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Hlebichuk J, Buck E, Brooker AL, Mackenzie JK, Cleary MB, Singh M, Hook M. Lessons Learned From Ventilated and Proned Patients With COVID-19: A Multisite Retrospective Study to Identify Predictive Factors for Facial Pressure Injuries. Dimens Crit Care Nurs 2024; 43:246-252. [PMID: 39074228 DOI: 10.1097/dcc.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Many patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation and proning. Although proning is lifesaving, it has been linked to the occurrence of facial pressure injuries (PIs). OBJECTIVES To evaluate the incidence and use of prevention strategies and identify predictors of facial PIs in patients who received ventilator and proning treatments in COVID-designated intensive care units at 2 large quaternary medical centers in the Midwest. METHOD This was a retrospective cohort study using data extracted from an electronic health record between October 2020 and February 2022. Demographics, clinical and care variables, and PI outcomes were analyzed to identify predictors of PI using logistic and Cox regression. RESULTS The cohort (N = 150) included patients from 2 units, unit a (n = 97) and unit b (n = 53) with a mean age of 60 years, with 68% identifying as male. Patients were vented for an average of 18 (SD, 16.2) days and proned for an average of 3 (SD, 2.5) days. Many (71%) died. Over half (56%) developed facial PI with a proning-exposure-adjusted incidence rate of 18.5%. Patients with PI were significantly different in several factors. Logistic regression showed predictors of PIs were duration of mechanical ventilation (in days; P = .02) and head turned (P = .01). Cox regression also identified head turn as predictive (P < .01), with Black/African American race as protective (P = .03). DISCUSSION Critically ill patients with COVID-19 receiving ventilator and proning therapy developed facial PIs despite the use of recommended prevention practices. Further research on effective PI prevention strategies is needed.
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Cai H, Luo S, Cai X, Lai T, Zhao S, Zhang W, Zhuang J, Li Z, Chen L, Chen B, Ye Y. Effect of Fu Zheng Jie Du Formula on outcomes in patients with severe pneumonia receiving prone ventilation: a retrospective cohort study. Front Pharmacol 2024; 15:1428817. [PMID: 39114366 PMCID: PMC11303160 DOI: 10.3389/fphar.2024.1428817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 08/10/2024] Open
Abstract
Background The effect of combining prone ventilation with traditional Chinese medicine on severe pneumonia remains unclear. Objective To evaluate the effect of Fu Zheng Jie Du Formula (FZJDF) combined with prone ventilation on clinical outcomes in patients with severe pneumonia. Methods This single-center retrospective cohort study included 188 severe pneumonia patients admitted to the ICU from January 2022 to December 2023. Patients were divided into an FZJD group (receiving FZJDF for 7 days plus prone ventilation) and a non-FZJD group (prone ventilation only). Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was the change in PaO2/FiO2 ratio after treatment. Secondary outcomes included 28-day mortality, duration of mechanical ventilation, length of ICU stay, PaCO2, lactic acid levels, APACHE II score, SOFA score, Chinese Medicine Score, inflammatory markers, and time to symptom resolution. Results After PSM, 32 patients were included in each group. Compared to the non-FZJD group, the FZJD group showed significantly higher PaO2/FiO2 ratios, lower PaCO2, and lower lactic acid levels after treatment (p < 0.05 for all). The FZJD group also had significantly lower APACHE II scores, SOFA scores, Chinese Medicine Scores, and levels of WBC, PCT, hs-CRP, and IL-6 (p < 0.05 for all). Time to symptom resolution, including duration of mechanical ventilation, length of ICU stay, time to fever resolution, time to cough resolution, and time to resolution of pulmonary rales, was significantly shorter in the FZJD group (p < 0.05 for all). There was no significant difference in 28-day mortality between the two groups. Conclusion FZJDF as an adjuvant therapy to prone ventilation can improve oxygenation and other clinical outcomes in severe pneumonia patients. Prospective studies are warranted to validate these findings.
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Affiliation(s)
- Hairong Cai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sicong Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xingui Cai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Lai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine, Guangzhou, China
| | - Weizhang Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieqin Zhuang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhishang Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bojun Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine, Guangzhou, China
- Clinical Research Team of Prevention and Treatment of Cardiac Emergencies with Traditional Chinese Medicine, Guangzhou, China
| | - Ye Ye
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine, Guangzhou, China
- Clinical Research Team of Prevention and Treatment of Cardiac Emergencies with Traditional Chinese Medicine, Guangzhou, China
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Chen Y, Wu G, Qu C, Ye Z, Kang Y, Tian X. Real-Time Camera Image-Guided Nasoenteric Tube Placement in Prone COVID-19 ICU Patients: A Single-Center Study. J Intensive Care Med 2024; 39:567-576. [PMID: 38105604 DOI: 10.1177/08850666231220909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background & Aims: This study aims to assess the application value of the real-time camera image-guided nasoenteric tube placement in critically ill COVID-19 patients undergoing endotracheal intubation and prone position ventilation therapy. Methods: We enrolled 116 COVID-19 patients receiving endotracheal intubation and prone position ventilation therapy in the intensive care unit (ICU). Patients were randomly divided into the real-time camera image-guided nasoenteric tube placement (n = 58) and bedside blind insertion (n = 58) groups. The success rate, placement time, complications, cost, heart rate, respiratory rate, Glasgow Coma Scale (GCS), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores were compared between the 2 groups. Results: For ICU patients with COVID-19 undergoing prone position ventilation therapy, the success rate and cost were significantly higher in the real-time camera image-guided group compared to the bedside blind group (P < .05). The placement time and complication incidence were significantly lower in the real-time camera image-guided group (P < .05). The differences in heart rate, respiratory rate, GCS scores, and APACHE-II scores were insignificant (P > .05). Conclusions: The real-time camera image-guided nasoenteric tube placement system had advantages for ICU COVID-19 patients undergoing prone position ventilation therapy, including a high success rate, short placement time, and no impact on patient position during tube placement. Real-time camera image-guided nasoenteric tube placement can be performed in any position, and demonstrates high efficiency, safety, and accuracy.
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Affiliation(s)
- Yuequn Chen
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Guiqiong Wu
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Chaojun Qu
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Zimao Ye
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Yihao Kang
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Xin Tian
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
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Ding F, Zhang Z, Qiao G, Fan T. Early Prone Position Ventilation in the Efficacy for Severe Hypoxemia and Neurological Complications Following Acute Type A Aortic Dissection (TAAD) Surgery. Int J Neurosci 2024:1-9. [PMID: 38497468 DOI: 10.1080/00207454.2024.2327408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/02/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To analyze the efficacy of early prone position ventilation in the treatment of severe hypoxemia after surgery for acute type A aortic dissection (TAAD). METHODS The patients were divided into a control group and a treatment group. Parameters assessed included blood gas analysis indicators [arterial oxygen partial pressure (PaO2). RESULTS (1) Blood gas analysis: Before treatment, there was no significant difference in PaO2, SpO2, and OI levels between the two groups; after treatment, the PaO2, SpO2, and OI levels in both groups significantly increased compared to pre-treatment, with a more pronounced improvement in the treatment group than in the control group (p < 0.05). (2) Hemodynamics: Before treatment, there was no significant difference in MAP and HR levels between the two groups; after treatment, the MAP levels increased significantly in both groups compared to pre-treatment, while HR levels decreased significantly, with no significant difference between the groups. (3) Prognosis recovery: MV time, ICU stay, and total hospital stay were significantly lower in the treatment group than in the control group; the 30-day mortality rate was 14.58% in the control group and 12.50% in the treatment group, with no significant difference in 30-day mortality rate between the groups. CONCLUSION Early prone position ventilation has shown promising application in the treatment of severe hypoxemia after TAAD surgery. Compared to traditional supine position ventilation, the use of early prone position ventilation can further improve blood gas analysis indicators in patients, and shorten MV time, ICU stay, and total hospital stay, thereby accelerating patient recovery.
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Affiliation(s)
- Fuyan Ding
- Department of Vascular Diseases Intensive Care Unit of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Zhidong Zhang
- Department of Vascular Surgery of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Gang Qiao
- Department of Vascular Surgery of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Taibing Fan
- Center of Children's Heart Diseases of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
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Priya V, Sen J, Ninave S. A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions. Cureus 2024; 16:e57247. [PMID: 38686225 PMCID: PMC11056907 DOI: 10.7759/cureus.57247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
This comprehensive review explores the intricate landscape of prone ventilation in the intensive care unit (ICU), spanning physiological rationale, challenges in implementation, psychosocial impacts, technological innovations, economic considerations, barriers to adoption, and implications for clinical practice. The physiological benefits of prone positioning, including improved oxygenation and lung compliance, are discussed alongside the challenges of patient selection and technical complexities. The psychosocial impact on patients and caregivers, as well as the economic implications for healthcare systems, adds a crucial dimension to the analysis. The review also delves into innovative technologies, such as advanced monitoring and automation, shaping the landscape of prone ventilation. Moreover, it addresses the barriers to widespread adoption and outlines strategies to overcome resistance, emphasizing the need for a comprehensive and collaborative approach. The implications for clinical practice underscore the importance of evidence-based guidelines, ongoing education, and a holistic patient-centered care approach. The conclusion highlights the call to action for further research to refine protocols and technology, ultimately optimizing the application of prone ventilation in critical care settings.
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Affiliation(s)
- Vishnu Priya
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jayashree Sen
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sanjot Ninave
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Graziani M, Rigutini AG, Bartolini D, Traballi L, Luzi L, Regina R, Bossi F, Caponi C, Becattini C. Awake prone positioning for patients with COVID-19-related respiratory failure: a systematic review and meta-analysis. Intern Emerg Med 2024; 19:147-158. [PMID: 37796372 PMCID: PMC10827908 DOI: 10.1007/s11739-023-03434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
The role of awake prone positioning (aPP) in patients with acute hypoxemic respiratory failure is debated. We performed a systematic review and meta-analysis to evaluate the role of aPP in acute respiratory failure related to COronaVIrus Disease-19 (COVID-19). Studies reporting on the clinical course of patients with acute respiratory failure related to COVID-19 treated or not treated by aPP were included in the systematic review and meta-analysis (ProsperoID: CRD42022333211). The primary study outcome was the composite of in-hospital death or orotracheal intubation; the individual components of the primary outcome were secondary study outcomes. The composite of in-hospital death or orotracheal intubation was available for 6 studies (1884 patients), five randomized and one prospective; a significant reduction in the risk of this outcome was observed in patients treated vs. not treated by aPP (33.5% vs. 39.8%; OR 0.73, 95% CI 0.60-0.89; I2 0%). In-hospital death was reported in 34 studies (6808 patients) and occurred in 17.4% vs. 23.5% of patients treated or not treated with aPP (random effect OR 0.60, 95% CI 0.46-0.79; I2 59%); orotracheal intubation was observed in 25.8% vs. 32.7% of patients treated or not treated with aPP (27 studies, 5369 patients; random effect OR 0.85, 95% CI 0.56-1.27; I2 84%). aPP reduces the risk for death or orotracheal intubation in patients with acute respiratory failure related to COVID-19. Further studies should be conducted to confirm the clinical benefit of aPP outside the ICU.Registration Prospero ID: CRD42022333211.
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Affiliation(s)
- Mara Graziani
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
| | | | - Diletta Bartolini
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Laura Traballi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Lorenzo Luzi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Rossana Regina
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Francesco Bossi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Carla Caponi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
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Chen X, Zhou Y, Zhou X, Su P, Yi J. Knowledge, attitudes, and practice related to the prone positioning of patients among intensive care unit nurses working in COVID-19 units: A cross-sectional study in China. Nurs Crit Care 2023; 28:967-975. [PMID: 37016834 DOI: 10.1111/nicc.12908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND An increasing number of studies persistently demonstrate that prone position ventilation can significantly improve the oxygenation index and blood oxygen saturation for most patients (70-80%) with acute respiratory distress syndrome (ARDS). Studies have also shown that the awake prone position was both safe and effective in helping patients with coronavirus disease 2019 (COVID-19) breathe spontaneously. However, the prone position is not widely adopted when treating patients with COVID-19 or ARDS from other causes. Basic knowledge, positive attitudes, and correct practices among the nursing staff are necessary to increase the use of prone positions, reduce the incidence of complications associated with prone positions, and improve the quality and safety of health care. AIM This study aimed to investigate the knowledge, attitudes, and practice of prone positioning of patients among intensive care unit (ICU) nurses working in COVID-19 units and provide suggestions for improvement. STUDY DESIGN ICU nurses were recruited from two designated tertiary hospitals for COVID-19 treatment in Shanghai, China, in April 2022, using convenience sampling. A questionnaire survey focusing on the dimensions of knowledge, attitudes, and practice of the prone position with 42 items, was conducted. RESULTS A total of 132 ICU nurses participated. The scores on the overall questionnaire and the dimensions of knowledge, attitudes, and practice of prone position were 167.28 (95% CI, 161.70-172.86), 78.35 (95% CI, 76.04-80.66), 32.08 (95% CI, 31.51-32.65), and 56.85 (95% CI, 52.42-61.28) respectively. The overall average score was 79.66% (95% CI, 0.77-0.82). The results of multiple linear regression analysis showed that prior experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. CONCLUSIONS The ICU nurses strongly believed in the effectiveness of prone positioning, but their knowledge and practice levels need improvement. The experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. Nursing managers should ensure that ICU nurses are well trained in prone positioning and help enhance the knowledge and attitudes toward prone positioning to promote its widespread use. RELEVANCE TO CLINICAL PRACTICE Clinical guidelines and in-service training modules need to be developed to promote the use of prone positioning and reduce prone position-related complications.
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Affiliation(s)
- Xiuwen Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xia Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Pan Su
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Yi
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
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Chen X, Liao P, Zhou Y. Construction of nursing-sensitive quality indicators for the care of patients with prone position ventilation using the Delphi method. BMC Nurs 2023; 22:336. [PMID: 37759252 PMCID: PMC10523608 DOI: 10.1186/s12912-023-01505-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Prone position ventilation (PPV) has gradually become an adjuvant treatment to improve oxygenation in patients with acute respiratory distress syndrome. Scientific and comprehensive evaluation of the quality of nursing care for patients with PPV is of great significance to ensure the effectiveness of treatment and patient safety. However, there are no established objective indicators for evaluating the quality of nursing care for patients with PPV. This study intended to identify a set of scientific, systematic and clinically applicable nursing-sensitive quality indicators for the care of patients with PPV. METHODS Based on the Donabedian structure-process-result theory model, the quality evaluation indicators of nursing care for patients with PPV were preliminarily constructed based on an evidence-based perspective, and two rounds of Delphi surveys were conducted with the purpose of collecting opinions from a panel of independent experts. RESULTS The questionnaire recovery rates of the two rounds of correspondence were 100.00% and 95.00%, the recovery rates of expert opinions were 80.00% and 26.32%, the expert authority coefficient values were 0.89, and the Kendall coordination coefficient W values were 0.110 and 0.133, respectively. The final nursing-sensitive quality indicators for the care of patients with PPV included 3 first-level indicators, 9 s-level indicators and 29 third-level indicators. CONCLUSION The constructed nursing-sensitive quality indicators for the care of patients with PPV involve quality supervision during the whole process of PPV from three dimensions: structure, process and results. These indicators have strong operability, reliability, practicability and scientificity and can provide a reference for the quality evaluation and monitoring of nursing care for patients with PPV. IMPLICATIONS FOR NURSING MANAGEMENT The quality indicators of nursing care for patients with PPV constructed in this research are scientific and reliable, and the content of the quality indicators can better reflect the technical characteristics of special nursing. Nursing managers are encouraged to use these quality indicators to evaluate the quality of clinical nursing care and improve safety for patients with PPV.
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Affiliation(s)
- Xiuwen Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Peng Liao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Chen X, Peng C, Xiao Y, Liu S. Construction and application of prone position ventilation management scheme for severe COVID-19 patients. Front Physiol 2023; 14:1152723. [PMID: 37693003 PMCID: PMC10488700 DOI: 10.3389/fphys.2023.1152723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background: Prone position ventilation (PPV) can significantly improve oxygenation index and blood oxygen saturation in most (70%-80%) patients with acute respiratory distress syndrome. However, although PPV is not an invasive procedure, there are many potential PPV-related complications, such as nerve compression, crush injury, venous stasis (e.g., facial oedema), pressure sores, retinal damage, vomiting, and arrhythmia, with an incidence of up to 56.9%. Nursing managers have focused on reducing the occurrence of PPV-related complications and improving safety. Objective: To construct a prone ventilation management scheme for patients with severe coronavirus disease 2019 (COVID-19) and analyse its application effect. Methods: Based on a previous evidence-based study combined with the COVID-19 Diagnosis and Treatment Protocol (Trial Edition 9), a prone ventilation management protocol for severe COVID-19 was formulated and applied to COVID-19 patients in the intensive care unit of a designated hospital. A prospective self-control study was used to compare changes in the oxygenation index and other outcome indicators before and after the intervention. Results: The oxygenation index of patients after intervention (321.22 ± 19.77 mmHg) was significantly higher (p < 0.05) than before intervention (151.59 ± 35.49 mmHg). The difference in oxygenation index in different prone position ventilation durations was statistically significant (p < 0.05). Nursing quality evaluation indicators showed that the implementation rate of gastric residual volume assessment was 100% and the incidence of occupational exposure and cross-infection was 0%; the incidences of pressure ulcers, drug extravasation, and facial oedema were 13.64% (3/22), 4.54% (1/22), and 4.54% (1/22), respectively. The incidence of unplanned extubation, aspiration, and falls/falls was 0%.
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Affiliation(s)
- Xiuwen Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- Department of Operating Room, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Cao Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
- Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, China
| | - Yao Xiao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shiqing Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Lung Cancer Center, Central South University, Changsha, China
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Avtaar Singh SS, Das De S, Al-Adhami A, Singh R, Hopkins PMA, Curry PA. Primary graft dysfunction following lung transplantation: From pathogenesis to future frontiers. World J Transplant 2023; 13:58-85. [PMID: 36968136 PMCID: PMC10037231 DOI: 10.5500/wjt.v13.i3.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/11/2022] [Accepted: 02/17/2023] [Indexed: 03/16/2023] Open
Abstract
Lung transplantation is the treatment of choice for patients with end-stage lung disease. Currently, just under 5000 lung transplants are performed worldwide annually. However, a major scourge leading to 90-d and 1-year mortality remains primary graft dysfunction. It is a spectrum of lung injury ranging from mild to severe depending on the level of hypoxaemia and lung injury post-transplant. This review aims to provide an in-depth analysis of the epidemiology, patho physiology, risk factors, outcomes, and future frontiers involved in mitigating primary graft dysfunction. The current diagnostic criteria are examined alongside changes from the previous definition. We also highlight the issues surrounding chronic lung allograft dysfunction and identify the novel therapies available for ex-vivo lung perfusion. Although primary graft dysfunction remains a significant contributor to 90-d and 1-year mortality, ongoing research and development abreast with current technological advancements have shed some light on the issue in pursuit of future diagnostic and therapeutic tools.
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Affiliation(s)
- Sanjeet Singh Avtaar Singh
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Sudeep Das De
- Heart and Lung Transplant Unit, Wythenshawe Hospital, Manchester M23 9NJ, United Kingdom
| | - Ahmed Al-Adhami
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom
- Department of Heart and Lung Transplant, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom
| | - Ramesh Singh
- Mechanical Circulatory Support, Inova Health System, Falls Church, VA 22042, United States
| | - Peter MA Hopkins
- Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Philip Alan Curry
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow G81 4DY, United Kingdom
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Caldonazo T, Treml RE, Vianna FSL, Tasoudis P, Kirov H, Mukharyamov M, Doenst T, Silva JM. Outcomes comparison between the first and the subsequent SARS-CoV-2 waves - a systematic review and meta-analysis. Multidiscip Respir Med 2023; 18:933. [PMID: 38155706 PMCID: PMC10690722 DOI: 10.4081/mrm.2023.933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/05/2023] [Indexed: 12/30/2023] Open
Abstract
Background In the beginning of the SARS-CoV-2 pandemic, health care professionals dealing with COVID-19 had to rely exclusively on general supportive measures since specific treatments were unknown. The subsequent waves could be faced with new diagnostic and therapeutic tools (e.g., anti-viral medications and vaccines). We performed a meta-analysis and systematic review to compare clinical endpoints between the first and subsequent waves. Methods Three databases were assessed. The primary outcome was in-hospital mortality. The secondary outcomes were intensive care unit (ICU) mortality, ICU length of stay (LOS), acute renal failure, extracorporeal membrane oxygenation (ECMO) implantation, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis and ventilator associated pneumonia. Results A total of 25 studies with 126,153 patients were included. There was no significant difference for the primary endpoint (OR=0.94, 95% CI 0.83-1.07, p=0.35). The first wave group presented higher rates of ICU LOS (SMD= 0.23, 95% CI 0.11-0.35, p<0.01), acute renal failure (OR=1.71, 95% CI 1.36-2.15, p<0.01) and ECMO implantation (OR=1.64, 95% CI 1.06-2.52, p=0.03). The other endpoints did not show significant differences. Conclusions The analysis suggests that the first wave group, when compared with the subsequent waves group, presented higher rates of ICU LOS, acute renal failure and ECMO implantation, without significant difference in in-hospital or ICU mortality, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis or ventilator- associated pneumonia.
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Affiliation(s)
- Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Ricardo E Treml
- Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Germany
| | - Felipe S L Vianna
- Department of Anesthesiology, University of Sao Paulo, Brazil
- Department of Intensive Care, Israeli Hospital Albert Einstein, Sao Paulo, Brazil
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill (NC), USA
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - João M Silva
- Department of Anesthesiology, University of Sao Paulo, Brazil
- Department of Intensive Care, Israeli Hospital Albert Einstein, Sao Paulo, Brazil
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12
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Aibara S, Okada M, Tanaka‐Nishikubo K, Asayama R, Sato E, Sei H, Aoishi K, Takagi T, Teraoka M, Mukai N, Konishi S, Okita M, Ogawa S, Annen S, Ohshita M, Matsumoto H, Murata S, Harima Y, Kikuchi S, Takeba J, Sato N, Hato N. Laryngeal complications after endotracheal intubation and prone positioning in patients with coronavirus disease 2019. Laryngoscope Investig Otolaryngol 2022; 7:1909-1914. [PMID: 36544958 PMCID: PMC9764797 DOI: 10.1002/lio2.874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/13/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Laryngeal complications have been reported after endotracheal intubation and prone positioning in patients with critical coronavirus disease 2019 (COVID-19), but their association is unclear. In this study, we investigated the rate of laryngeal complications in patients with COVID-19 compared to an alternative condition (control group). Methods We retrospectively analyzed the data of 40 patients who underwent endotracheal intubation for either COVID-19 or an alternative condition (control group). Data on age, sex, body mass index (BMI), cardiovascular disease (CVD) risk factors, use of prone therapy, duration of endotracheal intubation, and duration from extubation/tracheostomy to laryngeal evaluation were collected from medical records. Results There were no significant differences in BMI, frequency of CVD risk factors, duration of endotracheal intubation, or duration from extubation/tracheostomy to laryngeal evaluation between the two groups. In the COVID-19 group, all patients adopted the prone position. In comparison, only one patient in the control group adopted the prone position. Significant differences were observed between the two groups regarding the incidence of vocal fold immobility and laryngeal granuloma. Conclusion Laryngeal complications were more common in the COVID-19 group than in the control group. Prone positioning may be a risk factor for these complications. Level of Evidence 4.
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Affiliation(s)
- Shiori Aibara
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Kaori Tanaka‐Nishikubo
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Rie Asayama
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Eriko Sato
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Kunihide Aoishi
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Masato Teraoka
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Naoki Mukai
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Saki Konishi
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Mitsuo Okita
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Siro Ogawa
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Suguru Annen
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Hironori Matsumoto
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Satoru Murata
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Yutaka Harima
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Jun Takeba
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Norio Sato
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
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13
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Prone Positioning Decreases Inhomogeneity and Improves Dorsal Compliance in Invasively Ventilated Spontaneously Breathing COVID-19 Patients—A Study Using Electrical Impedance Tomography. Diagnostics (Basel) 2022; 12:diagnostics12102281. [PMID: 36291970 PMCID: PMC9600133 DOI: 10.3390/diagnostics12102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: We studied prone positioning effects on lung aeration in spontaneously breathing invasively ventilated patients with coronavirus disease 2019 (COVID-19). Methods: changes in lung aeration were studied prospectively by electrical impedance tomography (EIT) from before to after placing the patient prone, and back to supine. Mixed effect models with a random intercept and only fixed effects were used to evaluate changes in lung aeration. Results: fifteen spontaneously breathing invasively ventilated patients were enrolled, and remained prone for a median of 19 [17 to 21] hours. At 16 h the global inhomogeneity index was lower. At 2 h, there were neither changes in dorsal nor in ventral compliance; after 16 h, only dorsal compliance (βFe +18.9 [95% Confidence interval (CI): 9.1 to 28.8]) and dorsal end-expiratory lung impedance (EELI) were increased (βFe, +252 [95% CI: 13 to 496]); at 2 and 16 h, dorsal silent spaces was unchanged (βFe, –4.6 [95% CI: –12.3 to +3.2]). The observed changes induced by prone positioning disappeared after turning patients back to supine. Conclusions: in this cohort of spontaneously breathing invasively ventilated COVID-19 patients, prone positioning decreased inhomogeneity, increased lung volumes, and improved dorsal compliance.
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14
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Nascimento Junior JRD, Ceron CF, Signorini AV, Klein AB, Castelli CTR, Silvério CC, Otto DM, Antunes HDA, Sotero LKB, Cirino PB, Vizioli PT, Lima VC. DYSPHAGIA OCCURRENCE IN COVID-19-POSITIVE PATIENTS IN TWO HOSPITALS IN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:439-446. [PMID: 36102445 DOI: 10.1590/s0004-2803.202203000-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND COVID-19 comprises a respiratory infection resulting from contamination by SARS-CoV-2, with acute respiratory failure being one of its main characteristics, leading to a high frequency of orotracheal intubation (OTI), which in turn increases the risk for dysphagia. Since this can lead to pulmonary impairment, knowing the real occurrence of dysphagia in part of the Brazilian population and its associations allows early and effective clinical management of the multidisciplinary team in relation to patients. OBJECTIVE To verify the occurrence of dysphagia in COVID-19-positive adult patients in two Brazilian reference hospitals in the care of the pandemic. METHODS This was a prospective, longitudinal observational study carried out in two private hospitals in Brazil, both references in the care of patients with coronavirus isolation. Data were initially collected by consulting the medical records of each patient. Information was collected regarding sex, age, previous diseases, COVID-19 testing, and the OTI period. After data collection, the clinical speech-language assessment of swallowing for each patient was carried out using the adapted Gugging Swallowing Screen (GUSS), the ASHA NOMS and the Functional Oral Intake Scale (FOIS). RESULTS A total of 129 participants were evaluated, with a mean age of 72 years. According to the GUSS scale, 9.3% of the patients presented normal/functional swallowing, while 90.7% presented dysphagia, with mild dysphagia in 17.05%, moderate dysphagia in 33.33%, and severe dysphagia in 37.98%. As for the results of the ASHA NOMS, the majority (36.5%) of the patients were at level 1, which represents the patient who is not able to receive his or her food supply orally, having the need to use tube feedings. This is in line with the results observed with the FOIS scale, whereby most patients (42.1%) were classified as Level I, when food intake occurs exclusively through feeding tubes, with no oral supply. Of the 129 participants, 59% of them required OTI. When comparing the time of OTI and the severity of dysphagia, there was a statistically significant difference, with more severe dysphagia, the longer the patient remained intubated. CONCLUSION There is a high incidence of oropharyngeal dysphagia in patients with COVID-19, with increased severity during longer periods of OTI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paula Tasca Vizioli
- Hospital Moinhos de Vento, Serviço de Fonoaudiologia, Porto Alegre, RS, Brasil
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15
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Ashra F, Chen R, Kang XL, Chiang KJ, Pien LC, Jen HJ, Liu D, Hsiao STS, Chou KR. Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A Meta-Analysis. Intensive Crit Care Nurs 2022; 72:103257. [PMID: 35672215 PMCID: PMC8995327 DOI: 10.1016/j.iccn.2022.103257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/20/2022]
Abstract
Objectives To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation). Research methodology A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO2/FiO2) and secondary outcomes (SpO2 and PaO2) Results A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO2/FiO2 with standardised mean difference of 1.10 (95%CI 0.60–1.59), SpO2 with standardised mean difference of 3.39 (95% CI 1.30–5.48), and PaO2 with standardised mean difference of 0.77 (95% CI 0.19–1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning. Conclusions Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.
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Affiliation(s)
- Fauzi Ashra
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Institut Kesehatan Prima Nusantara Bukittinggi, Bukittinggi, Indonesia
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, University of Pennsylvania, USA
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shu-Tai Shen Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Superintendent Office, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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16
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Wang B, Yu J, Zeng Y, Zhang X, Han C, Lu Q, Wang X, Liang Y, Gu JJ, Shu Y. Successful treatment of an 82-year-old COVID-19 delta variant-infected patient with haemorrhagic stroke and active prostate cancer brain metastasis. CLINICAL AND TRANSLATIONAL DISCOVERY 2022; 2:e20. [PMID: 35464128 PMCID: PMC9015616 DOI: 10.1002/ctd2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Buhai Wang
- Department of Oncology Northern Jiangsu People's Hospital Yangzhou 255000 China.,Cancer Institute affiliated to Northern Jiangsu People's Hospital Yangzhou 255000 China.,Medical College Yangzhou University Yangzhou 255000 China
| | - Jiangquan Yu
- Intensive Care Unit Northern Jiangsu People's Hospital Yangzhou 255000 China
| | - Yichun Zeng
- Medical College Yangzhou University Yangzhou 255000 China
| | - Xian Zhang
- Cancer Institute affiliated to Northern Jiangsu People's Hospital Yangzhou 255000 China
| | - Chongxu Han
- Department of Clinical Laboratory Northern Jiangsu People's Hospital Yangzhou 255000 China
| | - Qili Lu
- Medical Service Division Yangzhou Third People's Hospital Yangzhou 255000 China
| | - Xiaolin Wang
- Department of Thoracic Surgery Northern Jiangsu People's Hospital Yangzhou 255000 China
| | - Yichen Liang
- Department of Oncology Northern Jiangsu People's Hospital Yangzhou 255000 China.,Cancer Institute affiliated to Northern Jiangsu People's Hospital Yangzhou 255000 China.,Medical College Yangzhou University Yangzhou 255000 China
| | - Juan J Gu
- Department of Oncology Northern Jiangsu People's Hospital Yangzhou 255000 China.,Cancer Institute affiliated to Northern Jiangsu People's Hospital Yangzhou 255000 China.,Medical College Yangzhou University Yangzhou 255000 China
| | - Yusheng Shu
- Department of Thoracic Surgery Northern Jiangsu People's Hospital Yangzhou 255000 China.,Medical College Yangzhou University Yangzhou 255000 China
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17
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Efendi D, Hasan F, Natalia R, Utami AR, Sonko I, Asmarini TA, Yuningsih R, Wanda D, Sari D. Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review. PLoS One 2022; 17:e0263267. [PMID: 35113925 PMCID: PMC8812980 DOI: 10.1371/journal.pone.0263267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting. METHODS AND FINDINGS The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning). CONCLUSION Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.
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Affiliation(s)
- Defi Efendi
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal Intensive Care Unit, Universitas Indonesia Hospital, Depok, Indonesia
| | - Faizul Hasan
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Regina Natalia
- School of Nursing, Mitra Bunda Health Institute, Batam, Indonesia
| | - Ayuni Rizka Utami
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Ismaila Sonko
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Ministry of Health and Social Welfare, The Quadrangle, Banjul, The Gambia, West Africa
| | - Titik Ambar Asmarini
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal and Pediatric Intensive Care Unit, Gatot Soebroto Indonesian Central of Army Hospital, Jakarta, Indonesia
| | - Risna Yuningsih
- Neonatal Intensive Care Unit, Dr. Dradjat Prawiranegara General Hospital, Banten, Indonesia
| | - Dessie Wanda
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Dian Sari
- School of Nursing, Prima Nusantara Health Institute, Bukittinggi, Indonesia
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18
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Eskell M, Thompson J, Powell O, Torlinski T, Mullhi R. Understanding the Intensive Care Unit Experience of Patients and Relatives at the End-of-Life During the Coronavirus Disease 2019 Pandemic. J Patient Exp 2022; 9:23743735221106586. [PMID: 35734470 PMCID: PMC9208028 DOI: 10.1177/23743735221106586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on patients and relatives’ experiences of end-of-life care, as well as changing the provision of these services in intensive care units (ICUs) across the world. Established methods for assisting relatives through the grieving process have required modification due to the unique features and circumstances surrounding deaths from this disease. This mixed-methods study from the United Kingdom (UK) aims to review data from patients who died in a large ICU (the unit had a capacity for more than 100 ventilated patients), over the course of approximately 1 year. The inpatient noting of these patients was reviewed specifically for details of visiting practices, chaplaincy support, and patient positioning (prone vs supine) prior to death. Using this data, recommendations are made to improve end-of-life care services. To allow relatives the opportunity to attend the ICU, there is a need for early recognition of patients approaching the end of life. Clear explanations of the need for prone positioning and increased access to chaplaincy services were also identified.
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Affiliation(s)
- Matthew Eskell
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jamie Thompson
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ohema Powell
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tomasz Torlinski
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Randeep Mullhi
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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19
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Affiliation(s)
- Maureen A Seckel
- Maureen A. Seckel is a critical care clinical nurse specialist and sepsis coordinator, ChristianaCare, Newark, Delaware
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20
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Adeola JO, Patel S, Goné EN, Tewfik G. A Quick Review on the Multisystem Effects of Prone Position in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2021; 15:11795484211028526. [PMID: 34276233 PMCID: PMC8255560 DOI: 10.1177/11795484211028526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/03/2021] [Indexed: 12/16/2022]
Abstract
Objective: The purpose of this review is to highlight the multisystem effects of prone position in ARDS patients with a focus on current findings regarding its use in COVID-19 patients. Methods: Two reviewers comprehensively searched PubMed database for literature regarding pathophysiology and efficacy of prone position in ARDS patients as well as specific data regarding this approach in COVID-19 patients. Conclusion: Prone positioning is well-documented to improve oxygenation and cardiac function in ARDS patients and might confer increased survival, with benefits that outweigh risks such as facial edema, endotracheal tube displacement, and intraabdominal organ dysfunction in obese patients. Severe COVID-19 pneumonia, while meeting ARDS criteria, differs from typical ARDS in several ways. Data would suggest that advantages of prone position would become limited after significant disease progression and fibrosis. The use of this technique in COVID-19 requires prolonged sessions that are unprecedented in the treatment of ARDS patients. New data regarding COVID-19 pathophysiology and patients continues to evolve daily. More frequently, patients are proned while maintaining spontaneous breathing—the results of this intervention are an area for future studies. There is more to learn about the appropriate use of prone position in COVID-19 patients. The multisystem risks and benefits require clinicians to adopt a patient centered decision-making algorithm when employing this technique in COVID-19 patients. Level of evidence: NA
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Affiliation(s)
- Janet O Adeola
- Department of Anesthesia and Perioperative Care, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Shivani Patel
- Department of Anesthesia and Perioperative Care, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Evelyne N Goné
- Department of Anesthesia and Perioperative Care, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - George Tewfik
- Department of Anesthesia and Perioperative Care, Rutgers New Jersey Medical School, Newark, NJ, USA
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