Wellbeing of ICU patients with COVID-19

Effects of awake-prone positioning on oxygenation and physiological outcomes in non-intubated patients with COVID-19: A randomized controlled trial

BACKGROUND

Prone positioning is a well-known supportive approach for increasing oxygenation and reducing mortality in non-COVID-19 patients with moderate to severe acute respiratory distress syndrome. However, studies highlighting the effects of proning in patients with COVID-19 are limited.

AIM

To investigate the effects of awake-prone positioning (APP) on oxygenation and physiological outcomes in non-intubated patients with COVID-19.

STUDY DESIGN

A randomized controlled trial was carried out with two parallel groups at 1:1 ratio. Adult awake non-intubated patients with confirmed COVID-19, non-rebreathing face mask or continuous positive airway pressure, PaO2 /FiO2 ratio ≤150 mmHg were randomly assigned to the APP group or control group. The control group was subjected to conventional positioning interventions. Outcome measures were PaO2 /FiO2 ratio, ROX index, PaO2 , PaCO2 , SaO2 , respiratory rate, blood pressure, and shock index. These parameters were recorded immediately before positioning, 10 min after patient positioning, and 1 h after patient positioning.

RESULTS

Of 115 patients assessed for eligibility, 82 were randomized to the APP group or control group (41 patients in each group). The use of APP for non-intubated patients with COVID-19 resulted in statistically significant improvements in oxygenation parameters, that is, SpO2 , PaO2 /FiO2 , ROX index, PaO2 , and SaO2 , at the three study time points (p = .000, .007, .000, .011, and .000 respectively). The SpO2 was increased to 92.15 ± 2.735 mmHg for the APP group versus 88.17 ± 4.847 for the control group after 1 h of patients' positioning. The PaO2 /FiO2 ratio increased in the APP group before proning compared with 1 h after proning (79.95 ± 22.508 vs. 98.91 ± 34.44) respectively. APP improved the SpO2 , PaO2 /FiO2 , ROX index, PaO2 , and SaO2 values for the APP group, representing an increase of 5.85%, 23.71%, 30.79%, 22.59%, and 5.26%, respectively.

CONCLUSION

Awake proning in non-intubated patients with COVID-19 showed marked improvement in oxygenation and physiological parameters.

RELEVANCE TO CLINICAL PRACTICE

This study provides evidence for critical care nurses to implement APP in non-intubated patients with COVID-19 to improve oxygenation and physiological parameters, as it was tolerated by most of the patients without serious adverse events.

A qualitative study of nurses' perception on patients' thirst in intensive care units

BACKGROUND

Thirst is a prevalent and intense symptom among patients in intensive care units. Occurrence of thirst in the intensive care unit cannot be avoided because of the nature of critical illnesses and their treatments like the side effects of administered medication or dehydration. In the intensive care unit, nurses have the opportunity and responsibility to prevent and reduce thirst by recognizing the different types of thirst. Thus, knowing nurses' perception on patients' thirst is crucial.

OBJECTIVES

Exploration of intensive care nurses' perception on patients' thirst.

RESEARCH DESIGN

A qualitative descriptive study.

METHODS

Data were collected from December 2020 to January 2021 and analyzed by using a phenomenographic methodology. Data were transcribed verbatim and thematic analysis was performed.

RESULTS

Sixteen nurses, in Chongqing, China, aged 25-48 years, were interviewed. Four themes emerged: (1) perceived barriers for thirst; (2) perceived signs of thirst; (3) perceived reasons of thirst; (4) perceived consequences for thirst. Overall nurses' perception of patients' thirst is poor. Nurses give a low priority and insufficient attention to the issue of thirst in intensive care patients.

CONCLUSION

Intensive care nurses' perception on thirst in patients should be evaluated and, if necessary, this issue should be given more attention in training in order to create sufficient awareness about the topic.