俯卧位护理与不良事件的发生：严重 SARS-CoV-2 肺部感染机械通气患者的特征。
Nursing care and prevalence of adverse events in prone position: Characteristics of mechanically ventilated patients with severe SARS-CoV-2 pulmonary infection.
机构信息
Intensive Care Unit, La Princesa University Hospital, Madrid, Spain.
Faculty of Nursing, Universidad de Castilla-La Mancha, Cuenca, Spain.
出版信息
Nurs Crit Care. 2022 Jul;27(4):493-500. doi: 10.1111/nicc.12606. Epub 2021 Mar 16.
BACKGROUND
Because of the coronavirus disease 2019 (COVID-19) pandemic, the use of prone positioning has dramatically increased in the intensive care unit (ICU). Because this manoeuvre is related to several complications, it must be performed in a protocolized manner by the appropriate personnel.
AIM
To determine the prevalence of adverse events (AEs) in patients admitted to the ICU with a diagnosis of COVID-19-related acute respiratory distress syndrome (C-ARDS) undergoing mechanical ventilation in prone position (PP).
DESIGN
Descriptive ambispective study of patients admitted to the ICU diagnosed with C-ARDS undergoing mechanical ventilation who were in the PP at least once. The number of PP manoeuvres and the time spent in the PP were recorded for each subject. AEs proportions and frequencies were calculated, and analysis of variance was used to assess mean differences in the number of manoeuvres and total hours in PP stratified by the number of facial pressure ulcers. IBM SPSS Statistics v.25.0. and EPIDAT 4.1 software were used.
RESULTS
Forty-four patients were analysed, and 130 PP manoeuvres were performed. The most frequently observed AEs were facial oedema in 26 patients (80.3%) and facial pressure ulcers in 20 (60.6%). There was a significant positive association between the time spent in PP and the development of facial pressure ulcers (P < .001). Enteral nutrition was well tolerated, and no serious AEs or sentinel events were noted.
CONCLUSION
Despite the stressful, demanding situation during the peak of the pandemic, the large number of PP manoeuvres, and long duration spent in this position, no serious AEs occurred. This study highlights the need to implement preventive measures to avoid the development of pressure ulcers secondary to prone positioning.
RELEVANCE TO PRACTICE
Prone positioning requires a nursing protocol to prevent the occurrence of AEs that may reduce the quality of nursing care.
背景
由于 2019 年冠状病毒病（COVID-19）大流行，重症监护病房（ICU）中俯卧位的使用急剧增加。由于这种操作与多种并发症有关，因此必须由适当的人员按照协议进行。
目的
确定患有 COVID-19 相关急性呼吸窘迫综合征（C-ARDS）并接受机械通气的 ICU 患者的患病率，这些患者在接受俯卧位（PP）通气。
设计
对至少接受过一次机械通气的 COVID-19 相关急性呼吸窘迫综合征患者进行描述性前瞻性研究，这些患者接受俯卧位通气。为每个患者记录俯卧位的次数和时间。计算不良事件（AE）的比例和频率，并使用方差分析评估根据面部压疮数量分层的操作次数和总俯卧位时间的平均差异。使用 IBM SPSS Statistics v.25.0 和 EPIDAT 4.1 软件。
结果
分析了 44 例患者，共进行了 130 次俯卧位通气操作。最常观察到的不良事件是 26 例患者（80.3%）的面部水肿和 20 例患者（60.6%）的面部压疮。俯卧位时间与面部压疮的发生呈显著正相关（P < 0.001）。肠内营养耐受良好，未发生严重不良事件或警戒事件。
结论
尽管在大流行高峰期面临紧张、高要求的情况，俯卧位通气操作次数多，持续时间长，但未发生严重不良事件。本研究强调需要实施预防措施，以避免因俯卧位导致的压疮发生。
实践相关性
俯卧位需要护理协议，以防止发生可能降低护理质量的不良事件。
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