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Bakgrund: Anestesisjuksköterskan arbete består i att ge god anestesiologisk omvårdnad. Varje enskild situation ställer krav på färdigheter, kunskap och kompetens. (Gran Bruun, 2013). Att “identifiera svår luftväg”, “skapa en handlingsplan”, “bevara lugn och fokusera på uppgiften”, “tekniska färdigheter” samt “använda utrustningen” är faktorer som anestesisjuksköterskan upplevde som avgörande för att hantera en svår luftväg på ett framgångsrikt sätt (Dabija et al., 2019). För att hantera väntade och oväntade händelser upplevde anestesisjuksköterskor att klinisk erfarenhet var en avgörande förutsättning för hur praktiskt och mentalt förberedda de var för oväntade situationer. Motiv: Baserat på tidigare evidens faller det sig intressant att undersöka hur anestesisjuksköterskan upplever att hantera ofri luftväg utanför operationssalens givna kontext. Syfte: Att studera anestesisjuksköterskans erfarenhet av beslutsfattande vid luftvägshantering i samband med uppdrag utanför operationsavdelningen. Metod: Kvalitativ design användes för studien, insamling av data gjordes med semistrukturerade intervjuer. Åtta anestesisjuksköterskor inkluderades i studien varav ett internt bortfall. Resultat: Anestesisjuksköterskan grundar sina beslut i observationer och bedömningar kring flera parametrar när de hanterar ofri luftväg på uppdrag utanför operationsavdelningen. De bedömer patientens kliniska tecken men också omgivning och förutsättningar för uppdraget, för att kunna hantera olika typer av väntade och oväntade händelser. Anestesisjuksköterskan kan uppleva en del utmaningar i form av svårigheter och negativa känslor men också utmaningar i att skapa kontroll i olika situationer. Som nyutbildad anestesisjuksköterska upplevde de att de behövde stöd i sitt beslutsfattande samt att de upplevde en del prövningar i form av oro och att vara oförberedd. Konklusion: Att vara förberedd för alla möjliga väntade och oväntade händelser beskrivs som mycket viktig. Erfarenhet i yrket underlättar förberedelser, beslutsfattande och ger en ökad trygghet i dessa situationer. För att förstå hur den nyutbildade anestesisjuksköterskan uppfattar dessa situationer vore det intressant att studera anestesisjuksköterskors upplevelser i ämnet vidare för att om möjligt utveckla riktlinjer och på det sättet stödja dem i arbetet. / Background: The nurse anesthetists’ work consists of providing good anesthesiologic nursing. Each individual situation places demands on skills, knowledge, and competence (Gran Bruun, 2013). "Identifying a difficult airway", "creating an action plan", "maintaining calm and focusing on the task", "technical skills" and "using the equipment" are factors that the nurse anesthetist experienced as crucial to managing a difficult airway successfully (Dabija et al., 2019). To deal with expected and unexpected events, nurse anesthetist feels that clinical experience was a crucial prerequisite for how practical and mentally prepared they were for unexpected situations. Motive: Based on previous evidence, it is remarkable to investigate how the nurse anesthetist experiences handling obstructed airways outside the operating ward. Aim: to investigate the nurse anesthetists’ experiences regarding decision making in airway management during assignments outside the operating ward. Methods: Qualitative design was used for the study; data collection was done with semi-structured interviews. Eight nurse anesthetists ‘were included in the study, of which one internally exulted. Results:  Show that the nurse anesthetists’ base their decisions on observations and assessments on several parameters when handling obstructed airways on tasks outside the operating ward. The nurse anesthetist may experience some challenges including difficulties and negative emotions, but also challenges in establishing control in different situations. As a newly trained nurse anesthetist, they felt that they needed support in their decision-making and that they experienced some difficulties in the form of anxiety and being unprepared. Conclusion: Being prepared for all kinds of expected and unexpected events is described as very important. Experience in the profession favors preparation and decision-making and provides increased security in these situations. To understand how the newly trained nurse anesthetist perceives these situations, it would be interesting to study the nurse anesthetists ‘experiences in the subject further to develop guidelines if possible and in that way support them in their work.

Bakgrund: Sjuksköterskor som arbetar prehospitalt ska kunna bedöma om en patient är kritiskt sjuk samt kunna påbörja en adekvat behandling. Det är sällsynt med komplikationer vid luftvägshantering men det kan i stället ha allvarliga konsekvenser. Tidigare forskning presenterar att det visar en brist på utbildning vid luftvägshantering inom de prehospitala verksamheterna, där utbildning saknas för att bibehålla en viss kompetens hos sjuksköterskorna. Syfte: Syftet var att undersöka hur utbildning påverkar sjuksköterskans hantering av en ofri luftväg prehospitalt.  Metod: En litteraturstudie med kvantitativ ansats med elva vetenskapliga studier. Datainsamlingen hämtades i databaserna PubMed och Cinahl. Resultat: Genom utbildning ökade kunskap och självkänslan hos sjuksköterskor som arbetar prehospitalt. Utbildningen bör hållas frekvent för att bibehålla kompetensen hos de prehospitala sjuksköterskorna. Efter utbildning av supraglottiska enheter för luftvägshantering, insåg personalen som arbetar prehospitalt att den är både lättare att hantera och går snabbare att använda jämfört med endotrakeal intubation.  Konklusion: Det är nödvändigt med en fortsatt kontinuerlig forskning i den prehospitala vården för att kunna ge och upprätthålla en säker vård till patienterna. / Background: The pre-hospital nurses must be able to assess if a patient is critically ill, as well as start adequate treatment for the patient. Complications in respiratory management are rare but can have serious consequences. Previous research indicate that airway management is worsening in pre-hospital settings, where there is a lack of training to maintain a certain level of competence within the nurse staff. Aim: The aim of the study was to investigate how training affects the nurse’s management of an airway obstruction in a pre-hospital setting. Method: A literature review based on eleven scientific studies. The data collection was collected from the databases PubMed and Cinahl. Results: The training increased the knowledge and self-esteem of the pre-hospital nurses and should be offered regularly to maintain the competence of the staff. After the training period with supraglottic airway management devices, the pre-hospital nurses realized that the devices were easier to manage and faster to use compared to endotracheal intubation. Conclusion: Continuous research in prehospital care is necessary in order to provide and maintain safe care to patients.

No description available.

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.

Endotracheal intubation is still the gold standard in airway management. For medical students and young professionals, it is often difficult to train personal skills. We tested a high-fidelity simulator with an additional quantitative feedback integration to elucidate if competence acquisition for airway management is increased by using this feedback method. In the prospective trial, all participants (n = 299; 4th-year medical students) were randomized into two groups—One had been trained on the simulator with additional quantitative feedback (n = 149) and one without (n = 150). Three simulator measurements were considered as quality criteria—The pressure on the upper front row of teeth, the correct pressure point of the laryngoscope spatula and the correct depth for the fixation of the tube. There were a total of three measurement time points—One after initial training (with additional capture of cognitive load), one during the exam, and a final during the follow-up, approximately 20 weeks after the initial training. Regarding the three quality criteria, there was only one significant difference, with an advantage for the control group with respect to the correct pressure point of the laryngoscope spatula at the time of the follow-up (p = 0.011). After the training session, the cognitive load was significantly higher in the intervention group (p = 0.008) and increased in both groups over time. The additional quantitative feedback of the airway management trainer brings no measurable advantage in training for endotracheal intubation. Due to the increased cognitive load during the training, simple airway management task training may be more efficient for the primary acquisition of essential procedural steps.

Introduktion: Att skapa fri luftväg i samband med prehospitalt hjärtstopp är en komplicerad åtgärd i en stressande situation. Det finns flera metoder för denna åtgärd och de har olika svårighetsgrad beroende på vilken metod som ambulanssjuksköterskan behöver använda för att nå framgång. Denna åtgärd förväntas ambulanssjuksköterskan klara av trots att miljön är utmanande och tidspressen stor.   Syfte: Att beskriva ambulanssjuksköterskors upplevelser av etablering av fri luftväg i samband med hjärtstopp.   Metod: Kvalitativ intervjustudie som analyseras med latent innehållsanalys. Tolv semistrukturerade intervjuer genomfördes på tre verksamhetsställen i södra Sverige.   Resultat: Ambulanssjuksköterskorna berättade om hur luftvägshantering är en liten men viktig del av allt de ska klara av i sin yrkesroll. Det finns en otrygghet i momentet intubation som beror på bristande utbildning i kombination med hur sällan ambulanssjuksköterskan gör detta i det dagliga arbetet. Studien resulterade i tre huvudkategorier: Otrygghet i yrkesrollen, Prehospitala framgångsfaktorer och Personcentrerad vård genom samarbete med tillhörande tolv subkategorier. Det som bekymrade ambulanssjuksköterskorna mest var luftvägshantering på barn. Det som upplevs vara den största framgångsfaktorn betonades vara de enkla åtgärderna när det gäller luftvägshantering.   Slutsats: För att öka ambulanssjuksköterskans trygghet i luftvägshantering krävs ökade utbildningsinsatser. Arbetsgivaren bör ta ett ökat ansvar för utbildning genom att skapa förutsättningar och uppföljning. Vidare bör de riktlinjer som finns för luftvägshantering ses över. De enklaste metoderna är oftast de bästa prehospitalt. / Introduction: To manage an airway in a prehospital environment is a complex measure in a stressful situation. There are several methods for this measure and they have various level of severity depending on the method the ambulance nurse chooses to apply. This measure is expected to be managed by the ambulance nurse despite rough environment and lack of time.   Purpose: To describe the ambulance nurse’s experiences of airway management in a cardiac arrest situation.   Method:  Twelve semi-structured qualitative interviews was made and analyzed by content analysis. The interviews were made at three different ambulance organizations in the south of Sweden     Result: The ambulance nurses told about how small but essential task airway management is. But it’s still a task they must be able to perform in their work.  There is an insecurity in the moment of intubation which is related to lack of training and how rarely they perform the moment in their daily duties. The study resulted in three main categories: Insecurity in the profession, Prehospital success factors and Person-centered care through teamwork with twelve subcategories. What concerned the ambulance nurses the most was airway management on children. They describe the greatest success factor to be the simplest possible measures when it comes to airway management.   Conclusion: To increase the ambulance nurse’s security in airway management more education efforts is needed. Employers should take a greater responsibility for education by creating conditions and monitoring. Therefore, should the guidelines for airway management be reviewed. The simplest methods in airway management are often the most successful.

The master thesis deals with an intensive home care - home care of intensive nursing and maps the situation concerning the home mechanical ventilation. The theoretical part draws from the researchers' reviews. It clarifies the basic concepts, intensive home care and trends in providing the home mechanical ventilation. Furthermore, this part of the thesis explains the term mechanical ventilation. To facilitate long-term ventilation of a chronic patients it is necessary to ensure an adequate airway. Therefore, it is included a chapter dealing with a tracheostomy and its treatment.The first part of the survey summarizes a statistical overview of the home mechanical ventilation used in the Czech Republic till 31th March 2013. Next section includes a qualitative form research, which is observing the whole indicating and transferring process of a patient from a hospital to the home environment where the home mechanical ventilation is assured. I have concluded that men are more ill and women, mothers or wives are taking part in the healing process according to the investigation results. We have 81 ventilated patients in home care in total. Mechanical ventilation is mostly indicated for children with spinal muscular atrophy disease. Men compared to women are more often affected by traumatic conditions,...

INTRODUÇÃO: A insuficiência respiratória pós-extubação é um evento comum após a descontinuação da ventilação mecânica, sendo a reintubação necessária em cerca de 10% (4-24%) dos casos. A ventilação não invasiva (VNI) tem sido considerada como uma terapia promissora para evitar a reintubação, sendo aplicada como um adjunto para extubação precoce, de forma preventiva ou em pacientes que desenvolveram insuficiência respiratória pós extubação. OBJETIVO: Comparar as características clínicas e os desfechos da população de estudo, de acordo com as três formas de aplicação da VNI no período pós extubação. MÉTODOS: Estudo observacional prospectivo em 11 Unidades de Terapia Intensiva por um período de nove meses, onde todos os pacientes adultos submetidos à VNI dentro de 48h após a extubação foram avaliados. RESULTADOS: Um total de 174 pacientes foi incluído no estudo. A média(DP) de idade foi de 56 (18) anos e 55% eram do sexo masculino. A média (DP) do SAPS II foi de 42(14). As formas de aplicação da VNI foram: Insuficiência respiratória pós-extubação (G-IRpA) (26%), como adjunto no desmame precoce (G-PRECOCE) (10%) e como VNI preventiva (G-PREVENT) (64%). O tempo mediano de tempo de ventilação mecânica foi similar nos três grupos (66h), o tempo mediano entre a extubação e o inicio da VNI foi de 0h (0-16h), e o tempo mediano entre a extubação e a reintubação foi de 2 dias (0,7-4d). Apenas 3% dos pacientes tinham DPOC. A taxa de sucesso da VNI foi de 67% no G-IRpA, 70% no G-PRECOCE e 64% no G-PREVENT, com taxa de reintubação de 34%. A taxa de mortalidade na UTI foi de 27%. Pacientes com hipercapnia tiveram uma taxa de sucesso maior (81%), já os pacientes que necessitaram de aspiração de secreção e que passaram mais tempo na VNI foram mais susceptíveis a serem reintubados. CONCLUSÃO: A VNI pode reduzir as taxas de reintubação em pacientes que apresentaram insuficiência respiratória pós extubação, apresentar um sucesso moderado em pacientes heterogêneos que a utilizaram no desmame precoce e quando utilizada em uma população não seleta de forma preventiva, não reduz, significativamente, as taxas de mortalidade e de reintubação / BACKGROUND: Respiratory failure after extubation is a common event and reintubation occurs in 10% (4-24%) of patients. Studies suggests that noninvasive ventilation (NIV) may be successfully used to avoid reintubation, being applied as an adjunct to an early extubation, to prevent postextubation respiratory failure or in patients who developed postextubation respiratory failure. OBJECTIVE: Observe the outcomes from daily routine standard use of NIV in postextubation in its three different forms of application. METHODS: A prospective observational study in 11 Intensive Care Units (ICU), was conducted over a 9 months period, it was evaluated all adult patients submitted to NIV within 48hs after extubation. RESULTS: A total of 174 patients were included in this study. The mean (SD) age was 56 (18) years, and 55% were male. The mean (SD) SAPS II was 42 (14). NIV forms of application were: (G-IRpA) posextubation respiratory failure (26%), (G-PRECOCE) as an adjunct to an early extubation (10%) and (G-PREVENT) NIV preventive (64%). The median time of mechanical ventilation was similar in the 3 groups (66 h), the median time between extubation and beginning of NIV was 0h (0-16h), and the median time between extubation and need of reintubation was 2 days (0,7-4d). There were only 2,8% COPD patients. NIV success rate was 67% in G1, 70% in G2 and 64% in G3, with reintubation rate of 34%. Mortality rate in ICU was 27%. Patients with hypercapnia had a higher success rate (80,6%), yet patients that needed secretion aspiration and that spent more time in NIV were more susceptible to be reintubated. CONCLUSION: NIV may reduce the reintubation rate in patients with respiratory failure after extubation, present a moderate success in heterogeneous patients who used in early weaning and when used in a non selected population in a preventive way does not reduce mortality and reintubation rates

Estudo com objetivo de avaliar e comparar o desempenho teórico e prático de estudantes de enfermagem submetidos a estratégias de ensino-aprendizagem, aula expositivo-dialogada e atividade prática em laboratório de habilidades ou aula simulada, no manejo da via aérea em emergências por meio da máscara laríngea (ML). Estudo com delineamento experimental, abordagem quantitativa, de intervenção tipo Ensaio Clínico Randomizado Controlado. A população consistiu dos estudantes do oitavo período, bacharelado, da Escola de Enfermagem de Ribeirão Preto e a amostra de 17 estudantes, randomizados para grupo controle (GC) e grupo intervenção (GI). O GC foi submetido à aula expositivo-dialogada seguida de atividade prática em laboratório de habilidades com manequim de baixa fidelidade e o GI à aula simulada em laboratório utilizando o mesmo manequim. Elaboraram-se os instrumentos de avaliação escrita, cenário de simulação e avaliação clínica objetiva e estruturada no cenário de simulação (checklist), validados em aparência e conteúdo por comitê de juízes. A estratégia de coleta de dados foi Workshop intitulado \"Manejo da via aérea em emergências: uso da ML\". Foram avaliados teste escrito e OSCE (Exame Clínico Objetivo Estruturado) - avaliação clínica estruturada em Laboratório de Simulação, este último empregando como ferramenta o manequim de média-fidelidade. A atividade foi filmada e analisada por três avaliadores. Analisaram-se os desfechos: desempenho teórico no teste escrito e prático no OSCE, tempo de execução do OSCE, tempo para obtenção da primeira ventilação eficaz, número de tentativas para inserção da ML até obtenção de ventilação efetiva. Resultados: 16 estudantes eram do sexo feminino e um do sexo masculino, a idade média 24,4±4,2 anos. No pré-teste a nota média do GC de 6,6±1,0 e do GI de 6,5±0,5 e a mediana para ambos 6,5. No pós-teste a nota média do GC foi 8,4±0,8 (mediana 8,5), do GI de 8,6±1,1 (mediana 8,6). Comparando-se as médias obtidas no pré-teste por ambos os grupos, não há diferença estatisticamente significante (p=07427). Tal fato também pôde ser constatado no pós-teste (p=0,7117). Comparando as notas pré e pós-teste do GC evidenciou diferença estatisticamente significante (p=0,0025) o que também ocorreu para o GI (p=0,0002). A média no OSCE do GC foi 7,8±0,52 e GI 8,4±0,89; comparou-se tais notas verificando-se que não há diferença estatisticamente significante (p=0,0822). A média obtida pelo GC no pós-teste foi maior que a média obtida no OSCE e, para o GI, são equivalentes. O tempo médio de execução do OSCE pelo GC foi 479,8±183,3s (mediana 468,5s) e no GI 520,3±157s (mediana 506s), não havendo diferença estatisticamente significante (p=0,6311) e também para obtenção da primeira ventilação eficaz (p=0,9835). A média do nº tentativas para inserção da ML pelo GC 1,63±0,74 e GI 1,56±0,63. Embora os resultados não apontem diferença estatisticamente significante entre as médias dos grupos no pós-teste, para o GI os escores foram superiores. No presente estudo, apesar de diferentes estratégias de ensino abordarem o manejo da via aérea em emergências com a ML, os resultados demonstram que as mesmas foram eficazes e os objetivos de aprendizagem foram alcançados, pois houve incremento nas notas obtidas no pós-teste e no OSCE em ambos os grupos. / Study aimed to evaluate and compare the theoretical and practical performance of nursing students subjected to teaching and learning strategies, exhibition-dialogued class, and practical activity in skill lab or simulated class in airway management in emergencies through laryngeal mask (LM). This is a study of experimental design, quantitative approach, intervention type, Controlled Randomized Trials. The population consisted of students in the eighth semester from the Bachelor\'s Degree of the University of São Paulo at Ribeirão Preto College of Nursing and the sample consisted of 17 students, randomly assigned to the control group (CG) and the intervention group (IG). The CG was subjected to exhibition-dialogued class followed by practical activity in skill lab with low-fidelity mannequin and the IG to simulated class in the lab using the same mannequin. Written evaluation instruments, simulation scenario and objective structured clinical evaluation in simulation scenario (checklist) were developed and validated in appearance and content by a committee of judges. The strategy for data collection was the workshop entitled \"Airway management in emergencies: use of LM\". They were evaluates through written test and the OSCE (Objective Structured Clinical Examination) - structured clinical evaluation in Simulation Laboratory, the latter employing the medium-fidelity mannequin as tool. The activity was filmed and analyzed by three evaluators. The outcomes were analyzed: theoretical performance in written and practical test in the OSCE, the OSCE runtime, time to obtain the first effective ventilation, number of attempts to insert the LM to obtain effective ventilation. Results: 16 students were female and one male, mean age 24.4±4.2 years. In the pre-test the score average of CG was 6.6±1.0 and of IG was 6.5±0.5 and the median for both was 6.5. At post-test, the average score of CG was 8.4±0.8 (median 8.5), of IG was 8.6±1.1 (median 8.6). Comparing the averages obtained in the pre-test for both groups, there was no statistically significant difference (p=0.7427). This fact could also be observed in the post-test (p=0.7117). Comparing notes of pre and post-test of CG there was a statistically significant difference (p=0.0025) which also occurred for IG (p=0.0002). The mean of the OSCE for CG was 7.8±0.52 and for IG was 8,4±0,89; compared to such notes and it was verified that there is no statistically significant difference (p=0.0822). The average obtained by CG in the post-test was higher than the average obtained IG in the OSCE, and for IG they were equivalent. The average execution time of the OSCE for CG was 479.8 ± 183.3s (median 468.5s) and for IG 520.3±157s (506s median), with no statistically significant difference (p=0.6311) and also for obtaining the first effective ventilation (p=0.9835). The average of attempts to insert the LM by CG was 1.63±0.74 and by IG was 1.56±0.63 GI. Although the results do not indicate a statistically significant difference between the averages of the groups in the post-test, the scores were higher for IG. In this study, although different teaching strategies addressing airway management in emergencies through LM were used, the results show that they were effective and the learning objectives have been achieved, because there was an increase in the scores obtained in the post-test and in the OSCE in both groups.