Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-09T13:38:42Z No. of bitstreams: 1 Gustavo Dias da Silva.pdf: 3137873 bytes, checksum: f82f8f22e1838a52d011f8d20995b925 (MD5) / Made available in DSpace on 2015-12-09T13:38:42Z (GMT). No. of bitstreams: 1 Gustavo Dias da Silva.pdf: 3137873 bytes, checksum: f82f8f22e1838a52d011f8d20995b925 (MD5) Previous issue date: 2013 / Mestrado Profissional em Enfermagem Assistencial / O objeto deste estudo é o erro nos processos do sistema de medicação da Unidade de Terapia Intensiva Neonatal (UTIN), tendo como objetivo geral elaborar um processo de reestruturação do sistema de medicação da UTIN, com base nos erros de medicação identificados por meio de incidentes críticos. Os objetivos específicos são descrever os sistemas de medicação e de notificação dos incidentes envolvendo medicamentos na UTIN; caracterizar os erros de medicação na UTIN relatados por profissionais de enfermagem; e discutir as situações, comportamento e consequências envolvendo os erros de medicação na UTIN. Foi realizada uma pesquisa aplicada do tipo descritiva, com uma abordagem quanti-qualitativa adotando-se a técnica dos incidentes críticos com base no referencial metodológico de Flanagan. Os sujeitos do estudo incluíram enfermeiros, técnicos e auxiliares de enfermagem da UTIN de uma maternidade do Rio de Janeiro. A coleta de dados compreendeu duas etapas: observação não-participante e entrevista individual com o uso de um instrumento semi-estruturado. Os incidentes coletados foram categorizados e submetidos à análise estatística e de conteúdo. Foram incluídos no estudo 40 sujeitos, dos quais 13 (32,5%) eram enfermeiros, 26 (65%) técnicos de enfermagem e 1 (2,5%) auxiliar de enfermagem. A média de tempo de experiência profissional foi de 12,6 anos (± 6,6) e de experiência na instituição foi de 8 anos (± 5,3). 65% dos sujeitos eram extra quadro e 77,5% tinham 2 ou mais vínculos de trabalho. Existem três grupos de profissionais diretamente envolvidos nos processos do sistema de medicação: equipe médica, de enfermagem e serviço de farmácia. A caracterização dos relatos dos profissionais de enfermagem revela que o tipo de erro mais freqüente é o de paciente errado (28,2%), seguido de medicamento errado e dose errada (17,0% cada), houve predominância de relatos de incidentes entre os enfermeiros (r=0,98), servidores estatutários, com média de tempo de experiência profissional de 12,6 anos (± 6,6) e tempo de vínculo na instituição de 8,4 anos (± 5,3). Através da análise de conteúdo das entrevistas emergiram 12 temas que foram agrupados nas categorias que compõem o Incidente Crítico: Situações (Sistema de Medicação, Processo de Trabalho e Comunicação); Comportamentos (Proatividade, Admissibilidade, Mestria, Negação); e Conseqüências (Inadequado Gerenciamento do Cuidado, Sofrimento Psíquico, Near miss ou Evento Adverso, Punição e Estratégias de Prevenção). O produto gerado pela análise e interlocução das características peculiares do sistema e do processo de trabalho dos profissionais de enfermagem com as situações, comportamentos e conseqüências dos erros de medicação foi um fluxograma gerencial para reestruturação do sistema de medicação. Os resultados desta pesquisa apontam que a ocorrência de erros e iatrogenias é freqüentemente associada às características sistemáticas e fatores latentes institucionais, sendo a interface destas características do sistema de medicação com o processo de trabalho vivo em ato do profissional de enfermagem, fator determinante para a ocorrência de incidentes críticos negativos envolvendo o uso de medicamentos na UTIN / The object of this study is the error in the processes of the medication system of Neonatal Intensive Care Unit (NICU), aiming to propose a general restructuring of the NICU medication system, based on medication errors identified by critical incidents. The specific objectives are to describe the medication systems and notification of incidents involving drugs in the NICU; characterize medication errors reported by the NICU nurses, and discuss situations, behavior and consequences involving medication errors in the NICU. We performed a descriptive type of applied research with a quantitative and qualitative approach adopting the critical incident technique based on the methodological framework of Flanagan. The study subjects included nurses, technicians and nursing assistants of a maternity in Rio de Janeiro. Data collection involved two stages: non-participant observation and individual interviews using a semi-structured instrument. The incidents were categorized collected and subjected to statistical analysis and content. The study included 40 subjects, 13 (32.5%) nurses, 26 (65%) nursing technicians and 1 (2.5%) nursing assistant. The average professional experience was 12.6 years (± 6.6) and experience in the institution was 8 years (± 5.3). 65% of subjects were extra frame and 77.5% had 2 or more working links. There are three groups of professionals directly involved in the processes of the medication system: medical staff, nursing and pharmacy service. The characterization of the reports of nurses reveals that the most frequent type of error is to the wrong patient (28.2%), followed by wrong drug and wrong dose (17.0% each), there was a predominance of reported incidents between nurses (r = 0.98), servers with average professional experience of 12.6 years (± 6.6) and time to bond with the institution of 8.4 years (± 5.3). Through content analysis of the interviews revealed that 12 subjects were grouped in categories of the Critical Incident: Situation (Medication System, Work Process and Communication); Behaviors (Proactivity, Admissibility, Mastery, Denial) and Consequences (Inadequate Management Care, Suffering Psychic, near miss or adverse event, Punishment and Prevention Strategies). The product generated by analysis and dialogue of the characteristics of the system and the working process of nursing with the situations, behaviors and consequences of medication errors was a flowchart for managerial restructuring of the medication system. The results of this study indicate that the occurrence of iatrogenic errors and is often associated with systemic features and latent institutional factors, and the interface of these characteristics of the medication system in the process of work in action nursing professional factor for the occurrence of negative critical incidents involving the use of drugs in the NICU

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-04T17:45:29Z No. of bitstreams: 1 Cristineide dos Anjos.pdf: 2616100 bytes, checksum: e94501195ff76b65226f80d3a2453fdc (MD5) / Made available in DSpace on 2016-05-04T17:45:29Z (GMT). No. of bitstreams: 1 Cristineide dos Anjos.pdf: 2616100 bytes, checksum: e94501195ff76b65226f80d3a2453fdc (MD5) Previous issue date: 2015 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O estudo teve como objetivo geral analisar os limites e possibilidades da presença do familiar acompanhante no cuidado à criança com câncer no centro de terapia intensivo pediátrico oncológico e como objetivos específicos: descrever o cuidado à criança no centro de terapia intensivo pediátrico oncológico na visão da equipe de enfermagem e do familiar acompanhante; identificar a visão da equipe de enfermagem sobre a presença do familiar acompanhante no centro de terapia intensiva pediátrico oncológico e conhecer como o familiar acompanhante vê sua presença no centro de terapia intensivo pediátrico oncológico. Trata-se de pesquisa de natureza qualitativa, do tipo estudo de caso, realizado no centro de terapia intensiva pediátrico oncológico de um hospital de referência no tratamento de câncer localizado na Cidade do Rio de Janeiro. A produção de dados envolveu as técnicas de observação simples, com registros em diário de campo, e entrevista semiestruturada com 25 membros da equipe de enfermagem e 10 familiares acompanhantes de crianças com câncer internadas no referido centro de terapia intensiva. Após organização e identificação dos dados, estes foram submetidos à análise temática de conteúdo segundo Bardin, emergindo-se as seguintes categorias: O familiar da criança com câncer até a entrada no centro de terapia intensivo pediátrico oncológico e as interações do familiar acompanhante e membros da equipe de enfermagem no cuidado à criança com câncer no Centro de Terapia Intensiva Oncológico. A partir dos depoimentos dos familiares acompanhantes e da equipe de enfermagem constatou-se que no cuidado a criança hospitalizada no CTIP a interação entre ambos favorece sua adaptação ao ambiente, que envolve inúmeros procedimentos e rotinas, demandando suporte emocional e conforto viabilizado pela presença do familiar e conhecimento técnico e científico da equipe de enfermagem. Assim, conclui-se que o centro de terapia intensivo pediátrico oncológico representa um espaço de interação do familiar acompanhante com a equipe de enfermagem no cuidado a criança com câncer, fundamentado na escuta atenta, viabilizada pelo diálogo que possibilita a troca de conhecimentos do familiar da criança com sua experiência, sentimentos e expectativas. Tal processo tem início com o adoecimento e conta com a equipe de enfermagem que tem como meta o cuidado integral à mesma, incluindo suporte e orientações ao familiar da criança, elemento fundamental no seu processo de hospitalização e tratamento. / The study aimed to analyze the limits and possibilities of the presence of an accompanying family member in the care of children with cancer in the pediatric oncologic intensive care unit and as specific objectives: to describe the care of children in the pediatric oncologic intensive care unit in the nursing team and companion family member´s point of view; identify the nursing team´s point of view about the presence of an accompanying family member in the pediatric oncologic intensive care unit and to know how the accompanying family member sees his presence in the pediatric oncologic intensive care unit. It´s a qualitative research, a case study, carried out at the pediatric oncologic intensive care unit of a reference hospital in the treatment of cancer located in the city of Rio de Janeiro. The data production involved the simple observation techniques, with records in field diary, and semi-structured interview with 25 members of the nursing team and 10 accompanying family members of hospitalized children with cancer in that intensive therapy unit. After data identification and organization, these were submitted to thematic content analysis according to Bardin, emerging the following categories: the family of the child with cancer to the entrance in the pediatric oncologic intensive care unit and the family member´s interactions and nursing team members in the care for children with cancer in the Oncologic Intensive Care Unit. From the testimonies of the accompanying family members and nursing team we found that in the care of children hospitalized in the CTIP interaction between them favors its adaptation to the environment, involving numerous procedures and routines, requiring emotional support and comfort made possible by the familiar member presence and scientific and technical knowledge of the nursing team. Thus, it is concluded that the pediatric oncologic intensive care unit is an accompanying family member interaction space with the nursing team in care of children with cancer, based on attentive listening, made possible by dialogue that enables the exchange of the knowledge of the family member with his experience, feelings and expectations. This process begins with the illness and has the nursing team that aims to the comprehensive care to it, including support and guidance to the child's family, a key element in the process of hospitalization and treatment.

The purpose of the study was to explore and describe the lived experiences of neophyte professional nurses working in ICU during their first year post graduation with the aim to discover strategies to support the nurse in critical care unit. An explorative, descriptive, interpretative qualitative design was conducted to uncover the nurse’s experiences. A purposive sampling was used which is based on belief that the researcher’s knowledge about the population can be used to hand pick sample elements. Data was collected through in-depth unstructured interviews and written narratives. Collaizi’s method of data analysis was used. The study findings revealed that neophyte professional nurses experienced difficulties and challenges in adjusting to the unit because of lack of mentors emanating from the shortage of staff. Nurses experienced mixed feelings regarding the relationship with colleagues in terms of support received. / Health Studies / M.A. (Health Studies)

MCur / Department of Advanced Nursing Science / Background: Doctors and nurses working in ICU are always confronted with ethical dilemmas when caring for critically ill patients no matter where they practice. The ethical dilemmas experienced by ICU nurses and doctors include amongst other: freedom of choice, truth telling, distribution of resources and confidentiality. Purpose: The study sought to explore the ethical dilemmas experienced by healthcare professionals working in ICU, Vhembe district in Limpopo province. Setting: The setting of the study was Tshilidzini hospital, Vhembe district in Limpopo Province Methodology: A qualitative, explorative, descriptive design was used. The population was nurses and doctors working in ICU, Tshilidzini hospital, Vhembe district in Limpopo province. A purposive sampling was used to select the study sample, and the study hospital. Data was collected by means of Semi-structured, in-depth interviews. Data was analyzed using Tesch`s method. Ethical considerations were adhered to. Findings: Participants expressed ethical dilemmas related to lack of resources, unsuitable infrastructure, hospital policies and patient`s decision making. Recommendations: The study recommends better policies by government and critical care societies to help guide resource allocation for ICU services. The number of ICU beds must be allocated according to the population it serves, in-service trainings to be conducted on regular bases in order to equip ICU health care professionals with knowledge of ethics and skills of decision-making, an active ethics committee to be elected to assist ICU practitioners when they encounter ethically challenging situation. / NRF

<p>Uvod: Učestalost akutne renalne insuficijencije, odnosno akutnog bubrežnog o&scaron;tećenja u jedinicama intenzivnog lečenja se kreće od 36 do 66 %. Akutno bubrežno o&scaron;tećenje povi&scaron;ava smrtnost, trajanje hospitalizacije i ukupne tro&scaron;kove lečenja. Ranije prepoznavanje prediktivnih faktora za nastanak akutnog bubrežnog o&scaron;tećenja može da ima značajan uticaj na pravovremeno započinjanje terapijskih mera i smanjivanje mortaliteta kod kritično obolelih. Cilj istraživanja: Utvrditi incidencu akutnog bubrežnog o&scaron;tećenja na Odeljenju reanimacije Urgentnog centra Kliničkog centra Vojvodine tokom 2011.godine, učestalost sepse kao etiolo&scaron;kog faktora i značajne prediktivne faktore za nastanak akutnog bubrežnog o&scaron;tećenja koji se javljaju u toku prvih 24 časa lečenja na odeljenju intenzivnog lečenja. Metodologija: Retrospektivno-prospektivna opservaciona studija uključila je uzorak od 251 ispitanika koji su se lečili na dva odeljenja intenzivnog lečenja u Kliničkom centru Vojvodine tokom 2010, 2011, i prvih 6 meseci 2012.godine. Iz medicinske dokumentacije (istorije bolesti, dnevne terapijske liste i liste vitalnih i laboratorijskih parametara) za svakog ispitanika je verifikovano prisutvo ili odsustvo potencijalnog prediktivnog faktora. Zatim je zabeležena pojava akutnog bubrežnog o&scaron;tećenja prema RIFLE kriterijumima. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 20 Statistics. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost određivana je na nivou p&lt; 0,05. Prikupljeni podaci su obrađeni standardnim statističkim testovima. Za izvođenje modela predviđanja primenjena je multivarijatna logistička regresija. Određene su granične tačke na osnovu ROC analize za dobijene značajne prediktore iz multivarijacione logističke regresije i izračunati su pridruženi bodovi koji bi činili skoring sistem za utvrđivanje rizika od nastanka akutnog bubrežnog o&scaron;tećenja. Rezultati: Incidenca akutnog bubrežnog o&scaron;tećenja na Odeljenju reanimacije Urgentnog centra Kliničkog centra Vojvodine u Novom Sadu kod bolesnika koji su hospitalizovani najkraće 48 časova u toku 2011.godine je 32 %. Rezna tačka (cut off value) zapremine provocirane diureze jedan čas nakon intravenskog davanja bolusa furosemida od 0,165 ml/kg telesne mase/čas/po miligramu datog furosemida ima najvi&scaron;u senzitivnost (82,3 %) i specifičnost (67,5 %) u diferenciranju bolesnika koji će razviti ABO. Konačni model predloženog skoring sistema sa ulogom predikcije nastanka ABO nakon 24 časa lečenja bolesnika na odeljenju intenzivnog lečenja sadrži sledeće varijable: starost vi&scaron;u od 53 godine, vrednost APACHE skora vi&scaron;u od 16, prosečnu diurezu prvih 6 časova hospitalizacije nižu od 0,875 ml/kg/h, primenu vazopresora, kalijemiju vi&scaron;u od 4,5 mmol/l i koncentraciju laktata iznad 2 mmol/l. Zaključak: Incidenca akutnog bubrežnog o&scaron;tećenja na Odeljenju reanimacije Urgentnog centra Kliničkog centra Vojvodine je slična literaturnim podacima. Bolesnici koji su stariji, imaju vi&scaron;e vrednosti APACHE II skora, nižu prosečnu zapreminu diureze u toku prvih 6 časova po prijemu, koji primaju vazopresorne medikamente, imaju vi&scaron;u koncentraciju kalijuma i vi&scaron;e koncentracije laktata u toku prvih 24 časa lečenja imaju veću &scaron;ansu da razviju akutno bubrežno o&scaron;tećenje.</p> / <p>Introduction: The incidence of acute renal insufficiency (acute kidney injury) in intensive care unit is between 36 and 66 %. Acute kidney injury is responsible for higher mortality, longer hospitalization and higher costs. Earlier recognition of acute kidney injury predictive factors could have important impact on right timing of therapeutic measures and lower mortality in critically ill patients. Aims: investigate the incidence of acute kidney injury during 2011. in patients who are hospitalized at Department of reanimation of Emergency centre, Clinical centre of Vojvodina, incidence of acute kidney injury caused by sepsis in the same period and detect acute kidney injury occurrence predicitive factors Methodology: This retrospective-prospective observational study investigated 251 critically ill patients-study subjects who were treated at two intensive care departments in Clinical centre of Vojvodina during 2010, 2011 and first six months of 2012. Potential predictive factors were identified out of medical records (patient history, daily therapeutic lists, vital parameters and laboratory values lists); the occurrence of acute kidney injury was noted according to RIFLE criteria. IBM SPSS version 20 was used for statistical analysis, standard statystical test were applied. The results were presented in tables and graphs, statystical significance was set at p value of less than 0,05. Multivariate logistic regression model was used for potential predictive factors. Statystically important factors were identified and their best sensitivity and specificity cut-off values were found using ROC curve analysis.; These cut-off values were used for creating a scoring system that determines the risk for acute kidney injury occurrence. Results: The incidence of acute kidney injury at Department of reanimation, Clinical centre of Vojvodina in patients who were hospitalized at least 48 hours was 32 % during 2011. The cut off value of provoked hourly urine output during first hour after furosemide intravenous bolus of 0.165 ml/kg body weight/h/miligram of administered furosemide has the highest sensitivity (82.3 %) and specifity (67.5 %) in differentiation of patients who would develop acute kidney injury and those who would not. The final suggested model of scoring system with the role of acute kidney injury prediction after 24 hours of treatment contains the next variables: age higher than 53 years, APACHE II score higher than 16, avarage hourly urine output during first 6 hours after ICU admission less than 0,875 ml/kg BW/h, vasopressor medication administration, blood potassium concentration higher than 4,5 mmol/l, lactates higher than 2 mmol/l after 24 hours of treatment. Conclusion: The incidence of acute kidney injury at Department of reanimation of Emergency centre, Clinical centre of Vojvodina is similar to world literature references. Critically ill patients who are more likely to develop acute kidney injury are older, have higher APACHE II score values, lower avarage urine output in the first 6 hours after ICU admission, are administered vasopressor medication, have higher blood potassium and lactate concentration in the first 24 hours of their treatment.</p>

As of late 2019, the COVID-19 pandemic has been a challenge to health care systems worldwide. Rapidly rising local COVID-19 incidence rates, result in demand for high hospital and intensive care bed capacities on short notice. A detailed up-to-date regional surveillance of the dynamics of the pandemic, precise prediction of required inpatient capacities of care as well as a centralized coordination of the distribution of regional patient fluxes is needed to ensure optimal patient care. In March 2020, the German federal state of Saxony established three COVID-19 coordination centers located at each of its maximum care hospitals, namely the University Hospitals Dresden and Leipzig and the hospital Chemnitz. Each center has coordinated inpatient care facilities for the three regions East, Northwest and Southwest Saxony with 36, 18 and 29 hospital sites, respectively. Fed by daily data flows from local public health authorities capturing the dynamics of the pandemic as well as daily reports on regional inpatient care capacities, we established the information and prognosis tool DISPENSE. It provides a regional overview of the current pandemic situation combined with daily prognoses for up to seven days as well as outlooks for up to 14 days of bed requirements. The prognosis precision varies from 21% and 38% to 12% and 15% relative errors in normal ward and ICU bed demand, respectively, depending on the considered time period. The deployment of DISPENSE has had a major positive impact to stay alert for the second wave of the COVID-19 pandemic and to allocate resources as needed. The application of a mathematical model to forecast required bed capacities enabled concerted actions for patient allocation and strategic planning. The ad-hoc implementation of these tools substantiates the need of a detailed data basis that enables appropriate responses, both on regional scales in terms of clinic resource planning and on larger scales concerning political reactions to pandemic situations.

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Nurse managers are responsible to staff different hospital units and departments with sufficient, trained and experienced personnel. Most critical care units in the private healthcare in South Africa are staffed below maximum workload levels and additional staff is supplemented when needed. Current staffing management strategies comprises the application of the patient acuity score, the utilisation of contracted agency staff and ward staff who assist occasionally in the critical care unit (CCU). The aim of the study was to explore the experiences of critical care nurses regarding staffing management within critical care units in private health care institutions in the Western Cape. The following objectives were set to: - explore the experiences of CCNs regarding staffing management strategies such as o the patient acuity score o the employment of ad hoc agency staff and o the utilization of ward staff A descriptive design with a qualitative approach was applied. A sample size of n=15 was drawn from a total population of N=377, using purposive sampling technique. A pilot-test was also completed. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. All ethical principles were met. The findings of the study demonstrated that nurses perceive the workload in critical care units as heavy. The utilisation of the acuity score does not really assist in relieving the workload as managers tend not to consider the staffing requirements as predicted by the acuity score due to budget constraints. The enrolled nurses who assist occasionally in the critical care unit require supervision as well as ongoing development to ensure safe and quality patient care. Yet agency nurses were perceived as either extraordinary good or incompetent. / AFRIKAANSE OPSOMMING: Verpleegbestuurders het die verantwoordelik om verskillende hospitaaleenhede en departemente met voldoende opgeleide en ervare personeel te voorsien. Die meeste kritieke sorgeenhede in Suid-Afrika word met minder as dan die maksimum werkladingsvlak beman en addisionele personeel word aangevul wanneer nodig. Huidige personeelbestuurstrategieë behels die toepassing van die pasiënt akuïteit telling, die gebruik van ingekontrakteerde agentskap-personeel en saalpersoneel wat per geleentheid in die kritiekesorgeenheid help. Die doel van die studie was om die ervaringe van kritieke-sorgverpleegsters ten opsigte van personeel bestuur binne die kritiekesorgeenhede in die privaat gesondheidsorginstellings in die Weskaap, te ondersoek. Die volgende doelwitte is gestel: - Om die ervaringe van kritieke-sorgverpleegsters aangaande personeelbestuur-strategieë te ondersoek, soos: o die pasiënt akuïteit telling o die gebruik van agentskapverpleegpersoneel en o die gebruik van saal personeel, te ondersoek ’n Beskrywende kwalitatiewe studie is toegepas. ’n Steekproef van n=15 is uit ’n totale populasie van N=377 getrek deur die doelgerigte steekproeftegniek te gebruik. ’n Loodstoetsing van die semi-gestruktureerde vraelys is ook gedoen. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria vir geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. Daar is aan alle etiese vereistes voldoen. Die bevindings van die studie toon dat die verpleegpersoneel die werklading in die kritiekesorgeenheid as veeleisend ervaar. Die aanwending van die pasiënt akuïteit-telling dra nie werklik by tot verligting van die werklading nie, aangesien bestuurders weens begrotingsbeperkings neig om nie die personeelbenodigdhede soos deur die akuïteit-telling voorspel in ag neem nie. Die ingeskrewe verpleegsters wat per geleentheid in die kritieke-sorgeenheid hulp verleen, benodig toesig asook volgehoue ontwikkeling ten einde veilige en kwaliteit pasiëntsorg te verseker. Die agentskapverpleegpersoneel is egter as baie bekwaam of onbevoeg beskou.

Thesis (MScMedSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2007. / Noise is a noxious stimulus with possible negative physiological effects on the infant, especially in the Neonatal Intensive Care Unit (NICU). The present study conducted a detailed noise assessment in a NICU of a state hospital in the Cape Metropole and documented 6 infants’ physiological responses to noise levels. Noise levels ranged from 62.3-66.7dBA (LAeq), which exceed all American and British standards (50dBA -60dBA) for a NICU. Continuous exposure to noise of these levels is potentially harmful to the infants’ auditory system and health stability. The general well-being of the staff working in the NICU may also be compromised. Analysis of the noise events revealed that staff conversations were the largest single contributor to the number of noise events, while the largest single non-human contributor was the alarm noise of the monitors. No significant correlations were found between the heart rates and noise levels and the respiratory rates and the noise levels for any of the participants in either room. The NICU was found to be an extremely reverberant environment, which suggested that the NICU noise levels were largely a result of reverberant noise reinforcements. NICU nursing staff’s most common suggestion for noise abatement strategies was reduction of staff conversation. Results of this study highlight the need for NICU noise abatement to optimise newborn patient care, reduce the risk of acoustic trauma and to improve the neonate’s quality of life, thus enhancing the infant’s physiologic stability, growth and health.

<p>Увод: Објективна процена оперативног ризика кардиохируршких болесника и процена потребне постоперативне ангажованости медицинских сестара у јединици интензивног лечења могу допринети брзом увиду у тежину здравственог стања болесника , осигурању оптималног броја сестара, омогућавању квалитетне здравствене неге болесника, олакшању организације рада , аргументованом уговарању потреба за сестринским кадром. Најчешће коришћени физиолошки скорови, за процену обима ангажованости медицинских сестара су: Nine Equivalent of Nursing Use Manpower Score (NEMS)и Nursing Activities Score (NAS). Током 2010. године, за процену ризика у кардиохирургији, креиран је модел European System for Cardiac Operative Risk Evaluation (EuroSCORE II). Циљеви истрађивања: 1.Испитати повезаност EuroSCORE II, и активности медицинских сестара у јединици интензивног лечења. 2.Утврдити утицај релевантних фактора ризика из EuroSCORE II, на активности медицинских сестара у јединици интензивног лечења. 3.Испитати повезаност EuroSCORE II, и специфичних интервенција медицинских сестара јединице интензивног лечења. Методе:У студију je била укључена консекутивна серија од 809 болесника, оперисаних на Клиници за кардиоваскуларну хирургију Института за кардиоваскуларне болести, у периоду од 01.02. 2014-30.11.2014. године. Подаци о вредностима EuroSCORE II и релевантним факторима ризика преузети су болничког информационог система.Подаци о сестринским активностима у јединици интензивног лечења, након кардиохируршке интервенције, регистровани у одговарајућим листама. Испитивање повезаности нивоа оперативног ризика и активност медицинских сетра вршено је помоћу линеарне корелације. Утицај појединих фактора из модела EuroSCORE II на активност медицинских сестара испитиван је мултиваријантном линеарном регресијом. Зависност специфичних интервенција медицинских сестара од нивоа EuroSCORE II и других параметара оцењивана је помоћу бинарне логистичке регресије. Квалитет предиктивног модела, одређиван је помоћу ROC кривих, укључујући одређивање оптималног пресека, сензитивности и специфичности. Резултати: EuroSCORE II је у позитивној корелацији са укупним NEMS (r=0,207;p&lt;0,0005) и NAS (r=0,242;p&lt;0,005). Ослабљена функција бубрега, ослабљена систолна функција леве коморе и плућна хипертензија, повезани су са повећаним активностима медицинских сестара (p&lt;0,0005). EuroSCORE II и укупна ангажованост медицинских сестра били су у корелацији (r=0,098; p=0,005 за NEMS, односно r=0,100; p=0,004 за NAS). Mултиваријантна бинарна логистичка регресија показује да на повећани NAS утичу комбинована кардиохиршка процедура (p=0,005), претходне операције (p=0,009), oслабљена функција бубрега (p&lt;0,0005), NYHA класа (p=0,007) и плућна хипертензија (p &lt; 0,0005). Модел има добру моћ дискриминације односно, добар је маркер за разликовање болесника код којих се, после операције на срцу, очекује повећан укупан NAS (area=0,702, p&lt;0,0005). Прeсечна тачка (cut-off) је 23, сензитивност 0,624 а специфичност 0,688. Закључак: Постоји позитивна корелација између нивоа EuroSCORE II и укупне активности медицинских сестара у јединици интензивног лечења. Ослабљена функција бубрега, ослабљена систолна функција леве коморе и плућна хипертензија, повезани су са повећаним активностима медицинских сестара израженим помоћу NEMS и NAS. EuroSCORE II и збир специфичних интервенција, односно укупна ангажованост медицинских сестара и EuroSCORE II били су у корелацији. Могуће је направити Модел за предикцију вероватноће повећаног укупног ангажовања медицинских сестара у јединици интензивног лечења кардиохируршких болесника.</p> / <p>Uvod: Objektivna procena operativnog rizika kardiohirurških bolesnika i procena potrebne postoperativne angažovanosti medicinskih sestara u jedinici intenzivnog lečenja mogu doprineti brzom uvidu u težinu zdravstvenog stanja bolesnika , osiguranju optimalnog broja sestara, omogućavanju kvalitetne zdravstvene nege bolesnika, olakšanju organizacije rada , argumentovanom ugovaranju potreba za sestrinskim kadrom. Najčešće korišćeni fiziološki skorovi, za procenu obima angažovanosti medicinskih sestara su: Nine Equivalent of Nursing Use Manpower Score (NEMS)i Nursing Activities Score (NAS). Tokom 2010. godine, za procenu rizika u kardiohirurgiji, kreiran je model European System for Cardiac Operative Risk Evaluation (EuroSCORE II). Ciljevi istrađivanja: 1.Ispitati povezanost EuroSCORE II, i aktivnosti medicinskih sestara u jedinici intenzivnog lečenja. 2.Utvrditi uticaj relevantnih faktora rizika iz EuroSCORE II, na aktivnosti medicinskih sestara u jedinici intenzivnog lečenja. 3.Ispitati povezanost EuroSCORE II, i specifičnih intervencija medicinskih sestara jedinice intenzivnog lečenja. Metode:U studiju je bila uključena konsekutivna serija od 809 bolesnika, operisanih na Klinici za kardiovaskularnu hirurgiju Instituta za kardiovaskularne bolesti, u periodu od 01.02. 2014-30.11.2014. godine. Podaci o vrednostima EuroSCORE II i relevantnim faktorima rizika preuzeti su bolničkog informacionog sistema.Podaci o sestrinskim aktivnostima u jedinici intenzivnog lečenja, nakon kardiohirurške intervencije, registrovani u odgovarajućim listama. Ispitivanje povezanosti nivoa operativnog rizika i aktivnost medicinskih setra vršeno je pomoću linearne korelacije. Uticaj pojedinih faktora iz modela EuroSCORE II na aktivnost medicinskih sestara ispitivan je multivarijantnom linearnom regresijom. Zavisnost specifičnih intervencija medicinskih sestara od nivoa EuroSCORE II i drugih parametara ocenjivana je pomoću binarne logističke regresije. Kvalitet prediktivnog modela, određivan je pomoću ROC krivih, uključujući određivanje optimalnog preseka, senzitivnosti i specifičnosti. Rezultati: EuroSCORE II je u pozitivnoj korelaciji sa ukupnim NEMS (r=0,207;p&lt;0,0005) i NAS (r=0,242;p&lt;0,005). Oslabljena funkcija bubrega, oslabljena sistolna funkcija leve komore i plućna hipertenzija, povezani su sa povećanim aktivnostima medicinskih sestara (p&lt;0,0005). EuroSCORE II i ukupna angažovanost medicinskih sestra bili su u korelaciji (r=0,098; p=0,005 za NEMS, odnosno r=0,100; p=0,004 za NAS). Multivarijantna binarna logistička regresija pokazuje da na povećani NAS utiču kombinovana kardiohirška procedura (p=0,005), prethodne operacije (p=0,009), oslabljena funkcija bubrega (p&lt;0,0005), NYHA klasa (p=0,007) i plućna hipertenzija (p &lt; 0,0005). Model ima dobru moć diskriminacije odnosno, dobar je marker za razlikovanje bolesnika kod kojih se, posle operacije na srcu, očekuje povećan ukupan NAS (area=0,702, p&lt;0,0005). Presečna tačka (cut-off) je 23, senzitivnost 0,624 a specifičnost 0,688. Zaključak: Postoji pozitivna korelacija između nivoa EuroSCORE II i ukupne aktivnosti medicinskih sestara u jedinici intenzivnog lečenja. Oslabljena funkcija bubrega, oslabljena sistolna funkcija leve komore i plućna hipertenzija, povezani su sa povećanim aktivnostima medicinskih sestara izraženim pomoću NEMS i NAS. EuroSCORE II i zbir specifičnih intervencija, odnosno ukupna angažovanost medicinskih sestara i EuroSCORE II bili su u korelaciji. Moguće je napraviti Model za predikciju verovatnoće povećanog ukupnog angažovanja medicinskih sestara u jedinici intenzivnog lečenja kardiohirurških bolesnika.</p> / <p>Introduction: Objective assessment of operative risk of cardiac surgery patients and assessment of the necessary postoperative nursing engagement in the intensive care units can contribute to rapid insight into the health status of the patients, ensuring optimal number of nurses, enabling quality health care, facilitating the work organization, providing the basis for contracting adequate number of personnel. The most commonly used physiological scores for assessment of the extent of involvement of nurses are: Nine Equivalent of Nursing Manpower Use Score (NEMS) and the Nursing Activities Score (NAS). In 2010, risk assessment model for cardiac surgery was developed - European System for Cardiac Operative Risk Evaluation (EuroSCORE II). Objectives of the research: 1. To examine the relationship between EuroSCORE II and the activities of nurses in the intensive care unit. 2. To determine the influence of relevant risk factors of EuroSCORE II model, to the activities of nurses in the intensive care unit. 3. To examine the relationship between EuroSCORE II and specific nursing interventions in intensive care unit. Methods: The study included consecutive series of 809 patients surgically treated at the Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases in Sremska Kamenica, from 01:02. 2014 to 30.11.2014. Data on EuroSCORE II values and relevant risk factors were taken from the hospital information system. Nursing activities in the intensive care unit after cardiac surgery were registered using the relevant lists. Correlation between operative risk and activity of the nursing staff was performed using linear correlation. The influence of certain factors from the EuroSCORE II model to the activity of nurses was investigated by multivariate linear regression. Dependence of specific nursing interventions on the level of EuroSCORE II and other parameters was evaluated using binary logistic regression. Quality of the predictive model was determined using ROC curves, including the determination of the optimum cross-section of sensitivity and specificity. Results:The EuroSCORE II was positively correlated with the total NEMS (r= 0.207; p &lt;0.0005) and NAS (r=0.242; p&lt;0.005). Impaired renal function, impaired left ventricular systolic function and pulmonary hypertension, were associated with increased activity of nurses (p&lt;0.0005). EuroSCORE II and the total involvement of nurses were correlated (r=0.098; p=0.005 for NEMS, respectively r =0.100; p = 0.004 for the NAS). Multivariate binary logistic regression showed that there is influence on the increased NAS by the following factors: combined cardiac suregry (p=0.005), previous surgery (p=0.009), impaired renal function (p&lt;0.0005), NYHA class (p=0.007) and pulmonary hypertension (p&lt;0.0005). Model showed good discriminative power, and is a good marker for distinguishing patients in whom, following the heart surgery, increased overall NAS might be expected (area=0.702, p &lt;0.0005). Intersection point (cut-off) is 23, the sensitivity and specificity 0.624 0.688. Conclusion: There is a positive correlation between the level of EuroSCORE II and the entire work of nurses in the intensive care unit. Impaired renal function, impaired left ventricular systolic function and pulmonary hypertension, are associated with increased activity of nurses expressed using NEMS and NAS. EuroSCORE II and the sum of specific interventions, and the engagement of nurses and EuroSCORE II were correlated. It is possible to make a model to predict the probability of increased overall engagement of nurses in the cardiac surgery intensive care unit.</p>

O objetivo da Estratégia de Recrutamento Máximo (ERM) guiada pela TC de tórax é minimizar a quantidade de colapso alveolar e os mecanismos de lesão induzida pela ventilação mecânica (VILI). Os objetivos deste trabalho são comparar por meio da análise quantitativa das imagens obtidas pela TC durante ERM, em pacientes com SDRA, os seguintes parâmetros: colapso, hiperdistensão Tidal Recruitment (TR), Tidal Stretch (TS) e a distribuição de ar nos pulmões Métodos - Doze pacientes foram transportados para a sala de TC e seqüências de imagens foram obtidas durante a pausa expiratória e inspiratória ao longo da ERM. A ERM consistiu em ventilação modo Pressão Controlada com diferencial fixo de pressão 15 cmH2O e elevações progressivas da PEEP de 10 - 45 cmH2O (fase de recrutamento) e titulação da PEEP (25 - 10 cmH2O) FR=10 - 15 irpm, relação I:E 1:1 e FiO2 1.0. Os pulmões foram divididos em quatro regiões de acordo com o eixo esterno - vertebral (1 anterior e 4 posterior) Resultados - A idade media da população estudada foi de 46 ± 20,5 anos e cerca de 92% dos pacientes tinham SDRA de origem primária. Com o objetivo de manter o recrutamento alcançado pela ERM foram necessários níveis elevados de PEEP média de 23,7 ± 2,3 cmH2O. A relação PaO2/FiO2 aumentou de 131,6 ± 37,6 para 335,9±58,7 (p<0,01) após a titulação da PEEP. A quantidade de colapso global diminuiu de 54 ± 8% (P10pré) para 4,8 ± 6% (P45) (p<0,01), e em P25pós foi mantido em níveis baixos 6,7 ± 6% (p=1,0). Em relação ao TR global, diminuiu de P10pre (4 ± 4%) para P45 (1 ± 1%) (p=0,029), e também foi mantido em níveis baixos após a titulação da PEEP em P25pós (p=1,0). Quanto à hiperdistensão, houve aumento estatisticamente significativo entre P10pré e P45 (p=0,032), embora em termos absolutos este aumento foi inferior a 5%. A comparação entre P25pré e P25pós revelou que não houve diferença entre eles (p=1,0). Não houve aumento do Tidal Hyperinflation entre P10pré e P45 (p=0,95). O Tidal Stretch também diminuiu durante a ERM e foi mantido em níveis baixos em P25pós, semelhantes aos observados em P45. Em P10pre durante pausa expiratória, quase 80% do ar se localizava distribuído na metade anterior dos pulmões. Durante ERM a distribuição de ar foi progressivamente em direção à metade posterior, até que em P25pós atingiu quase 40% (p<0,01). Discussão - A análise tomográfica detalhada destes 12 pacientes portadores de SDRA apresentou como principais resultados que a Estratégia de Recrutamento Máximo guiada por TC de tórax reduziu de forma significativa a quantidade de colapso pulmonar global, de Tidal Recruitment, de Tidal Stretch sem, no entanto, intensificar significativamente a geração de hiperdistensão. Foram necessários níveis elevados de PEEP (cerca de 25 cmH2O em média) para a manutenção do recrutamento adquirido e para garantir distribuição mais homogênea do ar nos pulmões. A elevação da PEEP de 10 cmH2O pra 20 cmH2O, sem a realização de manobra de recrutamento, pode exacerbar os mecanismos de VILI ao invés de diminuí-los. A ERM não promove aumento relevante da hiperdistensão, frente à imensa contribuição na redução do colapso e dos outros mecanismos de VILI. Conclusões - A ERM e titulação da PEEP guiados pela TC de tórax diminuiu significativamente a quantidade de colapso pulmonar, Tidal Recruitment e Tidal Stretch, sem no entanto, aumentar significativamente a hiperdistensão. A ERM também promoveu distribuição de ar mais homogênea no parênquima pulmonar. / The goal of Maximal Recruitment Strategy (MRS) guided by thoracic CT scan is to minimize alveolar collapse and the mechanisms of ventilator induced lung injury (VILI). The objectives of this study were to compare by quantitative analyzes of CT scan image of the lungs obtained during MRS of patients with ARDS, the following parameters: collapse, overdistension, Tidal Recruitment (TR), Tidal Stretch (TS) and the gas distribution throughout the lungs. Methods - Twelve patients were transported to the CT room and sequences of CT scan at expiratory and inspiratory pauses were performed during MRS. MRS consisted of 2 min steps of tidal ventilation with fixed deltaPCV=15 cmH2O and progressive increments in PEEP levels (recruitment 10 - 45 cmH2O) and PEEP titration (25 - 10 cmH2O). RR=10 - 15 bpm, I:E ratio 1:1, and FiO2 1.0. The lungs were divided in 4 regions according to the sternum-vertebral axis (1 anterior and 4 posterior). Results - The mean age of the studied population was 46 ± 20,5 y.o., and 92% of the patients ad primary ARDS. In order to sustain recruitment obtained by MRS, mean PEEP levels of 23,7 ± 2,3 cmH2O were necessary and PaO2/FiO2 ratio increased from 131,6 ± 37,6 to 335,9±58,7 (p<0,01) after MRS and PEEP titration. Global collapse decreased from 54 ± 8% (P10pre) to 4,8 ± 6% (P45) (p<0,01), and was sustained at similar levels at P25post 6,7 ± 6% (p=1,0). Global TR also decreased from P10pre (4 ± 4%) to P45 (1 ± 1%) (p=0,029), and was sustained with the same levels at P25post (p=1,0). Regarding overdistension there was statistically significant increment from P10pre to P45 (p=0,032), although in absolute terms the increment was very low < 5%, and P25pre and P25post were identical (p=1,0). There was no increment of Tidal Hyperinflation from P10pre to P45 (p=0,95). TS also decrease during MRS and was maintained at low levels similar to P45 at titrated PEEP (P25post). At P10pre almost 80% of the air at FRC was located at anterior regions. During MRS the distribution of air was directed towards the posterior regions and at P25post was almost 40% (p<0,01). Discussion - The tomographic analysis revealed that during MRS there was a significantly reduction of pulmonary collapse, Tidal Recruitment and Tidal Stretch, without increasing significantly overdistension. High levels of PEEP were necessary to sustain recruitment obtained during MRS and homogeneous gas distribution throughout the lung parenchyma. When PEEP was increased from P10pre to P20pre there was an increment in TR and TS, without a significantly reduction in absolute mass of collapsed lung, suggesting that it may exacerbate the mechanisms of VILI. MRS does not promote relevant overdistention when balanced by its effects on reduction of the mechanisms of VILI. Conclusions - MRS and PEEP titration guided by CT scan decreased significantly lung collapse, Tidal Recruitment and Tidal Stretch, without increasing significantly overdistension. MRS also promoted a homogeneous gas distribution throughout the lung parenchyma.