Nursing care and prevalence of adverse events in prone position: Characteristics of mechanically ventilated patients with severe SARS‐CoV‐2 pulmonary infection

Rodríguez-Huerta, María Dolores; Díez‐Fernández, Ana; Rodríguez-Alonso, María Jesús; Robles-González, María; Martín‐Rodríguez, María del Mar; González–García, A. César

doi:10.1111/nicc.12606

Cited by 41 publications

(46 citation statements)

References 26 publications

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“…In our data, there was no difference in mortality at day 28 between groups, but there was a difference in mortality at day 90. Duration of invasive ventilation is remarkably high in COVID-19 patients, and so is LOS in ICU in these patients [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. This can explain why 28-mortality was not different between the groups, while 90-day mortality was.…”

Section: Discussionmentioning

confidence: 99%

“…It could be hypothesized that the incidence of adverse events during a pandemic is high due to the stressful and demanding situation, with increased workloads and the lack of experienced staff. However, when dedicated prone position teams are present, as was often the case in the centers in the Netherlands early in the pandemic, the rate of procedure-related adverse events could also be low [30].…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Practice of Early Prone Positioning in Invasively Ventilated COVID-19 Patients—Insights from the PRoVENT-COVID Observational Study

Stilma

Meenen

Valk

et al. 2021

JCM

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We describe the incidence and practice of prone positioning and determined the association of use of prone positioning with outcomes in invasively ventilated patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. Patients were categorized into 4 groups, based on indication for and actual use of prone positioning. The primary outcome was 28-day mortality. Secondary endpoints were 90-day mortality, and ICU and hospital length of stay. In 734 patients, prone positioning was indicated in 60%—the incidence of prone positioning was higher in patients with an indication than in patients without an indication for prone positioning (77 vs. 48%, p = 0.001). Patients were left in the prone position for median 15.0 (10.5–21.0) hours per full calendar day—the duration was longer in patients with an indication than in patients without an indication for prone positioning (16.0 (11.0–23.0) vs. 14.0 (10.0–19.0) hours, p < 0.001). Ventilator settings and ventilation parameters were not different between the four groups, except for FiO2 which was higher in patients having an indication for and actually receiving prone positioning. Our data showed no difference in mortality at day 28 between the 4 groups (HR no indication, no prone vs. no indication, prone vs. indication, no prone vs. indication, prone: 1.05 (0.76–1.45) vs. 0.88 (0.62–1.26) vs. 1.15 (0.80–1.54) vs. 0.96 (0.73–1.26) (p = 0.08)). Factors associated with the use of prone positioning were ARDS severity and FiO2. The findings of this study are that prone positioning is often used in COVID-19 patients, even in patients that have no indication for this intervention. Sessions of prone positioning lasted long. Use of prone positioning may affect outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and Practice of Early Prone Positioning in Invasively Ventilated COVID-19 Patients—Insights from the PRoVENT-COVID Observational Study

Stilma

Meenen

Valk

et al. 2021

JCM

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“…Por otra parte, la PP se asocia con complicaciones como el desarrollo de úlceras por presión (UPP), siendo el evento adverso más frecuente (34%), seguido de la neumonía asociada a la ventilación mecánica (21%), la obstrucción del tubo orotraqueal (15%), la extubación accidental (11%), la pérdida del acceso venoso (11%), el neumotórax (6%) y el desplazamiento La PP se asocia con complicaciones como el desarrollo de úlceras por presión (UPP), siendo el evento adverso más frecuente (34%) del tubo orotraqueal (4%) 9 . Particularmente, en los pacientes con COVID-19 ventilados en PP, la prevalencia de las UPP oscila entre el 48% 15 y el 61% 16 . En términos de su localización, se observó una mayor frecuencia en el mentón, la frente, los pómulos y la nariz 16 y en cuanto a su severidad, las lesiones grado II son las más comunes (~64%) 17,18 .…”

Section: Introductionunclassified

“…Particularmente, en los pacientes con COVID-19 ventilados en PP, la prevalencia de las UPP oscila entre el 48% 15 y el 61% 16 . En términos de su localización, se observó una mayor frecuencia en el mentón, la frente, los pómulos y la nariz 16 y en cuanto a su severidad, las lesiones grado II son las más comunes (~64%) 17,18 .…”

Section: Introductionunclassified

“…Estos factores son similares a los descritos en otras poblaciones críticamente enfermas que requieren PP dentro del plan de manejo, incluyendo: a) la inmovilidad, la mala percepción y respuesta sensorial y, b) la susceptibilidad y tolerancia individual donde las características de la piel, la pobre perfusión y nutrición, la diabetes, el exceso de humedad y la albúmina disminuida son factores contribuyentes 23 . Además de lo anterior, un claro factor de riesgo es el promedio de duración de la PP, que se relaciona directamente con la aparición y la severidad de las UPP en las personas con COVID-19 [15][16][17] , incrementando sustancialmente el riesgo, incluso desde el tercer día 15 .…”

Section: Introductionunclassified

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Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19

Rojas

Rico²,

Barón³

et al. 2021

Rev Cuid

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Resumen Introducción: La posición prono (PP) es una alternativa terapéutica ampliamente recomendada e implementada en los pacientes con COVID-19. Sin embargo, aunque es un procedimiento no invasivo, es complejo y se asocia con eventos adversos como las úlceras por presión (UPP). Nuestro objetivo es proponer un plan de cuidados de enfermería basado en el lenguaje estandarizado NANDA-I, NIC, NOC para la prevención de las UPP secundarias a la PP en la enfermedad de COVID-19. Síntesis del contenido: En los pacientes con COVID-19, además de factores de riesgo propios del paciente como la edad avanzada y la presencia de comorbilidades, la PP contribuye a la presencia de los diagnósticos de enfermería de riesgo de úlcera por presión [00249], de deterioro de la integridad cutánea [00047] y tisular [00248]. Por su parte, la intervención de enfermería prevención de úlceras por presión [3540], es clave para minimizar el desarrollo de esta complicación, mejorar la calidad de la atención y el pronóstico en este tipo de pacientes. Finalmente, para determinar la efectividad del cuidado de enfermería se proponen los resultados NOC consecuencias de la inmovilidad: fisiológicas [0204] e integridad tisular: piel y membranas mucosas [1101]. Conclusión: La PP es una terapia coadyuvante recomendada para el manejo de los pacientes con COVID-19 críticamente enfermos, debido a que optimiza la función pulmonar, sin embargo está asociada a eventos adversos como las UPP. Este artículo presenta recomendaciones basadas en una revisión narrativa para facilitar la implementación de cuidados de enfermería preventivos que reduzcan su frecuencia en esta población. Cómo citar este artículo: Rojas LZ, Mora Rico LA, Acosta Barón JV, Cristancho Zambrano LY, Valencia Barón YD, Hernández Vargas JA. Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19. Revista Cuidarte. 2021;12(3):e2234. http://dx.doi.org/10.15649/cuidarte.2234

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Barriers to nutrition therapy in the critically ill patient with COVID‐19

Suliman

McClave

Taylor

et al. 2021

J Parenter Enteral Nutr

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Background Coronavirus disease 2019 (COVID‐19) has created challenges for intensivists, as high ventilatory demands and prolonged hypermetabolism make it difficult to sustain nutrition status. The purpose of this survey was to determine current practices in nutrition therapy and identify barriers to its delivery. Methods A survey about delivering nutrition therapy to critically ill patients with COVID‐19 was sent to clinicians at academic and community hospitals from September to December 2020. Results Of 440 who viewed the survey, 199 (45%) completed the questionnaire. Respondents were composed of 30%, physicians and 70% registered dietitians, with 51% representing community programs, 43% academic institutions, and 6% Veterans Affairs centers. Half (49%) had protocols for managing critically ill patients with COVID‐19, and 21% had a protocol for nutrition therapy. Although most respondents (83%) attempted to feed by the intragastric route, only 9% indicated that energy/protein needs were met. The biggest barriers to delivery of enteral nutrition (EN) involved the patients unpredictable clinical course and fear of aspiration given the lack of respiratory reserve. Intensivists were reluctant to add supplemental parenteral nutrition (PN) because of perceived lack of benefit. Conclusion The survey results would suggest that strategies for nutrition therapy based on the intragastric infusion of EN are unsuccessful in meeting the energy/protein needs of critically ill patients with COVID‐19. It is likely these barriers exist in providing nutrition to non‐Covid‐19 critically ill patients. Intensivists need protocols that optimally deliver intragastric EN, consider early postpyloric infusion, and address adding supplemental PN in a deteriorating nutrition status.

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Nursing care and prevalence of adverse events in prone position: Characteristics of mechanically ventilated patients with severe SARS‐CoV‐2 pulmonary infection

Cited by 41 publications

References 26 publications

Incidence and Practice of Early Prone Positioning in Invasively Ventilated COVID-19 Patients—Insights from the PRoVENT-COVID Observational Study

Incidence and Practice of Early Prone Positioning in Invasively Ventilated COVID-19 Patients—Insights from the PRoVENT-COVID Observational Study

Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19

Barriers to nutrition therapy in the critically ill patient with COVID‐19

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