Cuidado crítico

  • 文章类型: Journal Article
    目的:确定医疗团队对家庭参与危重病成人护理的准备程度,以及他们与智利圣地亚哥医疗外科重症监护病房(ICU)参与者个体特征的关系。
    方法:一项横断面相关性研究,使用定量方法,包括一个焦点小组,以探索医护人员对家庭参与危重病人护理的看法。
    结果:医疗团队对家庭参与危重病人护理的准备程度中等,在总共20个中的13.81。准备程度越高,年龄越低(r=-0.215;P=0.019),以前与家庭一起工作的经验评分越高(r=0.304;P=0.006),在危重病人的护理中,对不同活动的舒适度越高(r=0.495:P<0.001)。与会者还指出,单位的工作环境,病人的情况,亲属的特征,个人判断,亲戚的准备会影响他们的准备。
    结论:结果有助于确定医疗团队在研究对象尚未实施的情况下的准备水平。医疗团队的准备情况中等,并且与医护人员的个人特征有关,以及组织和家庭方面。因此,需要策略来解决这些可能增加准备的方面。
    OBJECTIVE: To determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile.
    METHODS: A cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient.
    RESULTS: The level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (r = -0.215; P = 0.019), the higher the rating of previous experience working with families (r = 0.304; P = 0.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (r = 0.495: P < 0.001). The participants also state that the work environment of the unit, the patient\'s condition, the relatives\' characteristics, personal judgement, and the preparedness of relatives affect their readiness.
    CONCLUSIONS: The results contribute towards determining the healthcare team\'s level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.
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  • 文章类型: Observational Study
    Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest.
    Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021.
    Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management.
    Endotracheal Intubation Adverse Events.
    The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest.
    Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest.
    In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent.
    www.
    gov identifier: NCT04909476.
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  • 文章类型: Journal Article
    BACKGROUND: Guillain-Barré syndrome, an acute polyradiculoneuropathy that presents with weakness and areflexia, is the most common cause of acute flaccid paralysis. In certain patients, respiratory failure is secondary to this disorder, eventually causing patients to require mechanical ventilation and experience additional complications due to diminished respiratory support and related mobility limitations. Prognoses for most of these cases are positive; treatment consists of basic support combined with plasmapheresis or administration of immunoglobulins.
    OBJECTIVE: This study sought to describe the socio-demographic, clinical, laboratory and neurophysiological characteristics of patients with Guillain-Barré syndrome who were hospitalised in the Intensive Care Unit of the Neurological Institute of Colombia between 2006 and 2012.
    METHODS: This study presents a case series.
    RESULTS: We surveyed 25 patients (32% female and 68% male) with Guillain-Barré syndrome and an average age of 54 years. Sixty per cent of these patients were admitted between days 3 and 7 after symptom onset; 64% had a history of respiratory infection and 20% had a history of intestinal infection. In addition, 84% of the patients presented with albuminocytological dissociation. We observed the following clinical subtypes of Guillain-Barré syndrome: inflammatory demyelinating polyneuropathy in 32%, acute motor-sensory axonal neuropathy in 28%, acute motor axonal neuropathy in 28%, and Miller Fisher syndrome in 12%.
    CONCLUSIONS: In this descriptive study of a group of critical care patients with GBS, results depended on patients\' clinical severity at time of admission. Our findings are similar to results published in the international literature.
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