Fu Yali, Li Xiaoqin, Yu Youxia, Li Renfeng, Shi Tian
Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Nursing, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Transl Pediatr. 2024 Feb 29;13(2):224-235. doi: 10.21037/tp-23-465. Epub 2024 Feb 26.
Due to immaturity, the nose of preterm infants can easily be injured, by even a short application of a nasal device. However, 20% to 60% of preterm infants suffer nasal damage while using nasal continuous positive airway pressure (NCPAP) due to weak skin tissue, prolonged use of nasal device, and improper nursing practices, leading to increased risk of infection and decreased compliance and tolerance. In this study, we retrieved, obtained and integrated the related evidences of prevention of nasal injury in premature infants with nasal noninvasive ventilation to provide reference for clinical practice.
We searched the relevant guidelines, expert consensus, evidence summaries and systematic reviews in the databases and guideline websites of the National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), the Agency for Health care Research and Quality (AHRQ), Guidelines International Network (GIN), the World Health Organization (WHO) guideline websites, Registered Nurses' Association of Ontario (RANO), Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), European Pressure Ulcer Advisory Panel (EPUAP), Yi Maitong, British Medical Journal best-practice, Cochrane Library, UpToDate, Embase, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang. The search was limited to the time of library establishment to February 2023.
In total, 16 articles were included, including six guidelines, three expert consensuses, two evidence summaries and five systematic reviews. Twenty-eight pieces of evidence were summarized from six aspects: risk assessment, ventilation and connection, skin protection, skin assessment, training and support, and continuous quality improvement.
This study summarized the best evidence for the prevention of nasal injury in premature infants through nasal noninvasive ventilation. It is suggested that nurses should consider the actual clinical situation when applying the suggestions from the evidence, formulate corresponding nursing measures, and reduce the occurrence of nasal injury in premature infants.
由于早产儿身体发育不成熟，即使短时间使用鼻用器械也很容易造成鼻损伤。然而，20%至60%的早产儿在使用鼻持续气道正压通气（NCPAP）时会因皮肤组织脆弱、鼻用器械使用时间长以及护理操作不当而出现鼻损伤，导致感染风险增加，依从性和耐受性降低。在本研究中，我们检索、获取并整合了关于预防早产儿鼻无创通气时鼻损伤的相关证据，为临床实践提供参考。
我们在英国国家卫生与临床优化研究所（NICE）、苏格兰校际指南网络（SIGN）、医疗保健研究与质量局（AHRQ）、指南国际网络（GIN）、世界卫生组织（WHO）指南网站、安大略注册护士协会（RANO）、妇女健康、产科和新生儿护士协会（AWHONN）、欧洲压疮咨询小组（EPUAP）、医脉通、英国医学杂志最佳实践、考克兰图书馆、UpToDate、Embase、PubMed、中国知网（CNKI）、万方等数据库和指南网站中检索相关指南、专家共识、证据总结和系统评价。检索时间限制为各数据库建库至2023年2月。
共纳入16篇文献，其中包括6篇指南、3篇专家共识、2篇证据总结和5篇系统评价。从风险评估、通气与连接、皮肤保护、皮肤评估、培训与支持以及持续质量改进6个方面总结出28条证据。
本研究总结了预防早产儿鼻无创通气时鼻损伤的最佳证据。建议护士在应用证据中的建议时应考虑实际临床情况，制定相应护理措施，减少早产儿鼻损伤的发生。
