.646，敏感性64.65%，特异性100%，阳性预测值100%，阴性预测值4.55%,AUC 0.874，相对风险为1.04,95%可信区间为1.01-1.08。结论现有的风险评估量表与诺顿量表类似，可用于区分危重患者压疮的发生。最佳评估可能是在入院后48小时，分界点为13。

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引用次数: 0

Factors associated with early readmission to Intensive Care Units. A systematic review 与早期再入院加护病房相关的因素。系统回顾

Enfermeria intensiva

Pub Date : 2025-02-28 DOI: 10.1016/j.enfie.2025.100498

Verónica Badilla-Morales RN, MSN , Regina Marcia Cardoso de Sousa RN, PhD , Verónica Nasabun-Flores RN, MSc , Cibeles González-Nahuelquin RN, MSN

Introduction

Readmission to the Intensive Care Unit (ICU) determines worse outcomes such as higher mortality, increased hospital and ICU stay, as well as higher economic costs. When deciding which patient is suitable for transfer from the ICU, factors associated with readmission must be considered to avoid it. Knowledge of these factors helps professionals identify those patients with a higher probability of readmission, prioritizing their care, establishing and preparing interventions that seek to reduce the risk of readmission.

Objective

Determine factors associated with early readmission in patients transferred from the ICU to general hospitalization wards of the same hospital.

Method

Studies were retrieved from databases: CINAHL, EMBASE, BVS, PubMed, SCOPUS and WOS identifying original studies on adult patients readmitted early to the ICU during the same hospitalization, in any language and without time limit. Studies of patient readmission after seven days, review articles, editorials, protocols, clinical guidelines, qualitative studies and opinion surveys were excluded.

Results

Of 755 files found, 28 articles made up the review. The most analyzed factors were age, sex, severity of the disease, comorbidity, length of stay in the ICU, mechanical ventilation and nocturnal discharge. Those most frequently associated with readmission were age, severity of illness, comorbidity, and length of ICU stay. NEWS, MEWS, and SWIFT scores were also factors associated with readmission.

Conclusion

More research is needed to identify those modifiable factors that can decrease readmission rates. Using readmission prediction instruments at the time of discharge could support the decision of which patient is most prepared for it.

再次入住重症监护室（ICU）决定了更糟糕的结果，如更高的死亡率，住院和ICU住院时间的增加，以及更高的经济成本。在决定哪些患者适合从ICU转出时，必须考虑与再入院相关的因素，以避免再入院。了解这些因素有助于专业人员识别那些再入院概率较高的患者，优先考虑他们的护理，建立和准备旨在降低再入院风险的干预措施。目的探讨从ICU转至同一医院普通住院病房患者早期再入院的相关因素。方法从CINAHL、EMBASE、BVS、PubMed、SCOPUS和WOS数据库中检索研究，确定同一住院期间早期再入院ICU的成人患者的原始研究，以任何语言和无时间限制。7天后患者再入院的研究、综述文章、社论、方案、临床指南、定性研究和意见调查被排除在外。结果在755份文献中，有28篇文章构成了综述。分析最多的因素是年龄、性别、疾病严重程度、合并症、ICU住院时间、机械通气和夜间出院。与再入院最相关的因素是年龄、病情严重程度、合并症和ICU住院时间。NEWS、MEWS和SWIFT评分也是与再入院相关的因素。结论需进一步研究降低再入院率的可调整因素。在出院时使用再入院预测仪器可以帮助决定哪位患者准备得最充分。

{"title":"Factors associated with early readmission to Intensive Care Units. A systematic review","authors":"Verónica Badilla-Morales RN, MSN , Regina Marcia Cardoso de Sousa RN, PhD , Verónica Nasabun-Flores RN, MSc , Cibeles González-Nahuelquin RN, MSN","doi":"10.1016/j.enfie.2025.100498","DOIUrl":"10.1016/j.enfie.2025.100498","url":null,"abstract":"<div><h3>Introduction</h3><div>Readmission to the Intensive Care Unit (ICU) determines worse outcomes such as higher mortality, increased hospital and ICU stay, as well as higher economic costs. When deciding which patient is suitable for transfer from the ICU, factors associated with readmission must be considered to avoid it. Knowledge of these factors helps professionals identify those patients with a higher probability of readmission, prioritizing their care, establishing and preparing interventions that seek to reduce the risk of readmission.</div></div><div><h3>Objective</h3><div>Determine factors associated with early readmission in patients transferred from the ICU to general hospitalization wards of the same hospital.</div></div><div><h3>Method</h3><div>Studies were retrieved from databases: CINAHL, EMBASE, BVS, PubMed, SCOPUS and WOS identifying original studies on adult patients readmitted early to the ICU during the same hospitalization, in any language and without time limit. Studies of patient readmission after seven days, review articles, editorials, protocols, clinical guidelines, qualitative studies and opinion surveys were excluded.</div></div><div><h3>Results</h3><div>Of 755 files found, 28 articles made up the review. The most analyzed factors were age, sex, severity of the disease, comorbidity, length of stay in the ICU, mechanical ventilation and nocturnal discharge. Those most frequently associated with readmission were age, severity of illness, comorbidity, and length of ICU stay. NEWS, MEWS, and SWIFT scores were also factors associated with readmission.</div></div><div><h3>Conclusion</h3><div>More research is needed to identify those modifiable factors that can decrease readmission rates. Using readmission prediction instruments at the time of discharge could support the decision of which patient is most prepared for it.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100498"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Experience of an advanced practice nurse in an intensive care unit 在重症监护室做高级实习护士的经验。

Enfermeria intensiva

Pub Date : 2025-01-01 DOI: 10.1016/j.enfie.2025.100482

R. Goñi-Viguria RN, MSN

The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice.

This article describes how the APN works with the different members of the health team and what the results have been since their incorporation.

The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.

重症监护病房的结构、技术的改进和病人的严重程度，要求所有参与协助危重病人的行动者之间保持和谐。在这种背景下，目前主管的角色包括承担越来越多的管理技能，同时也没有忽视在护理哲学框架内构建专业实践的必要性。鉴于主管面临的这一挑战，在我们的环境中出现的高级执业护士形象（APN）是一个机会。APN对于改善患者护理、员工发展和实施循证实践至关重要。本文描述了APN如何与卫生团队的不同成员合作，以及自他们成立以来取得的成果。APN领导维持护理质量的努力。他们利用自己的知识来评估实践中的差距和实践环境之间的差距，并设计和领导基于证据的实践变革，以便能够以最有效和及时的方式达到基准。此外，它支持组织应对不断变化的医疗保健环境，并有助于实现其目标。

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引用次数: 0

Parent experiences of child loss in a paediatric intensive care unit on human connection and compassionate care 在儿科重症监护病房失去孩子的父母经验对人际关系和同情关怀。

Enfermeria intensiva

Pub Date : 2025-01-01 DOI: 10.1016/j.enfie.2025.100504

Sara Alcón-Nájera RN, MsC, PhD , María Teresa González-Gil RN, MsC, PhD

Introduction

The death of a child in an Intensive Care Unit (ICU) is a rare event, the main causes being failed resuscitation efforts, brain death or limitation of the therapeutic effort. The family interpretation of this experience has a significant impact on mourning. Knowledge of the elements that condition this interpretation, is fundamental to be able to accompany and care.

Aims

General: to explore the experience of families who have suffered the loss of a child in the PICU. Specific: to describe the experience of "human connection and family centred compassionate care".

Methodology

A qualitative phenomenological study was carried out in the PICU of a high complexity hospital. Thirteen interviews were conducted (11 mothers/9 fathers), with an average duration of 60 min until thematic saturation. Data were analysed following Van Manen's hermeneutic approach.

Results

Compassionate family-centred care is based on the human connection between care team and family system with the objectives of: recognising care as a family affair, promoting a collaborative approach to care and strengthening family bonds. Their achievement requires: informing/training parents about the disease process and care, involving them in decision-making, facilitating their participation in care, generating spaces for honest communication with the care team, facilitating care respire and sibling visits, making, promoting "family magic spaces”, and generating family memories.

Conclusions

The experience of losing a child in the PICU is conditioned by the care team's approach to the management of the families' suffering. The co-creation of a relationship space centred on their needs and mediated by sincere communication and real collaboration is valued as a valuable gift.

儿童在重症监护病房（ICU）死亡是一件罕见的事件，主要原因是复苏失败，脑死亡或治疗努力有限。家属对这一经历的解释对哀悼有重大影响。对这些要素的了解，是能够陪伴和关怀的基础。目的：一般：探讨在重症监护病房中失去孩子的家庭的经验。具体：描述“人际关系和以家庭为中心的关爱”的体验。方法：对某高复杂性医院PICU进行定性现象学研究。进行了13次访谈（11位母亲/9位父亲），平均持续时间为60 分钟，直到主题饱和。数据分析遵循Van Manen的解释学方法。结果：富有同情心的以家庭为中心的护理是建立在护理团队和家庭系统之间的人际关系的基础上的，其目标是：认识到护理是一项家庭事务，促进合作的护理方法，加强家庭纽带。要实现这一目标，需要：向父母提供关于疾病过程和护理的信息/培训，让他们参与决策，促进他们参与护理，创造与护理团队坦诚沟通的空间，促进护理呼吸和兄弟姐妹探访，创造和促进“家庭神奇空间”，并产生家庭记忆。结论：在PICU中失去孩子的经历取决于护理团队处理家庭痛苦的方法。以他们的需求为中心，以真诚的沟通和真正的合作为媒介，共同创造一个关系空间，这是一种宝贵的礼物。

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引用次数: 0

Risk factors associated with adverse medication events reported by nurses in a Pediatric Hospital in Mexico 墨西哥一家儿科医院护士报告的与不良用药事件相关的危险因素

Enfermeria intensiva

Pub Date : 2025-01-01 DOI: 10.1016/j.enfie.2025.100492

Rosa María Hidalgo-Velasco RN , Graciela Martínez-Velasco RN , Martha Martínez-Salazar PhD , Karina Juárez-González MSc , Salvador Vázquez-Vega PhD

Introduction

During pediatric medication administration, patient safety-related incidents such as sentinel event, adverse event or quasi-failure still occur.

Objective

To identify risk factors associated with adverse events during the medication of pediatric patients reported by nurses.

Methods

Cross-sectional study, non-probabilistic sampling. From January to October 2021, 411 reports from the Vencer II System were reviewed, of which only 140 reported notifications of incidents during the medication of pediatric patients. Using Root Cause Analysis 38 factors associated with adverse events were investigated. Descriptive and inferential statistics were used.

Results

Of the 411 reports reviewed, 140 (34.0%) correspond to incidents; 116 (83.0%) to adverse events and 24 (17.0%) to quasi-failure, no sentinel events were reported. In the human factor, six of the seven proximal factors had a frequency ≥ 40%. Work overload was significantly associated with the occurrence of adverse events; OR = 3.24 (95% CI [1.31–7.99]) (p = 0.008). Contrary to what has been reported, LASA (Look-Alike, Sound-Alike) medications and double-check omission were identified as protective against the occurrence of incidents; OR = 0.323 (95% CI [0.13−0.84]) (p = 0.017); OR = 0.39 (95% CI [0.15−0.99]) (p = 0.047).

Conclusions

Work overload was identified as a risk factor associated with the occurrence of adverse events, so it is necessary to evaluate this factor from objective medication and from the nurses' perception of it. Having a documented incident notification and response system in place will allow healthcare institutions to demonstrate diligence and transparency. Finally, the usefulness of Root Cause Analysis and the Ishikawa Diagram to identify factors that can cause incidents is again supported, so their integration into the VENCER II instrument would be useful.

在儿童给药过程中，仍会发生与患者安全相关的事件，如哨点事件、不良事件或准失败。目的了解护士报告的儿科患者用药不良事件的相关危险因素。方法横断面研究，非概率抽样。从2021年1月至10月，我们审查了来自Vencer II系统的411份报告，其中只有140份报告了儿科患者用药期间的事件通知。采用根本原因分析对38个与不良事件相关的因素进行了调查。采用描述性统计和推断性统计。结果411份报告中，140份（34.0%）对应事件；不良事件116例（83.0%），准失败24例（17.0%），未报告前哨事件。在人为因素中，7个近端因素中有6个频率≥40%。工作负荷与不良事件的发生显著相关；OR = 3.24 (95% CI [1.31-7.99]) （p = 0.008）。与所报道的情况相反，LASA（相似，相似声音）药物和双重检查遗漏被确定为防止事件发生的保护措施；OR = 0.323 (95% CI[0.13−0.84])(p = 0.017)；OR = 0.39 (95% CI[0.15−0.99])（p = 0.047）。结论超负荷工作是不良事件发生的危险因素，有必要从客观用药和护士认知两方面对其进行评估。拥有一个记录在案的事件通知和响应系统将使医疗机构能够表现出勤勉和透明度。最后，再次支持根本原因分析和Ishikawa图用于识别可能导致事故的因素，因此将其集成到VENCER II仪器中将是有用的。

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引用次数: 0

Electrophisiological monitoring of pain in non-communicative critically ill patients 非交流重症患者疼痛的电生理监测。

Enfermeria intensiva

Pub Date : 2025-01-01 DOI: 10.1016/j.enfie.2024.100489

C. López-López RN, MSc, PhD , G. Robleda-Font RN, MSc, PhD , G. Via-Clavero RN, MSc, PhD , A. Castanera-Duro RN, MSc, PhD

Electrophysiological monitoring of pain provides objective measures that allow for pain control and adjustment of analgesia in non-communicative patients.

Among the available electrophysiological devices, automated infrared pupillometry, Analgesia Nociception Index (ANI), and Nociception Level Index (NOL®) stand out. These non-invasive measurement systems analyze the sympathetic or parasympathetic nervous system response to painful stimuli by observing pupillary dilatation and reactivity (pupillometry), heart rate during respiration (ANI), or a combination of multiple parameters from the nociceptive-autonomic medullary circuit (NOL®). These methods have mainly been used in the monitoring of nociception related to procedures in critically ill patients.

Furthermore, they have allowed for the prediction, adjustment, and customization of analgesia administration prior to painful procedures. To obtain accurate measurements and properly interpret the values provided by these devices, it is important to consider certain limitations in their use, such as the administration of specific medications or the presence of certain pathologies, due to their influence on the autonomic nervous system response. It is also important to note that the reported level of evidence is limited, as randomized clinical trials in the context of intensive care unit regarding these devices are currently lacking.

疼痛的电生理监测提供了客观的措施，允许疼痛控制和调整非交流患者的镇痛。在现有的电生理设备中，自动红外瞳孔测量仪、镇痛痛觉指数（ANI）和痛觉水平指数（NOL®）最为突出。这些非侵入性测量系统通过观察瞳孔扩张和反应性（瞳孔测量）、呼吸时心率（ANI）或来自伤害-自主髓神经回路（NOL®）的多个参数的组合来分析交感或副交感神经系统对疼痛刺激的反应。这些方法主要用于危重病人手术过程中伤害感觉的监测。此外，它们还允许在疼痛手术之前预测、调整和定制镇痛给药。为了获得准确的测量和正确解释这些装置提供的值，重要的是要考虑其使用中的某些限制，例如特定药物的施用或某些病理的存在，由于它们对自主神经系统反应的影响。同样值得注意的是，报告的证据水平有限，因为目前缺乏在重症监护病房中关于这些装置的随机临床试验。

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引用次数: 0

Nurses' role in spiritual care for patients and families in intensive care units: A scoping review 护士在重症监护室病人和家属的精神护理中的作用：范围审查。

Enfermeria intensiva

Pub Date : 2025-01-01 DOI: 10.1016/j.enfie.2025.100494

M. Kappes RN, MSc , C.A. Fernández-Silva RN, MSc , L. Catalán RN, MSc , C. Navalle RN , M. Diaz RN , I. Guglielmi RN, MSc

Introduction

Critically ill patients and their families benefit from spiritual care. There is limited evidence on how spiritual care is delivered in intensive care units (ICUs).

Aim

The objective of this review was to determine how nurses include spiritual care for patients and families in ICUs.

Methodology

A scoping review was conducted following the Joanna Briggs Institute methodology guidelines, with results reported using the PRISMA-ScR guidelines from March to April 2023. PubMed, Scopus by Elsevier, Web of Science (WOS), and the Ebsco search engine were consulted, including databases such as Medline Complete, Cinhal, and Academic Search Ultimate using the keywords: Nursing care, ICU, spirituality. Articles with qualitative and quantitative approaches of any design describing spirituality in nursing care for patients or families in ICUs were included, excluding editorials and letters to the editor. The time frame ranged from 2015 to 2023, with no language restrictions.

Results

A total of 316 articles were retrieved, after removing duplicates and applying inclusion criteria with critical reading, 11 studies were included, 6 with a quantitative approach and 5 with a qualitative approach. Conditions for spiritual care are described highlighting the need for physical space and nurse-related conditions such as motivation and empathy. Personal, organizational, and team-related barriers to spiritual care exist. Facilitators for spiritual care are described such as preparation, communication, and the presence of chaplains.

Conclusions

Nurses in ICUs have various ways to provide spiritual care to patients and families. These must be developed considering barriers such as physical space, personal, organizational, and team-related challenges.

简介：危重病人及其家属受益于精神关怀。关于如何在重症监护病房（icu）提供精神护理的证据有限。目的：本综述的目的是确定护士如何在icu中对患者和家属进行精神护理。方法学：根据Joanna Briggs研究所方法学指南进行了范围审查，并于2023年3月至4月使用PRISMA-ScR指南报告了结果。检索了PubMed、Scopus by Elsevier、Web of Science （WOS）和Ebsco搜索引擎，包括Medline Complete、Cinhal和Academic search Ultimate等数据库，关键词为：Nursing care、ICU、spirituality。采用任何设计的定性和定量方法描述icu患者或家属护理中的灵性的文章被纳入，不包括社论和给编辑的信。时间范围从2015年到2023年，没有语言限制。结果：共检索到316篇文献，在剔除重复文献并应用批判性阅读纳入标准后，纳入了11篇研究，其中6篇采用定量方法，5篇采用定性方法。描述了精神护理的条件，强调了对物理空间和护士相关条件的需求，如动机和同理心。个人、组织和团队在灵性关怀方面存在障碍。精神关怀的促进因素包括准备、沟通和牧师的在场。结论：icu护士对患者及家属的精神关怀方式多种多样。这些必须考虑到物理空间、个人、组织和团队相关挑战等障碍。

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