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Fernando JMG, Marçal MMG, Ferreira ÓR, Oliveira C, Pedreira L, Baixinho CL. Nursing Interventions for Client and Family Training in the Proper Use of Noninvasive Ventilation in the Transition from Hospital to Community: A Scoping Review. Healthcare (Basel) 2024; 12:545. [PMID: 38470656 PMCID: PMC10930648 DOI: 10.3390/healthcare12050545] [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: 01/10/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Noninvasive ventilation is an increasingly disseminated therapeutic option, which is explained by increases in the prevalence of chronic respiratory diseases, life expectancy, and the effectiveness of this type of respiratory support. This literature review observes that upon returning home after hospital discharge, there are difficulties in adhering to and maintaining this therapy. The aim of this study is to identify nursing interventions for client and family training in the proper use of noninvasive ventilation in the transition from hospital to community. A scoping review was carried out by searching MEDLINE, CINAHL, Scopus, and Web of Science. The articles were selected by two independent reviewers by applying the predefined eligibility criteria. Regarding transitional care, the authors opted to include studies about interventions to train clients and families during hospital stay, hospital discharge, transition from hospital to home, and the first 30 days after returning home. The eight included publications allowed for identification of interventions related to masks or interfaces, prevention of complications associated with noninvasive ventilation, leakage control, maintenance and cleaning of ventilators and accessories, respiratory training, ventilator monitoring, communication, and behavioral strategies as transitional care priority interventions to guarantee proper training in the transition from hospital to community.
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Affiliation(s)
| | - Margarida Maria Gaio Marçal
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
| | - Óscar Ramos Ferreira
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
| | - Cleoneide Oliveira
- Medical School Estácio Idomed Quixadá, University Center Estacio do Cearà, Fortaleza 60035-111, Brazil;
| | - Larissa Pedreira
- Nursing School, Federal University of Bahia, Salvador 40170-110, Brazil;
| | - Cristina Lavareda Baixinho
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
- Center of Innovative Care and Health Technology (ciTechCare), 2414-016 Leiria, Portugal
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Bedi PK, DeHaan K, Ofosu D, Olmstead D, MacLean JE, Castro-Codesal M. Predictors of NIV-related adverse events in children using long-term noninvasive ventilation. Pediatr Pulmonol 2023; 58:3549-3559. [PMID: 37701936 DOI: 10.1002/ppul.26689] [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: 05/31/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND AND OBJECTIVES An increasing number of children with diverse medical conditions are using long-term noninvasive ventilation (NIV). This study examined the impact of demographic, clinical, and technology-related factors on long-term NIV adverse events in a large cohort of children using long-term NIV. METHODS This was a multicenter retrospective review of all children who initiated long-term NIV in the province of Alberta, Canada, from January 2005 to September 2014, and followed until December 2015. Inclusion criteria were children who had used NIV for 3 months or more and had at least one follow-up visit with the NIV programs. RESULTS We identified 507 children who initiated NIV at a median age of 7.5 (interquartile range: 8.6) years and 93% of them reported at least one NIV-related adverse event during the initial follow-up visit. Skin injury (20%) and unintentional air leaks (19%) were reported more frequently at the initial visit. Gastrointestinal symptoms, midface hypoplasia, increased drooling, aspiration and pneumothorax were rarely reported (<5%). Younger age and underlying conditions such as Down syndrome, achondroplasia, and Duchenne muscular dystrophy were early predictors of unintentional air leak. Younger age also predicted child sleep disruption in the short term and ongoing parental sleep disruption. Obesity was a risk factor for persistent nasal symptoms. Mask type was not a significant predictor for NIV-related short- or long-term complications. CONCLUSIONS This study demonstrates that NIV-related complications are frequent. Appropriate mask-fitting and headgear adaptation, and a proactive approach to early detection may help to reduce adverse events.
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Affiliation(s)
- Prabhjot K Bedi
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Kristie DeHaan
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Daniel Ofosu
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Joanna E MacLean
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Maria Castro-Codesal
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
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Valls-Matarín J, Peradejordi-Torres RM, Del Cotillo-Fuente M. Dependency-related skin lesions in the prone critical patient. Incidence study. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:424-431. [PMID: 37898167 DOI: 10.1016/j.enfcle.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. METHOD Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. RESULTS Forty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 [61.8-71.3] vs. 64 [43-71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1-149.4] vs. 38.2 [18.8-57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01-1.05) and PVD (OR=8.9; 95%CI:1.3-58.9) as predisposing factors for developing DRSL. CONCLUSIONS There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.
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Affiliation(s)
- Josefa Valls-Matarín
- Unidad de Cuidados Intensivos, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
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Gautam G, Gupta N, Sasidharan R, Thanigainathan S, Yadav B, Singh K, Singh A. Systematic rotation versus continuous application of 'nasal prongs' or 'nasal mask' in preterm infants on nCPAP: a randomized controlled trial. Eur J Pediatr 2023:10.1007/s00431-023-04933-1. [PMID: 36967420 PMCID: PMC10040306 DOI: 10.1007/s00431-023-04933-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/04/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Abstract
To compare whether alternate rotation of nasal mask with nasal prongs every 8 h as compared to continuous use of either interface alone decreases the incidence of nasal injury in preterm infants receiving nasal Continuous Positive Airway Pressure (nCPAP). This was an open-label, three-arm, stratified randomized controlled trial where infants < 35 weeks receiving nCPAP were randomized into three groups using two different nasal interfaces (continuous prongs group, continuous mask group, and rotation group). All infants were assessed for nasal injury six hours post-removal of nCPAP using grading suggested by Fischer et al. The nursing care was uniform across all three groups. Intention-to-treat analysis was done. Fifty-seven infants were enrolled, with nineteen in each group. The incidence of nasal injury was 42.1% vs. 47.4% vs. 68.4% in the rotation group, continuous mask, and continuous prongs groups, respectively (P = 0.228). On adjusted analysis (gestational age, birth weight, and duration of nCPAP therapy), the incidence of nasal injury was significantly less in the rotation group as compared to continuous prongs group (Adjusted Odds Ratio [AOR], 95% confidence interval [CI]; 0.10 [0.01-0.69], P = 0.02) and a trend towards lesser nasal injury as compared to continuous mask group (AOR, 95% CI; 0.15 [0.02-1.08], P = 0.06). However, there was no significant difference in incidence of nasal injuries between continuous prongs versus continuous mask group (P = 0.60). The need for surfactant, nCPAP failure rate, duration of nCPAP, and common neonatal co-morbidities were similar across all three groups. Conclusion: Systematic rotation of nasal mask with nasal prongs significantly reduced nasal injury among preterm infants on nCPAP as compared to continuous use of nasal prongs alone without affecting nCPAP failure rate. Trial registration: CTRI/2019/01/017320, registered on 31/01/2019. What is Known: • Use of nasal mask as an interface for nasal Continuous Positive Airway Pressure decreases nasal injury as compared to nasal prongs. What is New: • Rotation of nasal prongs and nasal mask interfaces alternately every 8 h may reduce the nasal injury even further as compared to either interface alone.
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Affiliation(s)
- Gaurav Gautam
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Neeraj Gupta
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India.
| | - Rohit Sasidharan
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Sivam Thanigainathan
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Bharti Yadav
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Arun Singh
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
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Moser CH, Peeler A, Long R, Schoneboom B, Budhathoki C, Pelosi PP, Brenner MJ, Pandian V. Prevention of Endotracheal Tube-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care 2022; 31:416-424. [PMID: 36045034 DOI: 10.4037/ajcc2022644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. OBJECTIVE To determine the incidence of endotracheal tube-related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube-related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration's criteria. RESULTS Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. CONCLUSIONS Airway device-related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of standardized assessments.
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Affiliation(s)
- Chandler H Moser
- Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Robert Long
- Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce Schoneboom
- Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Chakra Budhathoki
- Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University
| | - Paolo P Pelosi
- Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Vinciya Pandian
- Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
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Wehlmann H, Ochmann T. [Influence of nurses on the experience of noninvasive ventilation]. Med Klin Intensivmed Notfmed 2021; 116:702-707. [PMID: 34191044 DOI: 10.1007/s00063-021-00836-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
Noninvasive ventilation (NIV) is established as an integral part of intensive care therapy for respiratory insufficiency. However, it is associated with restrictions on patient autonomy and comfort. A successful course of therapy is largely dependent on the acceptance and adherence of the patients concerned. Intensive care nurses can have a significant influence on the success of the therapy by dealing with the subjective experience of the patients and by maintaining close contact with them. The prerequisite for this is profound knowledge of the different technical aspects of therapy and equipment as well as positive and negative factors influencing NIV tolerance in order to be able to offer and implement an individual intervention.
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Affiliation(s)
- Henning Wehlmann
- Interdisziplinäre Intensivstation, Klinik für Anästhesie und Intensivmedizin, Alexianer St. Hedwig Kliniken Berlin, Große Hamburger Straße 5-11, 10115, Berlin, Deutschland.
| | - Tobias Ochmann
- Medizinische Intensivstation, Klinik für Kardiologie, Internistische Intensivmedizin und Angiologie, Zentrum für Innere Medizin, Kath. Marienkrankenhaus Hamburg, Hamburg, Deutschland
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Abstract
Long-term non-invasive ventilation (LTNIV) has been increasingly used in children to manage chronic respiratory failure and airway obstruction. Interfaces are of paramount importance for non-invasive ventilation (NIV) effectiveness and patient compliance. However, historically, the choice of pediatric mask has been limited by the scarce availability of commercial interfaces. In recent years, an increasing number of different masks have been commercialized for children, allowing to increase the number of patients who could benefit from LTNIV. Factors such as the age of the child, disease, craniofacial conformation, type of ventilator and mode of ventilation, and children's and family's preferences should be taken into account when selecting the appropriate mask. Adverse events such as skin lesions, facial growth impairment, and leaks must be prevented and promptly corrected. Humidification is a controversial issue on NIV, but it may be useful in certain circumstances. Regular cleaning and disinfection of interfaces and equipment must be addressed. During follow-up, educational programs, close supervision, and continuous support to children and families are crucial to the success of LTNIV therapy.
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Affiliation(s)
- Rosario Ferreira
- Pediatric Pulmonology Unit, Department of Pediatrics, Santa Maria Hospital, Academic Medical Centre of Lisbon, Lisbon, Portugal
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Ventilación mecánica no invasiva versus presión continua positiva en la vía aérea en el edema agudo de pulmón cardiogénico en una unidad de cuidados intensivos. Arch Bronconeumol 2019; 55:63-64. [DOI: 10.1016/j.arbres.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022]
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Raurell-Torredà M, Romero-Collado A, Rodríguez-Palma M. Carta al director en respuesta a « Prevención de lesiones cutáneas asociadas a ventilación mecánica no invasiva». ENFERMERIA INTENSIVA 2018; 29:95-96. [DOI: 10.1016/j.enfi.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/15/2017] [Indexed: 11/15/2022]
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Peña-Otero D, Eguillor-Mutiloa M. Prevención de lesiones cutáneas asociadas a ventilación mecánica no invasiva. ENFERMERIA INTENSIVA 2018; 29:94-95. [DOI: 10.1016/j.enfi.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/15/2017] [Indexed: 12/01/2022]
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