Bakgrund: När ett barn blir kritiskt sjukt och behöver intensivvård kan det innebära enorma kroppsliga och mentala påfrestningar för föräldrarna. Föräldrarna har oftast en central roll i barnets vård och tillfrisknande, men kan uppleva besvär med att få sina personliga behov uppfyllda under barnets vårdtid. Syfte: Beskriva föräldrars uttryckta behov av stöd från sjuksköterskor när deras barn vårdas på BIVA. Metod: Litteraturöversikt med analys av kvalitativ data. Resultat: Fem kategorier presenteras i studien; stöd i form av begriplig information, stöd till att bevara föräldrarollen, stöd i form av tillit till sjuksköterskor, stöd till kroppsligt välbefinnande samt emotionellt stöd. Slutsats: Föräldrar kan uppleva en förlorad känsla av kontroll när barnet vårdas på BIVA. Tankar och känslor, så som osäkerhet gällande barnets överlevnad, kan hindra dem från att ta hand om sig själva vilket i sin tur kan leda till utmattning. Information, delaktighet och goda relationer till sjuksköterskor uttrycks främja föräldrarnas välbefinnande, känsla av kontroll och trygghet. Klinisk betydelse: Resultatet i studien skulle kunna bidra till hur sjuksköterskor kan stödja och hjälpa föräldrar till sjuka barn. Resultatet skulle även kunna bidra till diskussion och reflektion över attityder och förhållningssätt inom hälso- och sjukvården när det kommer till föräldrars roll och välmående i vården av sjuka barn. / Background: When a child becomes critically ill and needs intensive care, it can involve enormous bodily and mental strain for parents. Parents often have a central role in the child's care and recovery, but can experience trouble with getting their personal needs met during the child's hospital stay. Aim: Describe parents expressed needs of support from nurses when their child is cared for in the PICU. Method: Literature review, analyzing qualitative data. Results: Five categories is presented in this study; support in the form of understandable information, support to preserve the parental role, support in the form of trust in nurses, support for bodily well-being and emotional support. Conclusion: Parents can experience a loss of control when the child is cared for in the PICU. Thoughts and feelings, such as uncertainty regarding the child's survival, can prevent them from taking care of themselves which can lead to exhaustion. Information, participation and trusting relationships with nurses can promote parents well-being, feelings of control and security. Clinical significance: The results of this study could contribute to how nurses can support and help parents of ill children. The results could also contribute to the discussion and reflection on the attitudes of health care when it comes to the role and well-being of parents in the care of ill children.

The main objective of this thesis is to contribute to the prevention and control of the cardiovascular risk, hydration state and nutritional state in dialysis patients using non-invasive electrical impedance measurements. The thesis is structured in three parts with the following objectives: 1) to establish electrical impedance reference data for healthy Cuban population, 2)to improve the diagnostic based on impedance methods in Cuban hemodialysis (HD)patients and 3) to develop the impedance methods for continuous ambulatory peritoneal dialysis patients (CAPD).Healthy population: We analyzed the impedance vector distribution using the Bioimpedance Vector Analysis (BIVA) for the three more representative race-ethnicities in Cuba. We measured 1196 healthy adult (689 M, 507 W, 18-70 yr). The 95% confidence ellipses were drawn using specific BIVA software for mean vectors of different races. Due to the close distribution of mean vectors that we found for the three race-ethnicities, we concluded that only one set of sex-specific tolerance ellipses can be used for the Cuban population.HD patients: The BIVA method was used in a sample of 74 HD patients in stable (without edema) and critical (hyper-hydrated and malnutrition) states in order to establish the relation between hyper-hydration and mortality. Stable group include 48 patients (28 M and 18 W), and critical group include 28 critical patients (16 M and 12 W). Student's t test and Hotelling's T2 test were used to analyse the separation of groups obtained by means of clinical diagnosis and those obtained by BIVA. A statistically significant difference was obtained (P < 0.05) in R/H, Xc/H and phase angle, PA. Critical patients (hyper-hydrated and malnutrition) were located below the inferior pole of the 75% tolerance ellipse, with PA lower than 4º. In conclusion, the BIVA method could be used to detect hyper-hydration state before edema appears, and to predict survival through PA. Advantages of the method are its simplicity, objectivity and that it does not require the definition of a patient dry weight.CAPD patients: Segmental impedance measurements were obtained using 9 configurations (7 longitudinal and 2 transversal) in 25 CAPD male patients.In a first study we analyzed Z, Z/H and ZBMI indexes. 23 male patients were classified according to the hydration state as normo-hydrated, group 0 (10 M) or hyper-hydrated, group 1 (13 M). Wilcoxon test was used to analyze the change in impedance produced by a PD session. Mann-Whitney U test was used to analyse the separation between groups obtained by means of clinical diagnosis and those obtained by Z, Z/H or ZBMI. Spearman correlation was used to study the correlation between impedance vectors in each segment and clinical assessment. Statistical significance was set at P < 0.05. Results show that ZBMI gives information about the specific resistivity of tissues and not about fluid and fat mass changes. BIVA separate hyper-hydrated and normo-hydrated patients. Transversal measurements in the leg region and longitudinal in the thorax region are useful to corroborate the hydration and nutritional state in CAPD patients.In a second study a new classification was performed. Group 0 has normo-hydrated patients (10 M) and group 1 includes patients (15 M) with varying degrees of hypertension, overhydration and high score on cardiovascular risk factors. Mann-Whitney U-test was used to compare the differences in clinical measurements, laboratory test, and bioimpedance measurements between groups. The Mahalanobis Distance (dM2) was calculated using a bidimensional space, using the resistance measurement, right-side (RRS/H) or thorax segment (RTH/H) and the BPmean. Hotelling's T2 test was used to analyzed difference between groups through (RTH/H, BPmean) and (RRS/H, BPmean) vectors. A statistically significant difference was obtained (P < 0.05) in both vectors. Group 1 showed a small dM2 with respect to a reference patient (a critical patient with acute lung oedema) with high BPmean and low values of RTH/H and RRS/H. Moreover, Group 0 showed a larger dM2 with respect to the reference patient with lower BPmean and higher values of RTH/H and RRS/H. All patients classified as hyper-hydrated leading to hypertension by clinical assessment were correctly classified using dM2(RTH/H, BPmean). We conclude that segmental bioimpedance of the thoracic region could be a simple, objective, non-invasive method of support to facilitate the clinical assessment in CAPD.

Made available in DSpace on 2014-12-17T14:14:03Z (GMT). No. of bitstreams: 1 MarciaMGD_DISSERT.pdf: 1438111 bytes, checksum: a8bce84fa0c49b4b1c4cc29044e690cf (MD5) Previous issue date: 2013-10-11 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / A preval?ncia de desequil?brio do estado nutricional tem aumentado em crian?as e adolescentes nos pa?ses desenvolvidos e em desenvolvimento, abrangendo tamb?m defici?ncias de vitaminas e minerais essenciais. Este fato tem gerado muitos dist?rbios nutricionais, comprometendo significativamente o crescimento e desenvolvimento deste grupo. A avalia??o nutricional ? importante para monitorar a sa?de e estado nutricional de crian?as saud?veis ou doentes. Existem muitos m?todos de avalia??o nutricional, por?m a maioria possui limita??es. A BIVA baseia-se exclusivamente nas propriedades el?tricas dos tecidos. A combina??o de mudan?as tanto na hidrata??o do tecido quanto na estrutura pode ser monitorizado atrav?s da BIVA, pois ambos os componentes do vector de imped?ncia s?o considerados simultaneamente e a composi??o corporal pode ser interpretada. Esta pesquisa caracterizou-se como um ensaio randomizado controlado, triplo-cego. O objetivo deste estudo foi utilizar, ineditamente, o vetor de imped?ncia bioel?trico para avaliar o estado nutricional de crian?as pr?-p?beres suplementadas com zinco, a fim de detectar poss?veis altera??es na composi??o corporal. As 60 crian?as saud?veis e eutr?ficas, idades entre 8 e 9 anos, foram divididas em grupo controle (sorbitol 10%) e grupo experimental (10 mg Zn/dia) e suplementadas durante 3 meses . A avalia??o antropom?trica foi realizada em todas as crian?as. O zinco s?rico foi medido por espectrofotometria de absor??o at?mica e a composi??o corporal pela BIVA software 2002 usando os testes T2 de Hotelling. O IMC para a idade aumentou ap?s a suplementa??o oral de zinco no grupo experimental (p < 0.005). A BIVA detectou aumento da massa magra no grupo experimental (p < 0.001). Al?m disso, quando comparamos este efeito entre os grupos, a BIVA n?o mostrou diferen?a entre os grupos experimental e controle. Em conclus?o, ap?s an?lises das elipses pela BIVA observamos que este m?todo pode detectar melhoria da composi??o corporal em crian?as saud?veis suplementadas com zinco. Estes resultados sugerem que a BIVA ? um bom m?todo para estudar uma pequena popula??o sob interven??o do zinco. No entanto, estudos adicionais s?o necess?rios envolvendo outras popula??es, incluindo dose farmacol?gica de zinco

Införandet av en mobil intensivvårdsgrupp (MIG) har visat sig ha goda resultat utomlands med minskade andningsstopp och mortalitet inom pediatrisk vård. Vid Astrid Lindgrens Barnsjukhus i Solna, Sverige (ALB) finns långt framskridna planer på att starta en MIG-verksamhet. Syftet med denna studie var att beskriva pediatriska patienter som faller in under potentiella MIG-kriterier innan inläggning på barnintensivvårdsavdelningen/barnintermediäravdelningen (BIVA/BIMA) på ALB. Studien gjordes retrospektivt genom journalgranskning av inskrivna pediatriska patienter på BIVA/BIMA under 2009. Totalt inkluderades 148 pediatriska patienter i åldern 0-18 år i studien. Resultat visade att Andningsbesvär var den vanligaste inskrivningsorsaken och att Andning var den vanligast förekommande kontaktorsaken. Provtagning var den mest förekommande åtgärden som utfördes på akutmottagningen/vårdavdelningen innan förflyttning till BIVA/BIMA. Slutsatsen blev att det skulle kunna finnas cirka 300 pediatriska patienter per år på ALB som skulle kunna vara aktuella för MIG-uppdrag. Det är en klar indikation för att starta en MIG-verksamhet på ALB för att minska inläggningar på BIVA/BIMA samt identifiera dessa pediatriska patienter i ett tidigt skede innan akut försämring. / The implementation of Pediatric Medical Emergency Team (PMET) has proven to reduce respiratory arrest and mortality in Pediatric hospitals worldwide. At Astrid Lindgrens Barnsjukhus in Solna, Sweden (ALB) there are advanced plans to start a PMET. The aim of this study was to describe pediatric patients that met potential PMET-criteria before being admitted to pediatric intensive care unit/high demand unit (PICU/HDU) at ALB. The study was a retrospective chart review of admitted pediatric patients at PICU/HDU during 2009. Totally 148 pediatric patients between the age of 0 to 18 years were included in the study. The result showed that respiratory problems were the most common reason for being admitted to the hospital and problems with breathing was the most frequent PMET-criteria. Before the patient moved to the PICU/HDU the most common intervention performed in the emergency department/wards was sample-taking. The conclusion was that around 300 pediatric patients a year could benefit from a PMET at ALB. That is a clear indication that a PMET should be started at ALB to reduce admitted patients to PICU/HDU and identify the patients at risk for acute worsening.

Bakgrund: Intuberade patienter inom intensivvården har en hög risk för att erhålla en ventilator-associerad pneumoni (VAP). Det finns evidensbaserade riktlinjer för vuxna somförebygger VAP. För barn behövs det däremot mer forskning för att klargöra vilka omvårdnadsåtgärder som kan standardiseras. Syfte: Syftet är att beskriva vilka omvårdnadsåtgärder som förebygger VAP hos barn inom intensivvården, en litteraturöversikt. Metod: En deskriptiv litteraturstudie med kvantitativ induktiv ansats valdes. 16 kvantitativa studier analyserades med en innehållsanalys. Det samlade materialet kvalitetsgranskades med hjälp av GRADE. Resultat: Fem huvudteman identifierades utifrån studiernas resultat. Huvudteman var VAP-omvårdnadspaket, munvård med klorhexidin, skötsel av endotrakealtub, olika nutritionssonder, omvårdnadsutbildning. VAP-omvårdnadspaket och omvårdnadsutbildning visade sig statistiskt signifikant sänka VAP-prevalensen hos barn. Munvård med klorhexidin kunde inte sänka VAP-prevalensen. Slutsats: Med rätt evidensbaserad vård kan VAP-prevalensen sänkas. Forskning kring VAP-prevention till barn saknar evidens i nuläget och kan ej anses vara evidensbaserad vård. För att göra vården evidensbaserad, rekommenderas att globala riktlinjer för VAP-prevention till barn tas fram. / Background: Intubated patients admitted to an intensive care unit have a higher risk ofacquiring ventilator-associated pneumonia (VAP). There are evidence-based guidelines for adults that prevent VAP. For children there is a need for more research in this area to clarifywhich nursing methods can be standardized. Aim: The aim was to describe which nursing care measures prevent VAP in children admitted to the intensive care unit, a literature review. Method: A descriptive literature study with a quantitative inductive approach was used. A total of 16 quantitative studies was analysed with a content analysis. A GRADE system was used to assess the quality of the included studies. Results: Five main themes were identified from the study’s results. The main themes where VAP-care bundles, oral care with chlorhexidine, care of endotracheal tube, different nutritional catheters, and nursing care education. VAP-care bundles and nursing care education showed to have statistically and significantly lowered the prevalence of VAP in children. Oral care with Chlorhexidine did not lower the prevalence significantly of VAP. Conclusion: The prevalence of VAP can be lowered with the right evidence-based practice. At the current situation research on preventing VAP in children lack evidence and can’t be considered as evidence-based practice. To make the nursing care evidence based, it´s recommended to create global guidelines of VAP-prevention for children.