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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Intensivvårdssjuksköterskans upplevelser av urträningsprocessen vid respiratorbehandling av patienter med Covid-19 : En intervjustudie med kvalitativ ansats

Hed, Anna, Svensson, Emelie January 2022 (has links)
Bakgrund: Under året 2020 spreds Covid 19-viruset och en global pandemi bröt ut. Patienterna som vårdades på intensivvårdsavdelningar hade symtom i form av respiratorisk insufficiens och vårdades i respirator. Intensivvårdssjuksköterskorna ställdes inför en ny patientkategori med avvikande symtom och reaktioner på behandling. Att träna ur patienter från respirator är en tidskrävande process som kräver förberedelser och planering. Hänsyn ska tas till flera faktorer, både fysiska, psykiska och miljömässiga. Syfte: Syftet var att beskriva intensivvårdssjuksköterskors upplevelser av urträningsprocessen vid respiratorbehandling av patienter med Covid-19.Metod: En intervjustudie med kvalitativ ansats gjordes och författarna analyserade materialet genom kvalitativ innehållsanalys. Totalt medverkade 10 intensivvårdssjuksköterskor i studien. Huvudresultat: Huvudkategorierna som framkom ur resultatet var ”intensivvårdssjuksköterskans nya erfarenheter och utmaningar under urträningsprocessen” ” Det kollegiala stödet är viktigt” samt ”behov av tydligare struktur för personalen under urträningsprocessen”. Det essentiella som identifierades var intensivvårds-sjuksköterskornas upplevelse av att arbeta med en ny och dittills okänd patientkategori, de upplevde det som en utmaning både yrkesmässigt och känslomässigt. De emotionella känslorna som intensivvårds-sjuksköterskan upplevde att hon ställdes inför var uppgivenhet, meningsfullhet, tålamodsprövning och svårigheten av att se patienterna lida av ångest. Det kollegiala stödet var betydelsefullt under den här perioden men bristen på fysioterapeuter, riktlinjer och kontinuitet identifierades.Slutsats: Att inte kunna förlita sig på sin tidigare kunskap gällande patientens vård upplevdes som frustrerande och osäkert eftersom Covid-19 är och var en ny sjukdom. Genom att utarbeta riktlinjer, upprätthålla en god kollegial stämning, skapa högre tillgänglighet av fysioterapeuter samt att vårdarbetet genomsyras av kontinuitet så kan patientsäkerheten öka, arbetsmiljön optimeras och intensivvårdssjuksköterskan kan känna en högre grad av säkerhet i sitt arbete. Det identifierades både organisatoriska och patientrelaterade faktorer som eventuellt kan ha påverkat längden på urträningsprocessen från respirator. / Background: During 2020, COVID-19 spread across the globe resulting in a pandemic. Patients that required intensive care suffered from respiratory insufficiency and were put on mechanical ventilation support. Intensive care unit (ICU) nurses were exposed to a new category of patients with unfamiliar symptoms and unpredictable reactions to treatment. Weaning patients from mechanical ventilation is a time consuming process that requires preparation and planning. Consideration needs to be taken to both physiological and psychological factors. Aim: To describe the ICU nurses´experiences on weaning patients with Covid-19 from mechanical ventilation. Method: An interview study with qualitative approach was used and the authors analyzed the material through context analysis. A total of 10 ICU nurses participated in the study. Results: The Category that appeared from the result was ”ICU nurses new experience and challengesin the weaningprocess” “The collaboration with the teams is important” and “ The need for better structure under the weaningprocess”. The essential that was identified was the ICU nurses´experience from working with a new and until then unknowncategory of patients, they experienced it as a challenge, both professional and emotional. Emotions that the ICU nurses´felt was a feeling of resignation, meaningfullness, patience testing and the struggle of seeing patients with anxiety. The support from colleagues was signficant under this period but the lack of physiotherapists, guidelines and need of continuity in the care for the patients was identified. Conclusion: To not be able to rely on ones previous knowledge about patients caregiving was frustrating and uncerting because the Covid 19 was a new type of disease. By developing guidelines, maintaining good teamwork, create a higher availability of physiotherapists and to let the caregiving of patients contain continuitycan the patient safety be increased, the working evironment can be optimized and the ICU nurse can feel a higher experience of surety in her work. It was identified that the organizational and patient related factors could have prolonged the weaning process from mechanical ventilation.
2

Asynchronies patient-ventilateur au cours de la ventilation assistée / Patient-ventilator asynchrony during mechanical ventilation

Thille, Arnaud 23 November 2010 (has links)
Des asynchronies patient-ventilateur sont fréquemment observées en ventilation assistée. Objectif : Déterminer l'incidence et les facteurs favorisants des asynchronies, venant du patient, du ventilateur ou des réglages, et préciser le réglage optimal du ventilateur. Méthodes : Nous avons évalué l'incidence des asynchronies avec une méthode simple et non invasive basée sur l'analyse des courbes du ventilateur. Chez les patients qui présentaient des efforts inefficaces, nous avons mesuré l'effort inspiratoire avec une sonde œsophagienne afin d'optimiser le réglage du ventilateur. Nous avons évalué l'impact du mode ventilatoire sur la qualité du sommeil avec une polysomnographie complète. Enfin, tous les ventilateurs de réanimation ont été testés sur banc afin de comparer les performances en termes de trigger et pressurisation. Résultats : Près d'un quart des patients présentaient des asynchronies fréquentes. La durée de ventilation de ces patients était plus longue et le sevrage plus difficile. Les efforts inefficaces, qui représentaient les asynchronies les plus fréquentes, étaient favorisés par une assistance ventilatoire excessive. La réduction du niveau d'aide inspiratoire (AI) permettait d'éliminer quasi-complètement les efforts inefficaces, sans augmenter l'effort inspiratoire et sans modifier la vraie fréquence respiratoire du patient. Le mode ventilatoire n'avait pas d'influence sur la qualité du sommeil et les asynchronies. Les efforts inefficaces survenaient aussi bien en AI qu'en ventilation assistée contrôlée. Avec un niveau d'AI adéquat, les apnées centrales étaient peu nombreuses et n'avaient pas d'influence sur la qualité du sommeil. Les performances insuffisantes observées avec certains ventilateurs peuvent également altérer la synchronisation. Conclusion : Les asynchronies patient-ventilateur sont fréquentes et associées à une durée de ventilation prolongée. Une « dose de ventilation » excessive favorise les efforts inefficaces, mais un réglage optimal du ventilateur permet de minimiser ces asynchronies. Cette thèse est un support pour déterminer dans une étude plus large si une synchronisation adéquate peut réduire la durée de ventilation. / Major patient-ventilator asynchrony seems common on ventilator screen during assisted mechanical ventilation. Objectives: To evaluate the incidence of major asynchrony and to identify factors related to patient's characteristics and ventilator parameters associated with asynchrony, and to determine optimal ventilator adjustments. Methods: We evaluated the incidence of major patterns of asynchrony easily detected using a noninvasive method based on flow and airway pressure curves. In patients with frequent ineffective efforts we measured patient's effort using esophageal pressure measurements to optimize ventilatory settings. We evaluated the impact of ventilatory mode on sleep quality using a complete polysomnography. All intensive-care-unit ventilators were compared on a bench test in terms of trigger performance and pressurization capacity. Results: One-fourth of intubated patients exhibited major asynchrony. Duration of mechanical ventilation was longer and weaning more difficult in patients with asynchrony as compared to patients without asynchrony. Ineffective triggering was the main pattern of asynchrony and was promoted by excessive ventilatory assistance. Reducing the pressure-support completely eliminated ineffective efforts in most of patients, without inducing excessive respiratory muscle effort and without modifying the true patient's respiratory rate. Ventilatory mode did not influence sleep quality and asynchrony. Ineffective efforts were detected during both pressure-support ventilation and assist-control ventilation, and central apneas were not common using adequate level of pressure-support. Some ventilators exhibited poor performances which could promote patient-ventilator asynchrony. Conclusion: Patient-ventilator asynchrony is frequent during assisted ventilation and associated with prolonged duration of mechanical ventilation. Excessive ventilatory support could promote ineffective efforts although optimal ventilatory settings could minimize asynchrony. This work is a starting point to determine in a large study, whether optimization of ventilatory settings could shorten duration of mechanical ventilation.

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