1
|
Trevi R, Chiappinotto S, Palese A, Galazzi A. Virtual Reality for Cardiopulmonary Resuscitation Healthcare Professionals Training: A Systematic Review. J Med Syst 2024; 48:50. [PMID: 38748244 PMCID: PMC11096216 DOI: 10.1007/s10916-024-02063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Virtual reality (VR) is becoming increasingly popular to train health-care professionals (HCPs) to acquire and/or maintain cardiopulmonary resuscitation (CPR) basic or advanced skills. AIM To understand whether VR in CPR training or retraining courses can have benefits for patients (neonatal, pediatric, and adult), HCPs and health-care organizations as compared to traditional CPR training. METHODS A systematic review (PROSPERO: CRD42023431768) following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. In June 2023, the PubMed, Cochrane Library, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched and included studies evaluated in their methodological quality with Joanna Briggs Institute checklists. Data were narratively summarized. RESULTS Fifteen studies published between 2013 and 2023 with overall fair quality were included. No studies investigated patients' outcomes. At the HCP level, the virtual learning environment was perceived to be engaging, realistic and facilitated the memorization of the procedures; however, limited decision-making, team building, psychological pressure and frenetic environment were underlined as disadvantages. Moreover, a general improvement in performance was reported in the use of the defibrillator and carrying out the chest compressions. At the organizational level, one study performed a cost/benefit evaluation in favor of VR as compared to traditional CPR training. CONCLUSIONS The use of VR for CPR training and retraining is in an early stage of development. Some benefits at the HCP level are promising. However, more research is needed with standardized approaches to ensure a progressive accumulation of the evidence and inform decisions regarding the best training methodology in this field.
Collapse
Affiliation(s)
- Roberto Trevi
- Master Degree in Nursing and Midwifery Science, University of Trieste and Udine, Trieste, Italy
- Azienda Sanitaria Universitaria G. Isontina, Trieste, Italy
| | | | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy.
| | | |
Collapse
|
2
|
Salinaro G, Pirrone M, Cardone C, Cova M, Abbruzzese C, Galazzi A. Effects of positive airway pressure on basilic vein diameter and venous flow velocity in healthy volunteers. J Vasc Access 2024; 25:928-934. [PMID: 36527186 PMCID: PMC11075407 DOI: 10.1177/11297298221124405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/07/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The placement of vascular catheters of adequate size in accordance to catheter-to-vein ratio (CVR) recommendations represents one of the cornerstones of catheter-related upper vein thrombosis prevention. However there is scarcity of data on its effect on the venous dynamics of the basilic vein, a common site for long-term catheter placement. This study investigates the effects of the application of positive airway pressure on the diameter and blood flow velocity of basilic vein. We also measured the effects of under-armpit straps, a device commonly used to keep continuous positive airway pressure (CPAP) helmets in place. METHODS We enrolled 28 healthy volunteers. Basilic vein diameter and minimum/maximum blood flow velocity, according to respiratory venous flow oscillation, were measured by ultrasound on the midpoint of their dominant arm during spontaneous breathing and during breathing in a CPAP helmet with 10 cm H2O of airway pressure applied, with the helmet kept in place either through armpit straps or by tying the helmet to the bed. RESULTS The application of 10 cm H2O of positive airway pressure significantly increased basilic vein diameter by 0.9 ± 0.2 mm, while reducing minimum blood flow velocity by 1.8 ± 0.4 cm/s. These effects were amplified by the application of under armpit straps. CONCLUSIONS Breathing with positive airway pressure increases basilic vein diameter while reducing blood flow-velocity. This phenomenon might lead to an incorrect assessment of CVR, misleading the operator into choosing improperly large catheters.
Collapse
Affiliation(s)
- Gianluca Salinaro
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Pirrone
- Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Cardone
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Cova
- Division of Vascular Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Abbruzzese
- Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
3
|
Chiappinotto S, Igoumenidis M, Galazzi A, Kokic A, Palese A. Between mandatory and aspirational ethics in nursing codes: a case study of the Italian nursing code of conduct. BMC Nurs 2024; 23:30. [PMID: 38200503 PMCID: PMC10777559 DOI: 10.1186/s12912-024-01697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Over the years, national and international nurses' organisations have drawn up Codes of Conduct and Codes of Ethics. A new differentiation has emerged over time between mandatory and aspirational approaches underlying how nurses can be supported by documents with rules to be respected (mandatory ethics) or by incentives (aspirational ethics). However, to date, no research has applied these approaches to analyse available Codes and to identify which approach are predominantly used. METHODS In this case study, the Italian Nursing Code of Conduct (NCC), published in 2019, composed of 53 articles distributed in eight chapters, was first translated, and then analysed using a developed matrix to identify the articles that refer to mandatory or aspirational ethics. A nominal group technique was used to minimise subjectivity in the evaluation process. RESULTS A total of 49 articles addressing the actions of the individual nurse were considered out of 53 composing the NNC. Articles were broken down into 97 units (from one to four for each article): 89 units (91.8%) were attributed to a unique category, while eight (8.2%) to two categories according to their meaning. A total of 38 units (39.2%) were categorised under the mandatory ethics and 58 (59.8%) under the aspirational ethics; however, one (1.0%) reflected both mandatory and aspirational ethics. CONCLUSIONS According to the findings, the Italian Professional Body (FNOPI) has issued a modern code for nursing professionals in which an aspirational perspective is dominant offering a good example for other nursing organisations in the process of updating their codes when aimed at embodying an aspirational ethics.
Collapse
Affiliation(s)
| | | | | | - Andjela Kokic
- Department of Medicine, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy.
| |
Collapse
|
4
|
Lombardi Fortino D, Galazzi A, Chiappinotto S, Palese A. Nurse managers' strategies promoting a Fundamentals of Care-based approach among nurses: A scoping review. Ann Ig 2024; 36:26-40. [PMID: 37885356 DOI: 10.7416/ai.2023.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction In the last few years, shortcomings in caring for patient needs have promoted a growing interest in the Fundamentals of Care (FoC) to promote the quality of nursing care. However, which strategies nurse managers should implement to facilitate a FoC-based nursing care approach have not been mapped to date; therefore, the intent of this study was to map those strategies related to the nurse manager role that have been documented as being capable of promoting (or hindering), a FoC-based approach among nurses. Methods A scoping review following the Preferred Reporting Items for Systematic Review and Meta-Analysis - Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed, CINAHL, Cochrane Library, Scopus and Web of Science databases and the conference proceedings of the International Learning Collaborative 2022 Annual International Conference were consulted. Studies exploring the relationship between FoC and nurse managers using any methodology, published from 2008 (year of birth of the FoC movement) to September 2022, in Italian or English, were eligible for inclusion. Findings were categorized narratively, according to their similarities and differences. Results Four qualitative studies, four discussion papers, two reviews and one mixed-method study, published from 2017 to 2021, predominantly in Australia, were included. Several strategies have emerged as promoting a FoC-based care approach by nurse managers. At the macro level, there is a need to disseminate a culture of attention towards patients that should be incorporated in the strategy of the entire system; moreover, synergies and effective leadership styles should be promoted by also providing education both in the undergraduate and continuing education settings. At the micro levels, among others, the required resources should be available, and the quality of the environment promoted. Conclusion Nurse managers may facilitate a FoC-based approach among nurses through a set of strategies that should be included and considered in their educational pathways.
Collapse
Affiliation(s)
- D Lombardi Fortino
- University of Tor Vergata, Rome, Italy
- Azienda Ospedaliera Universitaria delle Marche, Ancona, Italy
| | - A Galazzi
- Department of Medicine, University of Udine, Udine, Italy
| | - S Chiappinotto
- Department of Medicine, University of Udine, Udine, Italy
| | - A Palese
- Department of Medicine, University of Udine, Udine, Italy
| |
Collapse
|
5
|
Binda F, Marelli F, Galazzi A, Gambazza S, Vinci E, Roselli P, Adamini I, Laquintana D. Pressure ulcers after prone positioning in patients undergoing extracorporeal membrane oxygenation: A cross-sectional study. Nurs Crit Care 2024; 29:65-72. [PMID: 36740588 DOI: 10.1111/nicc.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/23/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The combination of prone positioning and extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) is recognized as safe but its use has been limited due to potential complications. AIM To report the prevalence of pressure ulcers and other complications due to prone positioning in adult patients receiving veno-venous ECMO. STUDY DESIGN This cross-sectional study was conducted in a tertiary level intensive care unit (ICU) in Milan (Italy), between January 2015 and December 2019. The study population was critically ill adult patients undergoing veno-venous ECMO. Statistical association between pressure ulcers and the type of body positioning (prone versus supine) was explored fitting a logistic model. RESULTS In the study period, 114 patients were treated with veno-venous ECMO and 62 (54.4%) patients were placed prone for a total of 130 prone position cycles. ECMO cannulation was performed via femoro-femoral configuration in the majority of patients (82.4%, 94/114). Pressure ulcers developed in 57.0% of patients (95%CI: 44.0%-72.6%), most often arising on the face and the chin (37.1%, 23/62), particularly in those placed prone. The main reason of prone positioning interruption was the decrease of ECMO blood flow (8.1%, 5/62). The fitted model showed no association between body position during ECMO and occurrence of pressure ulcers (OR 1.3, 95%CI: 0.5-3.6, p = .532). CONCLUSIONS Facial pressure ulcers were the most frequent complications of prone positioning. Nurses should plan and implement evidence-based care to prevent such pressure injuries in patients undergoing ECMO. RELEVANCE TO CLINICAL PRACTICE The combination of prone positioning and ECMO shows few life-threating complications. This manoeuvre during ECMO is feasible and safe when performed by experienced ICU staff.
Collapse
Affiliation(s)
- Filippo Binda
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Marelli
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Gambazza
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Vinci
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Roselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ileana Adamini
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
6
|
Fonda F, Galazzi A, Palese A. [Care assistants at the international level: a narrative review]. Assist Inferm Ric 2024; 43:35-43. [PMID: 38572706 DOI: 10.1702/4250.42269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
. Care assistants at the international level: a narrative review. INTRODUCTION At the international level, the role of care assistants, their competencies and scope of their professional practice has been debated for many years. Periodically updating the state of the art regarding the different training pathways, expected competencies, and responsibilities of care assistants at the international level is crucial for monitoring the evolution of these professional profiles. OBJECTIVE To map the available classifications of care assistants at the international level, by describing (a) where these figures receive training, with which pathways, and for which competencies, and (b) where they can work and with what level of professional autonomy/interdependence with respect to other healthcare professions. METHOD A narrative review of the literature was conducted by examining documents produced by the World Health Organization and the European Union; and that of three reference countries, the United Kingdom, Canada, and the United States of America. RESULTS Fourteen documents were selected. Numerous care assistant profiles are described in available classifications, totaling 32 different profiles; these individuals may receive training in upper secondary school or colleges to perform a range of competencies. They may be supervised in their practice not only by nurses. In some countries, compulsory registration is required. DISCUSSION The results show an important heterogeneity in care assistant figures internationally.
Collapse
Affiliation(s)
- Federico Fonda
- Dipartimento di Medicina, Università degli Studi di Udine
| | | | - Alvisa Palese
- Dipartimento di Medicina, Università degli Studi di Udine
| |
Collapse
|
7
|
Fonda F, Galazzi A, Chiappinotto S, Justi L, Frydensberg MS, Boesen RL, Macur M, Reig EA, Espaulella ER, Palese A. Healthcare System Digital Transformation across Four European Countries: A Multiple-Case Study. Healthcare (Basel) 2023; 12:16. [PMID: 38200922 PMCID: PMC10778608 DOI: 10.3390/healthcare12010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Digitization has become involved in every aspect of life, including the healthcare sector with its healthcare professionals (HCPs), citizens (patients and their families), and services. This complex process is supported by policies: however, to date, no policy analysis on healthcare digitalization has been conducted in European countries to identify the main goals of digital transformation and its practical implementation. This research aimed to describe and compare the digital health policies across four European countries; namely, their priorities, their implementation in practice, and the digital competencies expected by HCPs. A multiple-case study was performed. Participants were the members of the Digital EducationaL programme invoLVing hEalth profEssionals (DELIVER), a project funded by the European Union under the Erasmus+ programme, involving three countries (Denmark, Italy, and Slovenia) and one autonomous region (Catalonia-Spain). Data were collected using two approaches: (a) a written interview with open-ended questions involving the members of the DELIVER project as key informants; and (b) a policy-document analysis. Interviews were analysed using the textual narrative synthesis and the word cloud policy analysis was conducted according to the Ready, Extract, Analyse and Distil approach. Results showed that all countries had established recent policies at the national level to address the development of digital health and specific governmental bodies were addressing the implementation of the digital transformation with specific ramifications at the regional and local levels. The words "health" and "care" characterized the policy documents of Denmark and Italy (309 and 56 times, 114 and 24 times, respectively), while "development" and "digital" (497 and 478 times, respectively) were common in the Slovenia document. The most used words in the Catalonia policy document were "data" and "system" (570 and 523 times, respectively). The HCP competencies expected are not clearly delineated among countries, and there is no formal plan for their development at the undergraduate, postgraduate, and continuing educational levels. Mutual understanding and exchange of good practices between countries may facilitate the digitalization processes; moreover, concrete actions in the context of HCP migration across Europe for employment purposes, as well as in the context of citizens' migration for healthcare-seeking purposes are needed to consider the differences emerged across the countries.
Collapse
Affiliation(s)
- Federico Fonda
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Alessandro Galazzi
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Stefania Chiappinotto
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| | - Linda Justi
- Health Innovation Centre of Southern Denmark, Forskerparken 10, 5230 Odense, Denmark; (L.J.); (M.S.F.); (R.L.B.)
| | | | - Randi Lehmann Boesen
- Health Innovation Centre of Southern Denmark, Forskerparken 10, 5230 Odense, Denmark; (L.J.); (M.S.F.); (R.L.B.)
| | - Mirna Macur
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270 Jesenice, Slovenia;
| | - Erik Andrés Reig
- TIC Salut Social, Carrer de Roc Boronat 81, 08005 Barcelona, Catalonia, Spain; (E.A.R.); (E.R.E.)
| | | | - Alvisa Palese
- Department of Medical Science, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (F.F.); (A.P.)
| |
Collapse
|
8
|
Genoni F, Guerrini M, Sannino P, Palese A, Galazzi A. Italian Pediatric Intensive Care Units need to improve the assessment of delirium, like many other Countries. Minerva Anestesiol 2023; 89:1060-1061. [PMID: 37272275 DOI: 10.23736/s0375-9393.23.17452-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Francesca Genoni
- Department of Pediatric Nursing, University of Milan, Milan, Italy
| | - Marta Guerrini
- Department of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Patrizio Sannino
- Department of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
9
|
Chiappinotto S, Bayram A, Grassetti L, Galazzi A, Palese A. Were the unfinished nursing care occurrence, reasons, and consequences different between COVID-19 and non-COVID-19 patients? A systematic review. BMC Nurs 2023; 22:341. [PMID: 37759199 PMCID: PMC10523650 DOI: 10.1186/s12912-023-01513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Unfinished Nursing Care (UNC) has been documented also during the Coronavirus (COVID-19) pandemic; however, while several secondary studies were conducted before this period to summarise occurrences, reasons, and consequences of UNC and provide a global picture of the phenomenon, no synthesis of the evidence produced during the pandemic has been documented to date. Therefore, the aim of this review is to identify differences, if any, in the UNC occurrence, reasons, and consequences perceived by nurses caring for COVID-19 and non-COVID-19 patients. METHODS This study is a systematic review (PROSPERO CRD42023410602). According to the Population, Exposure, Comparator, and Outcomes framework, primary comparative cross-sectional, longitudinal, and cohort studies, randomised/non-randomised controlled trials were included from Medline, CINAHL, and Scopus, collecting perceptions of nurses with tools measuring UNC between COVID-19 and non-COVID-19 patients and published in English, Italian, or Turkish. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Johanna Briggs Quality Appraisal Tool were used, and findings were summarised narratively. RESULTS Five hospital-based cross-sectional studies using the self-administered MISSCARE and UNC Survey comparing data collected (a) before the pandemic vs. in the first wave; (b) before, in the second and in the third wave; and (c) simultaneously among COVID-19 and non-COVID-19 patients in the second wave. Three main patterns emerged suggesting a higher UNC occurrence among COVID-19 patients in the first wave, less occurrence among them compared to non-COVID-19 patients in the second wave, and contrasting findings with some in favour and others in contrast to COVID-19 patients. Similar patterns emerged regarding UNC reasons while no studies investigated the UNC consequences. CONCLUSIONS In the first wave, COVID-19 patients were likely to be at increased risk of UNC, while in later waves non-COVID-19 patients were at increased risk of UNC. Reasons also were different across waves. Findings documented during the COVID-19 pandemic may help to prevent UNC in future disasters.
Collapse
|
10
|
Galazzi A, Bruno M, Binda F, Caddeo G, Chierichetti M, Roselli P, Grasselli G, Laquintana D. Thematic analysis of intensive care unit diaries kept by staff: insights for caring. Intensive Crit Care Nurs 2023; 76:103392. [PMID: 36731262 PMCID: PMC9870754 DOI: 10.1016/j.iccn.2023.103392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/07/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To explore recurrent themes in diaries kept by intensive care unit (ICU) staff during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN Qualitative study. SETTING Two ICUs in a tertiary level hospital (Milan, Italy) from January to December 2021. METHODS ICU staff members wrote a digital diary while caring for adult patients hospitalized in the intensive care unit for >48 hours. A thematic analysis was performed. FINDINGS Diary entries described what happened and expressed emotions. Thematic analysis of 518 entries gleaned from 48 diaries identified four themes (plus ten subthemes): Presenting (Places and people; Diary project), Intensive Care Unit Stay (Clinical events; What the patient does; Patient support), Outside the Hospital (Family and topical events; The weather), Feelings and Thoughts (Encouragement and wishes; Farewell; Considerations). CONCLUSION The themes were similar to published findings. They offer insight into care in an intensive care unit during a pandemic, with scarce resources and no family visitors permitted, reflecting on the patient as a person and on daily care. The staff wrote farewell entries to dying patients even though no one would read them. IMPLICATIONS FOR CLINICAL PRACTICE The implementation of digital diaries kept by intensive care unit staff is feasible even during the COVID-19 pandemic. Diaries kept by staff can provide a tool to humanize critical care. Staff can improve their work by reflecting on diary records.
Collapse
Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Bruno
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Binda
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Corresponding author at: Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 – 20122 Milan, Italy
| | - Giorgia Caddeo
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Chierichetti
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Roselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
11
|
Slobod D, Spinelli E, Crotti S, Lissoni A, Galazzi A, Grasselli G, Mauri T. Effects of an asymmetrical high flow nasal cannula interface in hypoxemic patients. Crit Care 2023; 27:145. [PMID: 37072854 PMCID: PMC10111067 DOI: 10.1186/s13054-023-04441-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Optimal noninvasive respiratory support for patients with hypoxemic respiratory failure should minimize work of breathing without increasing the transpulmonary pressure. Recently, an asymmetrical high flow nasal cannula (HFNC) interface (Duet, Fisher & Paykel Healthcare Ltd), in which the caliber of each nasal prong is different, was approved for clinical use. This system might reduce work of breathing by lowering minute ventilation and improving respiratory mechanics. METHODS We enrolled 10 patients ≥ 18 years of age who were admitted to the Ospedale Maggiore Policlinico ICU in Milan, Italy, and had a PaO2/FiO2 < 300 mmHg during HFNC support with a conventional cannula. We investigated whether the asymmetrical interface, compared to a conventional high flow nasal cannula, reduces minute ventilation and work of breathing. Each patient underwent support with the asymmetrical interface and the conventional interface, applied in a randomized sequence. Each interface was provided at a flow rate of 40 l/min followed by 60 l/min. Patients were continuously monitored with esophageal manometry and electrical impedance tomography. RESULTS Application of the asymmetrical interface resulted in a -13.5 [-19.4 to (-4.5)] % change in minute ventilation at a flow rate of 40 l/min, p = 0.006 and a -19.6 [-28.0 to (-7.5)] % change at 60 l/min, p = 0.002, that occurred despite no change in PaCO2 (35 [33-42] versus 35 [33-43] mmHg at 40 l/min and 35 [32-41] versus 36 [32-43] mmHg at 60 l/min). Correspondingly, the asymmetrical interface lowered the inspiratory esophageal pressure-time product from 163 [118-210] to 140 [84-159] (cmH2O*s)/min at a flow rate of 40 l/min, p = 0.02 and from 142 [123-178] to 117 [90-137] (cmH2O*s)/min at a flow rate of 60 l/min, p = 0.04. The asymmetrical cannula did not have any impact on oxygenation, the dorsal fraction of ventilation, dynamic lung compliance, or end-expiratory lung impedance, suggesting no major effect on PEEP, lung mechanics, or alveolar recruitment. CONCLUSIONS An asymmetrical HFNC interface reduces minute ventilation and work of breathing in patients with mild-to-moderate hypoxemic respiratory failure supported with a conventional interface. This appears to be primarily driven by increased ventilatory efficiency due to enhanced CO2 clearance from the upper airway.
Collapse
Affiliation(s)
- Douglas Slobod
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Critical Care Medicine, McGill University, Montreal, Canada
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Stefania Crotti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alfredo Lissoni
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| |
Collapse
|
12
|
Galazzi A, Bruno M, Binda F, Laquintana D. Diaries for dying patients: An outlet for staff members' grief or a powerful way to humanize the intensive care unit? Intensive Crit Care Nurs 2023. [PMID: 36863955 DOI: 10.1016/j.iccn.2023.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Bruno
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Binda
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
13
|
Palese A, Longhini J, Landi A, Badagliacca G, Bianchini E, Caldarola A, Cecchini F, Cignola S, Clodig M, Covaz M, De Colle B, Dentice S, De Venuto G, Devetak L, Dreos M, Kozlovic E, Lupi T, Margarita P, Miorin F, Mustacchi A, Petrocchi V, Trevi R, Venier E, Zamolo P, Zannier M, Galazzi A, Chiappinotto S. [The nurses' strike in the United Kingdom: the reasons, the debate and the implications]. Assist Inferm Ric 2023; 42:21-32. [PMID: 37283136 DOI: 10.1702/4023.39983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
. The nurses' strike in the United Kingdom: an overview of the reasons, debate and implications. INTRODUCTION In the UK, where the National Health Service (NHS) was founded, one of the most important and long-lasting strikes in nursing is taking place. AIM To understand the historical, professional, political/social reasons for the UK nurse's strike. METHOD Historical, scientific literature and data from key informant interviews have been analysed. Data has been summarized narratively. RESULTS On 15th December 2022, more than 100,000 NHS nurses went on strike in England, Northern Ireland, and Wales asking for an increased salary; on the 6th and 7th of February and 1st of March the protest has continued. By improving pay, nurses believe the attractiveness of the profession can increase and counteract the loss of nurses who are leaving the public for the private sector, and the lack of attractiveness of the profession towards young people. The strike is organized by the Royal College of Nursing in a structured form which gives nurses precise information on how it should be explained to patients: according to a survey, 79% of the population supports the nurses' strike. However, not all agree with this strike action. DISCUSSION The media, social media and professional debate is passionate with some polarization between who is in favor and who is against. Nurses strike not only for better wages but also to increase patient safety. What we see in the UK today is the result of years of austerity, lack of investment and health priorities: a similar situation experienced in several countries as well.
Collapse
Affiliation(s)
- Alvisa Palese
- Dipartimento di Area Medica, Università degli Studi di Udine
| | - Jessica Longhini
- Dipartimento di Diagnostica e Sanità Pubblica, Università degli Studi di Verona
| | | | - Giuseppe Badagliacca
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Elisa Bianchini
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Alessandro Caldarola
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Francesco Cecchini
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Sara Cignola
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Majda Clodig
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Monica Covaz
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Beatrice De Colle
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Sara Dentice
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Giovanna De Venuto
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Laura Devetak
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Manuela Dreos
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Elisa Kozlovic
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Tommaso Lupi
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Pamela Margarita
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Francesca Miorin
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Annamaria Mustacchi
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Valentina Petrocchi
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Roberto Trevi
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Erica Venier
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Paola Zamolo
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | - Mirco Zannier
- Corso di Laurea Magistrale Interateneo in Scienze Infermieristiche ed Ostetriche, Università degli Studi di Trieste e di Udine
| | | | | |
Collapse
|
14
|
Scquizzato T, Gamberini L, D'Arrigo S, Galazzi A, Babini G, Losiggio R, Imbriaco G, Fumagalli F, Cucino A, Landoni G, Scapigliati A, Ristagno G, Semeraro F, Bertoncello F, Canalini A, Colelli S, Conti G, Giacometti M, Giuliani G, Graziano A, Mina A, Orazio S, Paoli A, Peratoner A, Pegani C, Roncarati A, Sabetta C, Savastano S, Stella F, Varutti R, Verginella F, Zuliani M. Incidence, characteristics, and outcome of out-of-hospital cardiac arrest in Italy: A systematic review and meta-analysis. Resusc Plus 2022; 12:100329. [DOI: 10.1016/j.resplu.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
|
15
|
Colombo SM, Scaravilli V, Cortegiani A, Corcione N, Guzzardella A, Baldini L, Cassinotti E, Canetta C, Carugo S, Hu C, Fracanzani AL, Furlan L, Paleari MC, Galazzi A, Tagliabue P, Peyvandi F, Blasi F, Grasselli G. Use of high flow nasal cannula in patients with acute respiratory failure in general wards under intensivists supervision: a single center observational study. Respir Res 2022; 23:171. [PMID: 35754021 PMCID: PMC9233759 DOI: 10.1186/s12931-022-02090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few data exist on high flow nasal cannula (HFNC) use in patients with acute respiratory failure (ARF) admitted to general wards. RATIONALE AND OBJECTIVES To retrospectively evaluate feasibility and safety of HFNC in general wards under the intensivist-supervision and after specific training. METHODS Patients with ARF (dyspnea, respiratory rate-RR > 25/min, 150 < PaO2/FiO2 < 300 mmHg during oxygen therapy) admitted to nine wards of an academic hospital were included. Gas-exchange, RR, and comfort were assessed before HFNC and after 2 and 24 h of application. RESULTS 150 patients (81 male, age 74 [60-80] years, SOFA 4 [2-4]), 123 with de-novo ARF underwent HFNC with flow 60 L/min [50-60], FiO2 50% [36-50] and temperature 34 °C [31-37]. HFNC was applied a total of 1399 days, with a median duration of 7 [3-11] days. No major adverse events or deaths were reported. HFNC did not affect gas exchange but reduced RR (25-22/min at 2-24 h, p < 0.001), and improved Dyspnea Borg Scale (3-1, p < 0.001) and comfort (3-4, p < 0.001) after 24 h. HFNC failed in 20 patients (19.2%): 3 (2.9%) for intolerance, 14 (13.4%) escalated to NIV/CPAP in the ward, 3 (2.9%) transferred to ICU. Among these, one continued HFNC, while the other 2 were intubated and they both died. Predictors of HFNC failure were higher Charlson's Comorbidity Index (OR 1.29 [1.07-1.55]; p = 0.004), higher APACHE II Score (OR 1.59 [1.09-4.17]; p = 0.003), and cardiac failure as cause of ARF (OR 5.26 [1.36-20.46]; p = 0.02). CONCLUSION In patients with mild-moderate ARF admitted to general wards, the use of HFNC after an initial training and daily supervision by intensivists was feasible and seemed safe. HFNC was effective in improving comfort, dyspnea, and respiratory rate without effects on gas exchanges. Trial registration This is a single-centre, noninterventional, retrospective analysis of clinical data.
Collapse
Affiliation(s)
- Sebastiano Maria Colombo
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza, 35, 20122, Milan, Lombardia, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Lombardia, Italy
| | - Vittorio Scaravilli
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza, 35, 20122, Milan, Lombardia, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Lombardia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Sicilia, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Sicilia, Italy
| | - Nadia Corcione
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.,Azienda Ospedaliera Antonio Caldarelli, Interventional Pulmunology, Naples, Campania, Italy
| | - Amedeo Guzzardella
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Lombardia, Italy
| | - Luca Baldini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Lombardia, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Ciro Canetta
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Stefano Carugo
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Lombardia, Italy
| | - Cinzia Hu
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Lombardia, Italy.,Unit of Internal Medicine and Metabolic Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Ludovico Furlan
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Lombardia, Italy
| | - Maria Chiara Paleari
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza, 35, 20122, Milan, Lombardia, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Lombardia, Italy
| | - Alessandro Galazzi
- Healthcare Profession Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Paola Tagliabue
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza, 35, 20122, Milan, Lombardia, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Lombardia, Italy.,Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Lombardia, Italy.,Internal Medicine Department and Respiratory Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Giacomo Grasselli
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza, 35, 20122, Milan, Lombardia, Italy. .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Lombardia, Italy.
| |
Collapse
|
16
|
Galazzi A, Binda F, Gambazza S, Cantù F, Colombo E, Adamini I, Grasselli G, Lusignani M, Laquintana D, Rasero L. The end of life of patients with COVID-19 in intensive care unit and the stress level on their family members: A cross-sectional study. Nurs Crit Care 2022; 28:133-140. [PMID: 35599352 PMCID: PMC9348431 DOI: 10.1111/nicc.12783] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND During the Coronavirus disease 2019 (COVID-19) pandemic, hospital visits were suspended and video calls were offered to connect patients with their family members, especially toward the end of life (EoL). AIM The primary aim was to describe EoL care for COVID-19 patients dying in an intensive care unit (ICU). The secondary aim was to explore whether making video calls and allowing visits was associated with lower death-related stress in family members. DESIGN Single centre cross-sectional study. The setting was the ICU of a COVID-19 center in northern Italy, during the first year of the pandemic. Data on patients who died in the ICU were collected; death-related stress on their family members was measured using the Impact of Event Scale-Revised (IES-R). The statistical association was tested by means of logistic regression. RESULTS The study sample included 70 patients and 56 family members. All patients died with mechanical ventilation, hydration, nutrition, analgesia and sedation ongoing. Resuscitation procedures were performed in 5/70 patients (7.1%). Only 6/56 (10.7%) of the family members interviewed had visited their loved ones in the ICU and 28/56 (50%) had made a video call. EoL video calls were judged useful by 53/56 family members (94.6%) but all (56/56, 100%) wished they could have visited the patient. High-stress levels were found in 38/56 family members (67.9%), regardless of whether they were allowed ICU access or made a video call. Compared with other degrees of kinship, patients' offspring were less likely to show a positive IES-R score (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.05 to 0.89). CONCLUSIONS During the first year of the COVID-19 pandemic, patients died without their family members at the bedside while on life-sustaining treatment. Stress levels were high in most family members, especially in patients' spouses. Video calls or ICU visits were judged favourably by family members but insufficient to alleviate death-related stress. RELEVANCE FOR CLINICAL PRACTICE During a pandemic, ICU access by patients' family members should be considered, particularly as the time of death approaches. Although generally appreciated by family members, EoL video calls should be arranged together with other measures to alleviate death-related stress, especially for the patient's spouse.
Collapse
Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare ProfessionsFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Filippo Binda
- Department of Healthcare ProfessionsFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of AnesthesiaIntensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Simone Gambazza
- Department of Healthcare ProfessionsFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Filippo Cantù
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Elisa Colombo
- Department of Neurosciences and Mental HealthFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Ileana Adamini
- Department of Healthcare ProfessionsFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of AnesthesiaIntensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Giacomo Grasselli
- Department of AnesthesiaIntensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Maura Lusignani
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | - Dario Laquintana
- Department of Healthcare ProfessionsFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Laura Rasero
- Department of Health SciencesUniversity of FlorenceFlorenceItaly
| |
Collapse
|
17
|
Buzzi F, Yahya NB, Gambazza S, Binda F, Galazzi A, Ferrari A, Crespan S, Al-Atroushy HA, Cantoni BM, Laquintana D. Use of Musical Intervention in the Pediatric Intensive Care Unit of a Developing Country: A Pilot Pre–Post Study. Children 2022; 9:children9040455. [PMID: 35455499 PMCID: PMC9032317 DOI: 10.3390/children9040455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
Music is frequently used in different clinical settings, and it is implemented as a complementary, low-cost and useful intervention to reduce pain, anxiety and to improve relaxation. This pilot pre–post study aimed to examine the feasibility and preliminary effectiveness of a specific musical intervention in patients ≤16 years admitted to the Pediatric Intensive Care Unit (PICU) of an Iraqi hospital. The COMFORT Behavior Scale (CBS) was used by nurses to assess the level of sedation. Fifty-nine children were enrolled during the study period (March 2020–August 2021). CBS was lowered by 2.2 (95% CI: 1.9 to 2.6) points after 30 min, and by 3.3 (95% CI: 2.9 to 3.6) points after 60 min from music initiation. Thirty minutes after music initiation, heart rate decreased by 6.3 (95% CI: 4.5 to 8.1) beats per minute, whereas at 60 min, heart rate decreased by 9.1 (95% CI: 7.2 to 10.9) beats per minute. No clinically significant variations were detected in the other vital signs (blood pressure, respiratory rate and oxygen saturation). These findings support the feasibility of musical intervention in a developing country. CBS and heart rate variation may be worth following up in larger and conclusive studies.
Collapse
Affiliation(s)
- Federica Buzzi
- Pediatric Unit, Istituto Scientifico, Universitario San Raffaele, 20132 Milan, Italy;
- EU Project MADAD, Italian Association for Solidarity among Peoples, Duhok 42001, Iraq
| | - Nizar Bakir Yahya
- Hospital Direction, Hevi Pediatric Teaching Hospital, Duhok 42001, Iraq;
| | - Simone Gambazza
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.G.); (F.B.); (B.M.C.); (D.L.)
| | - Filippo Binda
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.G.); (F.B.); (B.M.C.); (D.L.)
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.G.); (F.B.); (B.M.C.); (D.L.)
- Correspondence: ; Tel.: +39-02-5503-3107
| | | | - Stefano Crespan
- Curadelsuono432 Project, 30020 Venice, Italy; (A.F.); (S.C.)
| | | | - Barbara Maria Cantoni
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.G.); (F.B.); (B.M.C.); (D.L.)
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.G.); (F.B.); (B.M.C.); (D.L.)
| | - Collaborative Group
- Pediatric Intensive Care Unit, Hevi Pediatric Teaching Hospital, Duhok 42001, Iraq;
| |
Collapse
|
18
|
Stellabotte M, Galazzi A. Dawn in intensive care unit. Intensive Care Med 2021; 48:381-382. [PMID: 34676437 DOI: 10.1007/s00134-021-06556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Michele Stellabotte
- Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| |
Collapse
|
19
|
Galazzi A, Adamini I, Bazzano G, Cancelli L, Fridh I, Laquintana D, Lusignani M, Rasero L. Intensive care unit diaries to help bereaved family members in their grieving process: a systematic review. Intensive Crit Care Nurs 2021; 68:103121. [PMID: 34373147 DOI: 10.1016/j.iccn.2021.103121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/30/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. AIM To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. METHODS Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal. RESULTS Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. CONCLUSION The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.
Collapse
Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
| | - Ileana Adamini
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Bazzano
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Livia Cancelli
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden; Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Florence, Italy.
| |
Collapse
|
20
|
Maiandi S, Galazzi A, Villa A, Zarini M, Sironi S, Lusignani M. Prejudice between triage nurses and emergency medical technicians: is it a big deal? Acta Biomed 2021; 92:e2021026. [PMID: 34328136 PMCID: PMC8383224 DOI: 10.23750/abm.v92is2.11549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Stefano Maiandi
- Health Professions Directorate, Research and Development, ASST di Lodi, Lodi, Italy .
| | - Alessandro Galazzi
- Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Alessandro Villa
- Corso di Laurea in Infermieristica, Università degli Studi di Milano, Sezione ASST Fatebenefratelli, Milano, Italy.
| | - Mariangela Zarini
- Corso di Laurea in Infermieristica, Università degli Studi di Milano, Sezione ASST Fatebenefratelli, Milano, Italy.
| | - Stefano Sironi
- Formazione AREU, Azienda Regionale Emergenza Urgenza Lombardia, Milano, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy.
| |
Collapse
|
21
|
Bambi S, Giusti GD, Galazzi A, Mattiussi E, Comisso I, Manici M, Rosati M, Lucchini A. Pressure Injuries Due to Personal Protective Equipment in COVID-19 Critical Care Units. Am J Crit Care 2021; 30:287-293. [PMID: 33912903 DOI: 10.4037/ajcc2021178] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Caring for patients with COVID-19 requires wearing a full set of personal protective equipment (PPE) to avoid contamination. Personal discomfort has been associated with use of PPE, and anecdotal reports describe pressure injuries related to wearing PPE. OBJECTIVES To investigate the occurrence of device-related pressure injuries due to wearing PPE among Italian nurses caring for patients with COVID-19 in critical care settings. METHODS This descriptive study used an online survey investigating both the demographic characteristics of respondents and complications related to wearing PPE, including the development of pressure injuries. RESULTS A total of 266 nurses throughout Italy completed the survey; 32% of respondents were men. Nurses' median age was 36 years (range 22-59 years), and the median time spent working in their current clinical setting (an intensive care or high-dependency unit) was 3 years (range 0-32 years). Personal protective equipment was worn for a median duration of 5 hours (range 2-12 hours). While wearing PPE, 92.8% of nurses experienced pain and 77.1% developed device-related pressure injuries, mainly on the nose, ears, and forehead. Pain was more frequent among nurses with such injuries. Transparent dressings, emollient cream, and no dressing were associated with development of device-related pressure injury. CONCLUSIONS Pressure injuries related to PPE represent an important adverse effect for nurses caring for patients with COVID-19. This topic deserves study to determine adequate solutions for preventing and treating such injuries and their potential influence on nurses' work tolerance.
Collapse
Affiliation(s)
- Stefano Bambi
- Stefano Bambi is a staff nurse in the medical and surgical intensive care unit, Careggi University Hospital, Florence, Italy
| | - Gian Domenico Giusti
- Gian Domenico Giusti is a staff nurse in the intensive care unit, Perugia University Hospital, Perugia, Italy, and a nurse educator in the Department of Experimental Medicine, School of Nursing, University of Perugia, Perugia, Italy
| | - Alessandro Galazzi
- Alessandro Galazzi is a clinical nurse educator in the Healthcare Professions Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Mattiussi
- Elisa Mattiussi is a nurse educator in the Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy; and a staff nurse in the Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Irene Comisso
- Irene Comisso is a staff nurse in the Clinica di Anestesia e Rianimazione, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Matteo Manici
- Matteo Manici is a staff nurse in the postsurgical intensive care unit, University Hospital of Parma, Parma, Italy
| | - Moris Rosati
- Moris Rosati is a staff nurse in the Anestesia e Rianimazione DEA e dei Trapianti, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Alberto Lucchini
- Alberto Lucchini is a nurse coordinator in the general intensive care unit, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
22
|
Gambazza S, Galazzi A, Binda F, Passeri O, Bosco P, Costantino G, Laquintana D. Pattern of Visits in a Metropolitan Emergency Department in Lombardia (Italy): January 2019-December 2020. Healthcare (Basel) 2021; 9:791. [PMID: 34202591 PMCID: PMC8304284 DOI: 10.3390/healthcare9070791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This retrospective study assessed the change in the number of presentations in the ED of a tertiary level university hospital in Milano (Lombardia, Italy). Compared to 2019, a significant drop in ED presentations occurred (-46.4%), and we recorded a -15.7% difference in the proportion of patients admitted with white codes. The pattern of hourly presentations to the ED was unchanged, with overcrowding during the working daytime. COVID-19 changed ED flows, likely causing an overall reduction in the number of deferrable conditions. However, the pattern associated with urgent conditions did not change abruptly in 2020.
Collapse
Affiliation(s)
- Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Alessandro Galazzi
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Onorina Passeri
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Paola Bosco
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy;
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, 20122 Milano, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| |
Collapse
|
23
|
Mistraletti G, Giannini A, Gristina G, Malacarne P, Mazzon D, Cerutti E, Galazzi A, Giubbilo I, Vergano M, Zagrebelsky V, Riccioni L, Grasselli G, Scelsi S, Cecconi M, Petrini F. Why and how to open intensive care units to family visits during the pandemic. Crit Care 2021; 25:191. [PMID: 34078445 PMCID: PMC8171999 DOI: 10.1186/s13054-021-03608-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.
Collapse
Affiliation(s)
- Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. .,SC Anesthesia and Intensive Care, San Paolo Hospital - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Gristina
- Italian Society of Anaesthesia, Analgesia, Reanimation, and Intensive Care Medicine (SIAARTI) Ethics, Rome, Italy
| | | | - Davide Mazzon
- UOC Anesthesia and Intensive Care, Belluno Hospital, Belluno, Italy
| | - Elisabetta Cerutti
- Department of Anesthesia and Transplant, Surgical Intensive Care, AOU Ospedali Riuniti, Ancona, Italy
| | - Alessandro Galazzi
- Direction of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, AULSS 3 Serenissima Veneto, Venice, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Turin, Italy
| | - Vladimiro Zagrebelsky
- Director, Laboratorio dei Diritti Fondamentali, Collegio Carlo Alberto, Turin, Italy
| | | | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Scelsi
- Chair Aniarti, Director of Health Profession Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Flavia Petrini
- SIAARTI President - Retired Full Professor of Anesthesia and Intensive Care, Chieti-Pescara University, Chieti, Italy
| |
Collapse
|
24
|
Binda F, Galazzi A, Marelli F, Gambazza S, Villa L, Vinci E, Adamini I, Laquintana D. Complications of prone positioning in patients with COVID-19: A cross-sectional study. Intensive Crit Care Nurs 2021; 67:103088. [PMID: 34244027 PMCID: PMC8166520 DOI: 10.1016/j.iccn.2021.103088] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. METHODS Cross-sectional study conducted in the hub COVID-19 centre in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if no unplanned extubation was recorded. The majority of patients (17.5%) experienced bleeding of upper airways. Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04-3.6). CONCLUSION The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.
Collapse
Affiliation(s)
- Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Alessandro Galazzi
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Health Sciences Department, University of Florence, Florence, Italy.
| | - Federica Marelli
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Lucia Villa
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Elisa Vinci
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Ileana Adamini
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| |
Collapse
|
25
|
Galazzi A, Giusti GD, Pagnucci N, Bambi S. Assessment of delirium in adult patients in Intensive Care Unit: Italian Critical Care Nurses Best Practices. Intensive Crit Care Nurs 2021; 66:103072. [PMID: 34059415 DOI: 10.1016/j.iccn.2021.103072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alessandro Galazzi
- CCRN, Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Gian Domenico Giusti
- CCRN, School of Nursing, Azienda Ospedaliera Universitaria di Perugia, Perugia, Italy.
| | - Nicola Pagnucci
- CCRN, University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy.
| | - Stefano Bambi
- PhD, CCRN, Health Sciences Department, University of Florence, Italy.
| | -
- Composed of the Aniarti Executive Comittee (2020-2022) and Reviewers
| |
Collapse
|
26
|
Galazzi A, Binda F, Gambazza S, Lusignani M, Grasselli G, Laquintana D. Video calls at end of life are feasible but not enough: A 1-year intensive care unit experience during the coronavirus disease-19 pandemic. Nurs Crit Care 2021; 26:531-533. [PMID: 33955111 PMCID: PMC8242526 DOI: 10.1111/nicc.12647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Alessandro Galazzi
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Health Sciences Department, University of Florence, Florence, Italy
| | - Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
27
|
Binda F, Marelli F, Galazzi A, Pascuzzo R, Adamini I, Laquintana D. Nursing Management of Prone Positioning in Patients With COVID-19. Crit Care Nurse 2021; 41:27-35. [PMID: 33341885 DOI: 10.4037/ccn2020222] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND At the height of the coronavirus disease 2019 (COVID-19) pandemic, Italy had the highest number of deaths in Europe; most occurred in the Lombardy region. Up to 4% of patients with COVID-19 required admission to an intensive care unit because they developed a critical illness (eg, acute respiratory distress syndrome). Numerous patients with acute respiratory distress syndrome who had been admitted to the intensive care unit required rescue therapy like prone positioning. OBJECTIVE To describe the respiratory management of and the extensive use of prone positioning in patients with COVID-19 at the intensive care unit hub in Lombardy, Italy. METHODS A total of 89 patients (67% male; median age, 59 years [range, 23-80 years]) with confirmed COVID-19 who were admitted between February 23 and March 31, 2020, were enrolled in this quality improvement project. RESULTS Endotracheal intubation was required in 86 patients (97%). Prone positioning was used as rescue therapy in 43 (48%) patients. Significantly more younger patients (age ≤ 59 years) were discharged alive (43 of 48 [90%]) than were older patients (age ≥ 60 years; 26 of 41 [63%]; P < .005). Among the 43 patients treated with prone ventilation, 15 (35% [95% CI, 21%-51%]) died in the intensive care unit, of which 10 (67%; P < .001) were older patients. CONCLUSIONS Prone positioning is one strategy available for treating acute respiratory distress syndrome in patients with COVID-19. During this pandemic, prone positioning can be used extensively as rescue therapy, per a specific protocol, in intensive care units.
Collapse
Affiliation(s)
- Filippo Binda
- Filippo Binda is a senior critical care registered nurse, Intensive and Critical Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Marelli
- Federica Marelli is a senior critical care registered nurse, Intensive and Critical Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Alessandro Galazzi
- Alessandro Galazzi is a senior critical care registered nurse, Intensive and Critical Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Riccardo Pascuzzo
- Riccardo Pascuzzo is a research fellow in statistics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ileana Adamini
- Ileana Adamini is a nurse manager, Intensive and Critical Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and an adjunct professor of critical care nursing, University of Milan, Milan, Italy
| | - Dario Laquintana
- Dario Laquintana is a nurse director, Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and an adjunct professor of nursing management, University of Milan
| |
Collapse
|
28
|
Privitera D, Mazzone A, Pierotti F, Airoldi C, Galazzi A, Geraneo A, Cozzi M, Mora Garrido R, Vailati P, Scaglioni R, Capsoni N, Ganassin EC, Salinaro G, Scala CGR, Dal Molin A. Ultrasound-guided peripheral intravenous catheters insertion in patient with difficult vascular access: Short axis/out-of-plane versus long axis/in-plane, a randomized controlled trial. J Vasc Access 2021; 23:589-597. [PMID: 33794708 DOI: 10.1177/11297298211006996] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the rate of successful peripheral cannulation between short-axis and long-axis ultrasound guided techniques. METHODS A single-center, two-arm randomized controlled, intention-to-treat, open-label study was conducted at the Emergency Department, between August and November 2020. Patients requiring a peripheral intravenous catheter insertion and identified as having a difficult intravascular access, were enrolled and followed for up to 96 h.The primary endpoint was the correct placement of the peripheral intravenous catheter. The secondary endpoints were number of venipunctures, intra-procedural pain, local complications, and positive blood return during the follow up. RESULTS A total of 283 patients were enrolled: 141 subjects were randomized to the short-axis and 142 to the long-axis group. Success rate was 96.45% (135/141; 95% CI, 91.92%-98.84%) in the short-axis group compared with 92.25% (132/142; 95% CI, 86.56%-96.07%) in the long-axis group (p = 0.126). No significant differences were found in terms of intraprocedural pain and local complications. Higher rate of positive blood return at 72 h [3/17 long-axis, 14/17 short-axis (p = 0.005)] and 96 h [1/10 long-axis, 9/10 short-axis 96 h, (p = 0.022)] was found for the short-axis group. CONCLUSIONS No differences were found between short-axis and long-axis techniques in terms of success rate, intraprocedural pain, and local complications. Despite this, a slightly higher success rate, a lower number of venipunctures, and a higher rate of positive blood return at 72 and 96 h together with an easier ultrasound technique could suggest a short-axis approach.
Collapse
Affiliation(s)
- Daniele Privitera
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Annamaria Mazzone
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Pierotti
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Airoldi
- Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alessandro Galazzi
- Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Geraneo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mattia Cozzi
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raquel Mora Garrido
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Vailati
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberta Scaglioni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gianluca Salinaro
- Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Alberto Dal Molin
- Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy.,Health Professions' Direction, Maggiore della Carità Hospital, Novara, Italy
| |
Collapse
|
29
|
Galazzi A, Giusti GD, Pagnucci N, Bambi S. Pain in Intensive Care Unit: Italian critical care nurses' best practice. Minerva Anestesiol 2021; 87:839-840. [PMID: 33591154 DOI: 10.23736/s0375-9393.21.15565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Gian D Giusti
- School of Nursing, University Hospital of Perugia, Perugia, Italy -
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Bambi
- Medical and Surgical Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | | |
Collapse
|
30
|
Liti A, Giusti GD, Gili A, Giontella M, Dell'Omo S, Camerlingo V, Fronteddu A, Galazzi A, Bambi S. Insertion of four different types of supraglottic airway devices by emergency nurses. A mannequin-based simulation study. Acta Biomed 2020; 91:e2020016. [PMID: 33263351 PMCID: PMC8023114 DOI: 10.23750/abm.v91i12-s.10832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND During medical emergencies, one of the main steps to improve patient outcomes is to achieve airway management. Orotracheal intubation is highly effective for advanced airway management, but it requires experienced health professionals. The use of a supraglottic airway device (SAD) is an acceptable alternative. AIM To assess which of the four considered SADs takes the shortest time and the lowest number of attempts to be correctly placed. The secondary aim was to evaluate the influence of some characteristics of the study population on time taken and number of attempts required. METHODS A crossover trial was conducted at the Advanced Medical Simulation Center of the University of Perugia (Italy) between June and September 2017. Eighty-three nurses were enrolled in the study. Each participant was asked to place four different SADs in a manikin: Laryngeal Tube Suction-D (LTS-D), i-gel™, Ambu® Laryngeal Mask AuraGain™ and LMA® Protector™ Cuff Pilot™. RESULTS The median insertion time for the different devices was: 8.0 seconds (s) for LTS-D, 6.0 s for i-gel, 5.4 s for AuraGain, 5.8 s for LMA Protector (p<0.05); the median number of insertion attempts was: 2 for LTS-D, 1 for i-gel, AuraGain and LMA Protector (p<0.05). There was no significant relationship between insertion time and attempts required and the participants' working experience, training, or knowledge of the devices. CONCLUSION With the exception of LTS-D, which had the worst performance, there was a high degree of homogeneity between the studied SADs in terms of time and attempts required to achieve correct placement.
Collapse
Affiliation(s)
| | - Gian Domenico Giusti
- Azienda Ospedaliero Universitaria di Perugia. Didactic Tutor. School of Nursing Department of Experimental Medicine University of Perugia .
| | - Alessio Gili
- PhD, Department of Experimental Medicine University of Perugia.
| | - Mirella Giontella
- Azienda Ospedaliero Universitaria di Perugia. School of Nursing Department of Medicine University of Perugia .
| | | | | | | | - Alessandro Galazzi
- Department of Anesthesia, Intensive Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy .
| | - Stefano Bambi
- Medical and Surgical Intensive Care Unit. Azienda Ospedaliero Universitaria Careggi, Florence.
| |
Collapse
|
31
|
Basile MC, Mauri T, Spinelli E, Dalla Corte F, Montanari G, Marongiu I, Spadaro S, Galazzi A, Grasselli G, Pesenti A. Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study. Crit Care 2020; 24:654. [PMID: 33225971 PMCID: PMC7682052 DOI: 10.1186/s13054-020-03344-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
Background Nasal high flow delivered at flow rates higher than 60 L/min in patients with acute hypoxemic respiratory failure might be associated with improved physiological effects. However, poor comfort might limit feasibility of its clinical use.
Methods We performed a prospective randomized cross-over physiological study on 12 ICU patients with acute hypoxemic respiratory failure. Patients underwent three steps at the following gas flow: 0.5 L/kg PBW/min, 1 L/kg PBW/min, and 1.5 L/kg PBW/min in random order for 20 min. Temperature and FiO2 remained unchanged. Toward the end of each phase, we collected arterial blood gases, lung volumes, and regional distribution of ventilation assessed by electrical impedance tomography (EIT), and comfort. Results In five patients, the etiology was pulmonary; infective disease characterized seven patients; median PaO2/FiO2 at enrollment was 213 [IQR 136–232]. The range of flow rate during NHF 1.5 was 75–120 L/min. PaO2/FiO2 increased with flow, albeit non significantly (p = 0.064), PaCO2 and arterial pH remained stable (p = 0.108 and p = 0.105). Respiratory rate decreased at higher flow rates (p = 0.014). Inhomogeneity of ventilation decreased significantly at higher flows (p = 0.004) and lung volume at end-expiration significantly increased (p = 0.007), but mostly in the non-dependent regions. Comfort was significantly poorer during the step performed at the highest flow (p < 0.001). Conclusions NHF delivered at rates higher than 60 L/min in critically ill patients with acute hypoxemic respiratory failure is associated with reduced respiratory rate, increased lung homogeneity, and additional positive pressure effect, but also with worse comfort.
Collapse
Affiliation(s)
- Maria Cristina Basile
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. .,Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Dalla Corte
- Intensive Care Unit, Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Giacomo Montanari
- Intensive Care Unit, Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Ines Marongiu
- Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy
| | - Savino Spadaro
- Intensive Care Unit, Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Alessandro Galazzi
- Direction of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy
| |
Collapse
|
32
|
Galazzi A, Brioni M, Mistraletti G, Roselli P, Abbruzzese C. End of life in the time of COVID-19: the last farewell by video call. Minerva Anestesiol 2020; 86:1254-1255. [DOI: 10.23736/s0375-9393.20.14906-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
33
|
Mistraletti G, Gristina G, Mascarin S, Iacobone E, Giubbilo I, Bonfanti S, Fiocca F, Fullin G, Fuselli E, Bocci MG, Mazzon D, Giusti GD, Galazzi A, Negro A, De Iaco F, Gandolfo E, Lamiani G, Del Negro S, Monti L, Salvago F, Di Leo S, Gribaudi MN, Piccinni M, Riccioni L, Giannini A, Livigni S, Maglione C, Vergano M, Marinangeli F, Lovato L, Mezzetti A, Drigo E, Vegni E, Calva S, Aprile A, Losi G, Fontanella L, Calegari G, Ansaloni C, Pugliese FR, Manca S, Orsi L, Moggia F, Scelsi S, Corcione A, Petrini F. How to communicate with families living in complete isolation. BMJ Support Palliat Care 2020:bmjspcare-2020-002633. [PMID: 33060189 DOI: 10.1136/bmjspcare-2020-002633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Abstract
IMPORTANCE During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals. OBJECTIVE This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient's relatives under circumstances of complete isolation. EVIDENCE REVIEW PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure. FINDINGS Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation. CONCLUSIONS AND RELEVANCE The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.
Collapse
Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy
| | - Giuseppe Gristina
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Roma, Italy
| | - Sara Mascarin
- Educational Services for Health and Social Development, Officina Comunicativa, Treviso, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Silvia Bonfanti
- Department of Palliative Care, Azienda USL di Piacenza, Piacenza, Italy
| | - Federico Fiocca
- Anestesia e Rianimazione 1, ASST Spedali Civili, Brescia, Italy
| | - Giorgio Fullin
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Ennio Fuselli
- UOC Anestesia Rianimazione 1 Dip.to Emergenza Accettazione, A. O. San Camillo-Forlanini, Roma, Italy
| | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Terapia Intensiva, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Davide Mazzon
- UOC Anestesia e Rianimazione, Ospedale di Belluno, Aulss 1 Dolomiti, Belluno, Italy
| | | | - Alessandro Galazzi
- Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Fabio De Iaco
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Enrico Gandolfo
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Giulia Lamiani
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Silvia Del Negro
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Laura Monti
- Servizio Psicologia Ospedaliera, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Fabrizia Salvago
- Dipartimento di Neuroscienze, Azienda Ospedaliera G Brotzu, Cagliari, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mariassunta Piccinni
- Department of Political Science, Law and International Studies, Università degli Studi di Padova, Padova, Italy
| | | | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Sergio Livigni
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Carla Maglione
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Napoli, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Franco Marinangeli
- Department of Anesthesiology and Intensive Care, University of L'Aquila, L'Aquila, Italy
| | - Luisa Lovato
- UO Anestesia e Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | | | - Elio Drigo
- Associazione Nazionale Infermieri di Area Critica (Aniarti), Udine, Italy
| | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Sally Calva
- Educational Services for Health and Social Development, Officina Comunicativa, Torino, Italy
| | - Anna Aprile
- Department of Molecular Medicine, Università degli Studi di Padova, Padova, Italy
| | | | - Lucia Fontanella
- Dipartimento di Scienze del Linguaggio e Letterature moderne e comparate, Università degli Studi di Torino, Torino, Italy
| | | | | | | | - Salvatore Manca
- SC Medicina e Chirurgia di Accettazione e di Urgenza, Ospedale di Oristano, Oristano, Italy
| | - Luciano Orsi
- Società Italiana di Cure Palliative (SICP), Milano, Italy
| | - Fabrizio Moggia
- DATeR Processo Assistenziale nelle Cure Palliative, Azienda USL di Bologna, Bologna, Italy
| | - Silvia Scelsi
- Dipartimento Infermieristico e delle professioni tecnico sanitarie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Antonio Corcione
- UOC Anestesia e TIPO, Azienda dei Colli, Ospedale Monaldi-Cotugno, Napoli, Italy
| | - Flavia Petrini
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, ASL2 - Chieti Pescara University, Chieti, Italy
| |
Collapse
|
34
|
Dalla Corte F, Mauri T, Spinelli E, Lazzeri M, Turrini C, Albanese M, Abbruzzese C, Lissoni A, Galazzi A, Eronia N, Bronco A, Maffezzini E, Pesenti A, Foti G, Bellani G, Grasselli G. Dynamic bedside assessment of the physiologic effects of prone position in acute respiratory distress syndrome patients by electrical impedance tomography. Minerva Anestesiol 2020; 86:1057-1064. [DOI: 10.23736/s0375-9393.20.14130-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Galazzi A, Bonasera Vincenti NM, Giusti GD, Brioni M, Adamini I, Laquintana D, Ristagno G, Grasselli G. The Medical Emergency Team in Italy: an overview of in-hospital emergencies response. Acta Biomed 2020; 91:9-18. [PMID: 32573502 PMCID: PMC7975838 DOI: 10.23750/abm.v91i6-s.9878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
Background and aim: Medical Emergency Team (MET), implemented in many hospitals worldwide, aims to improve the safety of in-hospital patients whose condition is deteriorating. This study describes MET presence and organization in the Italian National Healthcare System Hospitals. Methods: A national survey with an online questionnaire was performed. The questionnaire, created ad hoc, was sent by e-mail to the nursing coordinators and MET referents of the Hospitals affiliated to the Italian National Healthcare System with an Anesthesia and Intensive Care service. Results: One hundred-ninety-seven hospitals were interviewed (36.2% of the whole national network). A dedicated MET, composed at least by an intensivist and a nurse, was present only in 118 cases (59.9%). The team was composed by a non-dedicated staff (67.8% of doctors, 69.5% of nurses) and a minimum shared standard of education for the nurse component was absent. One third of the estimated hospitals did not use a warning score for emergency call activation. Discussion and conclusion: This survey showed a heterogenous and often lacking organization of in-hospital emergency management in Italy. MET system needs to be implemented in terms of presence in the Italian hospitals, and standardized for personnel structure and training, and equipment availability. A broader study is necessary to compare our data with those of other European Countries to better identify the specific areas which need to be improved more promptly. (www.actabiomedica.it)
Collapse
|
36
|
Di Mauro R, Di Silvio V, Bosco P, Laquintana D, Galazzi A. Case management programs in emergency department to reduce frequent user visits: a systematic review. Acta Biomed 2019; 90:34-40. [PMID: 31292413 PMCID: PMC6776176 DOI: 10.23750/abm.v90i6-s.8390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Inappropriate visits to the Emergency Department (ED) by frequent users (FU) are a common phenomenon because this service is perceived as a rapid and concrete answer to any health and social issue not necessarily related to urgent matters. Could Case Management (CM) programs be a suitable solution to address the problem? The purpose is to examine how CM programs are implemented to reduce the number of FU visits to the ED. METHODS PubMed, CINAHL and EMBASE were consulted up to December 2018. This review follows PRISMA guidelines for systematic review, as first outcomes were considered the impact of CM interventions on ED utilization, costs and composition of teams. RESULTS Fourteen studies were included and they showed patients with common characteristics but the FU definition wasn't the same. Twelve studies provided a reduction of ED utilization and seven studies a cost reduction. The main tool used is the individual care plan with telephone contact, supportive group therapy, facilitated contacts with healthcare providers and informatics system for immediate identification. The CM team composition is heterogeneous, even if nurses are considered the most used professional figures. CONCLUSIONS In contrast with a standardized method, a customized approach of CM program helps frequent users in finding an appropriate answer to their needs, thus decreasing inappropriate visits to the ED.
Collapse
|
37
|
Giusti GD, Reitano B, Lusignani M, Rasero L, Galazzi A. Italian in-hospital emergency number: A call for action. Resuscitation 2019; 140:84-85. [DOI: 10.1016/j.resuscitation.2019.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
|
38
|
Galazzi A, Panigada M. Microbiological colonization of healthcare workers' mobile phones in a tertiary-level Italian intensive care unit. Intensive Crit Care Nurs 2019; 53:112. [PMID: 30926173 DOI: 10.1016/j.iccn.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Alessandro Galazzi
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Mauro Panigada
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| |
Collapse
|
39
|
Galazzi A, Panigada M, Broggi E, Grancini A, Adamini I, Binda F, Mauri T, Pesenti A, Laquintana D, Grasselli G. Microbiological colonization of healthcare workers' mobile phones in a tertiary-level Italian intensive care unit. Intensive Crit Care Nurs 2019; 52:17-21. [PMID: 30737099 DOI: 10.1016/j.iccn.2019.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/07/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Careful hand hygiene of healthcare workers is recommended to reduce transmission of pathogenic microorganisms to patients. Mobile phones are commonly used during work shifts and may act as vehicles of pathogens. OBJECTIVE To assess the colonizsation rate of intensive care unit healthcare workers' mobile phones before and after work shifts. METHODS Prospective observational study conducted in an academic, tertiary-level intensive care unit. Healthcare workers (including doctors, nurses and healthcare assistants) had their mobile phones sampled for microbiology before and after work shifts. Samples were taken with a swab in a standardizsed modality. RESULTS Fifty healthcare workers participated in the study (91% of the department staff). One hundred swabs were taken from 50 mobile phones. Forty-three healthcare workers (86%) reported a habitual use of their phones during the work shift. All phones (100%) were positive for bacteria. The most frequently isolated bacteria were Coagulase Negative Staphylococci, Bacillus sp. and Methicillin-resistant Staphylococcus aureus (97%, 56%, 17%, respectively). No patient admitted to the intensive care unit during the study period was positive for bacteria found on healthcare workers' mobile phones. No difference in bacteria types and burden was found between the beginning and the end of work shifts. CONCLUSION Healthcare workers' mobile phones are colonized even before the work shift and irrespective of the patients' microbiological flora.
Collapse
Affiliation(s)
- Alessandro Galazzi
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Mauro Panigada
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Elena Broggi
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Anna Grancini
- Chemical-Clinical Analysis and Microbiology Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Ileana Adamini
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Filippo Binda
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Tommaso Mauri
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy.
| | - Antonio Pesenti
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy.
| | - Dario Laquintana
- Direction of Healthcare Professions Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Giacomo Grasselli
- Anesthesia, Intensive Care and Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy.
| |
Collapse
|
40
|
Lucchini A, Bambi S, Galazzi A, Elli S, Negrini C, Vaccino S, Triantafillidis S, Biancardi A, Cozzari M, Fumagalli R, Foti G. Unplanned extubations in general intensive care unit: A nine-year retrospective analysis. Acta Biomed 2018; 89:25-31. [PMID: 30539936 PMCID: PMC6502139 DOI: 10.23750/abm.v89i7-s.7815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/23/2022]
Abstract
Background and aim: Unplanned extubation (UE) in Intensive Care Units (ICU) is an indicator of quality and safety of care. UEs are classified in: accidental extubations, if involuntarily caused during nursing care or medical procedures; self-extubation, if determined by the patient him/herself. In scientific literature, the cumulative incidence of UEs varies from 0.3% to 35.8%. The aim of this study is to explore the incidence of UEs in an Italian university general ICU adopting a well-established protocol of tracheal tube nursing management and fixation. Methods: retrospective observational study. We enrolled all patients undergone to invasive mechanical ventilation from 1st January 2008 to 31st December 2016. Results: in the studied period 3422 patients underwent to endotracheal intubation. The UEs were 35: 33 self extubations (94%) and 2 accidental extubations (6%). The incidence of UEs calculated on 1497 patients intubated for more than 24 hours was 2.34%. Instead, it was 1.02%, if we consider the whole number of intubated patients. Only in 9 (26%) cases out of 35 UEs the patient was re-intubated. No deaths consequent to UE were recorded. Conclusions: The incidence of UEs in this study showed rates according to the minimal values reported in scientific literature. A standardized program of endotracheal tube management (based on an effective and comfortable fixing system) seems to be a safe and a valid foundation in order to maintain the UE episodes at minimum rates.
Collapse
Affiliation(s)
- Alberto Lucchini
- ASST Monza, Ospedale San Gerardo - università degli Studi di Milano-Bicocca.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Mauri T, Galazzi A, Binda F, Masciopinto L, Corcione N, Carlesso E, Lazzeri M, Spinelli E, Tubiolo D, Volta CA, Adamini I, Pesenti A, Grasselli G. Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula. Crit Care 2018; 22:120. [PMID: 29743098 PMCID: PMC5941611 DOI: 10.1186/s13054-018-2039-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The high-flow nasal cannula (HFNC) delivers up to 60 l/min of humidified air/oxygen blend at a temperature close to that of the human body. In this study, we tested whether higher temperature and flow decrease patient comfort. In more severe patients, instead, we hypothesized that higher flow might be associated with improved comfort. METHODS A prospective, randomized, cross-over study was performed on 40 acute hypoxemic respiratory failure (AHRF) patients (PaO2/FiO2 ≤ 300 + pulmonary infiltrates + exclusion of cardiogenic edema) supported by HFNC. The primary outcome was the assessment of patient comfort during HFNC delivery at increasing flow and temperature. Two flows (30 and 60 l/min), each combined with two temperatures (31 and 37 °C), were randomly applied for 20 min (four steps per patient), leaving clinical FiO2 unchanged. Toward the end of each step, the following were recorded: comfort by Visual Numerical Scale ranging between 1 (extreme discomfort) and 5 (very comfortable), together with respiratory parameters. A subgroup of more severe patients was defined by clinical FiO2 ≥ 45%. RESULTS Patient comfort was reported as significantly higher during steps at the lower temperature (31 °C) in comparison to 37 °C, with the HFNC set at both 30 and 60 l/min (p < 0.0001). Higher flow, however, was not associated with poorer comfort. In the subgroup of patients with clinical FiO2 ≥ 45%, both lower temperature (31 °C) and higher HFNC flow (60 l/min) led to higher comfort (p < 0.01). CONCLUSIONS HFNC temperature seems to significantly impact the comfort of AHRF patients: for equal flow, lower temperature could be more comfortable. Higher flow does not decrease patient comfort; at variance, it improves comfort in the more severely hypoxemic patient.
Collapse
Affiliation(s)
- Tommaso Mauri
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alessandro Galazzi
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Filippo Binda
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Laura Masciopinto
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Nadia Corcione
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Eleonora Carlesso
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy
| | - Marta Lazzeri
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Daniela Tubiolo
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Ileana Adamini
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Antonio Pesenti
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy. .,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Giacomo Grasselli
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| |
Collapse
|
42
|
Mauri T, Galazzi A, Binda F, Masciopinto L, Corcione N, Carlesso E, Lazzeri M, Spinelli E, Tubiolo D, Volta CA, Adamini I, Pesenti A, Grasselli G. Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula. Crit Care 2018. [PMID: 29743098 DOI: 10.1186/s13054‐018‐2039‐4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The high-flow nasal cannula (HFNC) delivers up to 60 l/min of humidified air/oxygen blend at a temperature close to that of the human body. In this study, we tested whether higher temperature and flow decrease patient comfort. In more severe patients, instead, we hypothesized that higher flow might be associated with improved comfort. METHODS A prospective, randomized, cross-over study was performed on 40 acute hypoxemic respiratory failure (AHRF) patients (PaO2/FiO2 ≤ 300 + pulmonary infiltrates + exclusion of cardiogenic edema) supported by HFNC. The primary outcome was the assessment of patient comfort during HFNC delivery at increasing flow and temperature. Two flows (30 and 60 l/min), each combined with two temperatures (31 and 37 °C), were randomly applied for 20 min (four steps per patient), leaving clinical FiO2 unchanged. Toward the end of each step, the following were recorded: comfort by Visual Numerical Scale ranging between 1 (extreme discomfort) and 5 (very comfortable), together with respiratory parameters. A subgroup of more severe patients was defined by clinical FiO2 ≥ 45%. RESULTS Patient comfort was reported as significantly higher during steps at the lower temperature (31 °C) in comparison to 37 °C, with the HFNC set at both 30 and 60 l/min (p < 0.0001). Higher flow, however, was not associated with poorer comfort. In the subgroup of patients with clinical FiO2 ≥ 45%, both lower temperature (31 °C) and higher HFNC flow (60 l/min) led to higher comfort (p < 0.01). CONCLUSIONS HFNC temperature seems to significantly impact the comfort of AHRF patients: for equal flow, lower temperature could be more comfortable. Higher flow does not decrease patient comfort; at variance, it improves comfort in the more severely hypoxemic patient.
Collapse
Affiliation(s)
- Tommaso Mauri
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alessandro Galazzi
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Filippo Binda
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Laura Masciopinto
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Nadia Corcione
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Eleonora Carlesso
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy
| | - Marta Lazzeri
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Daniela Tubiolo
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Ileana Adamini
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Antonio Pesenti
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy. .,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Giacomo Grasselli
- Anesthesia and Critical Care, Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| |
Collapse
|
43
|
Binda F, Galazzi A, Brambilla A, Adamini I, Laquintana D. [Risk factors for delirium in intensive care unit<BR>in liver transplant patients]. Assist Inferm Ric 2017; 36:90-97. [PMID: 28652635 DOI: 10.1702/2721.27754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
. Risk factors for delirium in intensive care unit in liver transplant patients. INTRODUCTION Delirium is a disorder of the state of consciousness characterized by acute onset and temporal variability of cognitive abilities. It is frequent in intensive care unit (ICU) and it is associated with worst outcomes. AIM To identify risk factors for the development of delirium in patients in intensive care unit (ICU) after orthotopic liver transplantation (OLTx). METHODS Observational retrospective study on all the patients undergoing OLTx between January 2014 and December 2015. The daily assessment for delirium was performed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), by nemed nurses. RESULTS Of the 123 patients included, 15 (12.2%) developed post-operative delirium. The main risk factor was preoperative hepatic encephalopathy (OR = 8.80, 95% CI 2.70-28.59): the deterioration of the state of consciousness (GCS pre-OLTx score < 15) increased the risk of developing delirium (OR 6.18; IC 95% 1.51 - 25.31). A high Acute Physiologic and Health Evaluation (APACHE II) score (OR=1.29, IC 95%: 1.12-1.47) showed how patients with a more severe clinical situation at ICU admission were more likely to develop delirium. CONCLUSIONS The risk factors identified predict the development of delirium in ICU. Its prevention with the implementation of pharmacological or other strategies may reduce the onset of delirium and improve the quality of care.
Collapse
|
44
|
Karavana V, Smith I, Kanellis G, Sigala I, Kinsella T, Zakynthinos S, Liu L, Chen J, Zhang X, Liu A, Guo F, Liu S, Yang Y, Qiu H, Grimaldi DG, Kaya E, Acicbe O, Kayaalp I, Asar S, Dogan M, Eren G, Hergunsel O, Pavelescu D, Grintescu I, Mirea L, Guanziroli M, Gotti M, Marino A, Cressoni M, Vergani G, Chiurazzi C, Chiumello D, Gattinoni L, Guanziroli M, Gotti M, Vergani G, Cressoni M, Chiurazzi C, Marino A, Spano S, Chiumello D, Gattinoni L, Guanziroli M, Gotti M, Vergani G, Marino A, Cressoni M, Chiurazzi C, Chiumello D, Gattinoni L, Massaro F, Moustakas A, Johansson S, Larsson A, Perchiazzi G, Zhang XW, Guo FM, Chen JX, Xue M, Yang Y, Qiu HB, Chen JX, Liu L, Yang L, Zhang XW, Guo FM, Yang Y, Qiu HB, Fister M, Knafelj R, Suzer MA, Kavlak ME, Atalan HK, Gucyetmez B, Cakar N, Weller D, Grootendorst AF, Dijkstra A, Kuijper TM, Cleffken BI, Regli A, De Keulenaer B, Van Heerden P, Hadfield D, Hopkins PA, Penhaligon B, Reid F, Hart N, Rafferty GF, Grasselli G, Mauri T, Lazzeri M, Carlesso E, Cambiaghi B, Eronia N, Maffezzini E, Bronco A, Abbruzzese C, Rossi N, Foti G, Bellani G, Pesenti A, Bassi GL, Panigada M, Ranzani O, Kolobow T, Zanella A, Cressoni M, Berra L, Parrini V, Kandil H, Salati G, Livigni S, Livigni S, Amatu A, Girardis M, Barbagallo M, Moise G, Mercurio G, Costa A, Vezzani A, Lindau S, Babel J, Cavana M, Torres A, Panigada M, Bassi GL, Ranzani OT, Kolobow T, Zanella A, Cressoni M, Berra L, Parrini V, Kandil H, Salati G, Livigni S, Amatu A, Girardis M, Barbagallo M, Moise G, Mercurio G, Costa A, Vezzani A, Lindau S, Babel J, Cavana M, Torres A, Umbrello M, Taverna M, Formenti P, Mistraletti G, Vetrone F, Marino A, Vergani G, Baisi A, Chiumello D, Garnero AG, Novotni DN, Arnal JA, Urner M, Fan E, Dres M, Vorona S, Brochard L, Ferguson ND, Goligher EC, Leung C, Joynt G, Wong W, Lee A, Gomersall C, Poels S, Casaer M, Schetz M, Van den Berghe G, Meyfroidt G, Holzgraefe B, Von Kobyletzki LB, Larsson A, Cianchi G, Becherucci F, Batacchi S, Cozzolino M, Franchi F, Di Valvasone S, Ferraro MC, Peris A, Phiphitthanaban H, Wacharasint P, Wongsrichanalai V, Lertamornpong A, Pengpinij O, Wattanathum A, Oer-areemitr N, Boddi M, Cianchi G, Cappellini E, Ciapetti M, Batacchi S, Di Lascio G, Bonizzoli M, Cozzolino M, Peris A, Lazzeri C, Cianchi G, Bonizzoli M, Di Lascio G, Cozzolino M, Peris A, Katsin ML, Hurava MY, Dzyadzko AM, Hermann A, Schellongowski P, Bojic A, Riss K, Robak O, Lamm W, Sperr W, Staudinger T, Buoninsegni LT, Bonizzoli M, Cozzolino M, Parodo J, Ottaviano A, Cecci L, Corsi E, Ricca V, Peris A, de Garibay APR, Ende-Schneider B, Schreiber C, Kreymann B, Turani F, Resta M, Niro D, Castaldi P, Boscolo G, Gonsales G, Martini S, Belli A, Zamidei L, Falco M, Lamas T, Mendes J, Galazzi A, Mauri T, Benco B, Binda F, Masciopinto L, Lazzeri M, Carlesso E, Lissoni A, Grasselli G, Adamini I, Pesenti A, Thamjamrassri T, Watcharotayangul J, Numthavaj P, Kongsareepong S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Mohamed A, Sklar M, Munshi L, Mauri T, Lazzeri M, Alban L, Turrini C, Panigada M, Taccone P, Carlesso E, Marenghi C, Spadaro S, Grasselli G, Volta C, Pesenti A, Higuera J, Alonso DC, Blandino A, Narváez G, González LR, Aroca M, Saéz S, De Pablo R, Franci A, Stocchi G, Cappuccini G, Socci F, Cozzolino M, Guetti C, Rastrelli P, Peris A, Nestorowicz A, Glapinski J, Fijalkowska-Nestorowicz A, Wosko J, Fijalkowska-Nestorowicz A, Glapinski J, Wosko J, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Ollieuz S, Reychler G, Bonus T, Duprez F, Cuvelier G, Mashayekhi S, Ollieuz S, Reychler G, Kuchyn I, Bielka K, Sergienko A, Jones H, Day C, Park SC, Yeom SR, Myatra SN, Gupta S, Rajnala V, Divatia J, Silva JV, Olvera OA, Schulte RC, Bermudez MC, Zorrilla LP, Ferretis HL, García KT, Balciuniene N, Ramsaite J, Kriukelyte O, Krikscionaitiene A, Tamosuitis T, Terragni P, Brazzi L, Falco D, Pistidda L, Magni G, Bartoletti L, Mascia L, Filippini C, Ranieri V, Kyriakoudi A, Rovina N, Koltsida O, Konstantellou E, Kardara M, Kostakou E, Gavriilidis G, Vasileiadis I, Koulouris N, Koutsoukou A, Van Snippenburg W, Kröner A, Flim M, Buise M, Hemler R, Spronk P, Regli A, Noffsinger B, De Keulenaer B, Singh B, Hockings L, Van Heerden P, Spina C, Bronco A, Magni F, Di Giambattista C, Vargiolu A, Bellani G, Foti G, Citerio G, Scaramuzzo G, Spadaro S, Waldmann AD, Böhm SH, Ragazzi R, Volta CA, Heines SJ, Strauch U, Van de Poll MC, Roekaerts PM, Bergmans DC, Sosio S, Gatti S, Maffezzini E, Punzi V, Asta A, Foti G, Bellani G, Glapinski J, Mroczka J, Nestorowicz A, Fijalkowska-Nestorowicz A, Yaroshetskiy AI, Rezepov NA, Mandel IA, Gelfand BR, Ozen E, Karakoc E, Ayyildiz A, Kara S, Ekemen S, Yelken BB, Saasouh W, Freeman J, Turan A, Hajjej Z, Sellami W, Bousselmi M, Samoud W, Gharsallah H, Labbene I, Ferjani M, Vetrugno L, Barbariol F, Forfori F, Regeni I, Della Rocca G, Jansen D, Jonkman A, Doorduin J, Roesthuis L, Van der Hoeven J, Heunks L, Marocco SA, Bottiroli M, Pinciroli R, Galanti V, Calini A, Gagliardone M, Bellani G, Fumagalli R, Gatti S, Abbruzzese C, Ippolito D, Sala VL, Meroni V, Bronco A, Foti G, Bellani G, Elbanna M, Nassar Y, Abdelmohsen A, Yahia M, Mongodi S, Mojoli F, Via G, Tavazzi G, Fava F, Pozzi M, Iotti GA, Bouhemad B, Ruiz-Ferron F, Simón JS, Gordillo-Resina M, Chica-Saez V, Garcia MR, Vela-Colmenero R, Redondo-Orts M, Gontijo-Coutinho C, Ozahata T, Nocera P, Franci D, Santos T, Carvalho-Filho M, Fochi O, Gatti S, Nacoti M, Signori D, Bronco A, Bonacina D, Bellani G, Bonanomi E, Mongodi S, Bonvecchio E, Stella A, Roldi E, Orlando A, Luperto M, Bouhemad B, Iotti GA, Mojoli F, Trunfio D, Licitra G, Martinelli R, Vannini D, Giuliano G, Vetrugno L, Forfori F, Näslund E, Lindberg LG, Lund I, Larsson A, Frithiof R, Nichols A, Freeman J, Pentakota S, Kodali B, Pranskunas A, Kiudulaite I, Simkiene J, Damanskyte D, Pranskuniene Z, Arstikyte J, Vaitkaitis D, Pilvinis V, Brazaitis M, Pool R, Haugaa H, Botero A, Escobar D, Maberry D, Tønnessen T, Zuckerbraun B, Pinsky M, Gomez H, Lyons H, Trimmings A, Domizi R, Scorcella C, Damiani E, Pierantozzi S, Tondi S, Monaldi V, Carletti A, Zuccari S, Adrario E, Pelaia P, Donati A, Kazune S, Grabovskis A, Volceka K, Rubins U, Bol M, Suverein M, Delnoij T, Driessen R, Heines S, Delhaas T, Vd Poll M, Sels J, Jozwiak M, Chambaz M, Sentenac P, Richard C, Monnet X, Teboul JL, Bitar Z, Maadarani O, Al Hamdan R, Huber W, Malbrain M, Chew M, Mallat J, Tagami T, Hundeshagen S, Wolf S, Huber W, Mair S, Schmid R, Aron J, Adlam M, Dua G, Mu L, Chen L, Yoon J, Clermont G, Dubrawski A, Duhailib Z, Al Assas K, Shafquat A, Salahuddin N, Donaghy J, Morgan P, Valeanu L, Stefan M, Provenchere S, Longrois D, Shaw A, Mythen MG, Shook D, Hayashida D, Zhang X, Munson SH, Sawyer A, Mariyaselvam M, Blunt M, Young P, Nakwan N, Khwannimit B, Checharoen P, Berger D, Moller P, Bloechlinger S, Bloch A, Jakob S, Takala J, Van den Brule JM, Stolk R, Vinke E, Van Loon LM, Pickkers P, Van der Hoeven JG, Kox M, Hoedemaekers CW, Werner-Moller P, Jakob S, Takala J, Berger D, Bertini P, Guarracino F, Colosimo D, Gonnella S, Brizzi G, Mancino G, Baldassarri R, Pinsky MR, Bertini P, Gonnella S, Brizzi G, Mancino G, Amitrano D, Guarracino F, Goslar T, Stajer D, Radsel P, De Vos R, Dijk NBV, Stringari G, Cogo G, Devigili A, Graziadei MC, Bresadola E, Lubli P, Amella S, Marani F, Polati E, Gottin L, Colinas L, Hernández G, Vicho R, Serna M, Canabal A, Cuena R, Jozwiak M, Gimenez J, Teboul JL, Mercado P, Depret F, Richard C, Monnet X, Hajjej Z, Sellami W, Sassi K, Gharsallah H, Labbene I, Ferjani M, Herner A, Schmid R, Huber W, Abded N, Nassar Y, Elghonemi M, Monir A, Nikhilesh J, Apurv T, Uber AU, Grossestreuer A, Moskowitz A, Patel P, Holmberg MJ, Donnino MW, Graham CA, Hung K, Lo R, Leung LY, Lee KH, Yeung CY, Chan SY, Trembach N, Zabolotskikh I, Caldas J, Panerai R, Camara L, Ferreira G, Almeida J, de Oliveira GQ, Jardim J, Bor-Seng-Shu E, Lima M, Nogueira R, Jatene F, Zeferino S, Galas F, Robinson T, Hajjar LA, Caldas J, Panerai R, Ferreira G, Camara L, Zeferino S, Jardim J, Bor-Seng-Shu E, Oliveira M, Norgueira R, Groehs R, Ferreira-Santos L, Galas F, Oliveira G, Almeida J, Robinson T, Jatene F, Hajjar L, Ferreira G, Ribeiro J, Galas F, Gaiotto F, Lisboa L, Fukushima J, Rizk S, Almeida J, Jatene F, Osawa E, Franco R, Kalil R, Hajjar L, Chlabicz M, Sobkowicz B, Kaminski K, Kazimierczyk R, Musial W, Tycińska A, Siranovic M, Gopcevic A, Gavranovic ZG, Horvat AH, Krolo H, Rode B, Videc L, Trifi A, Abdellatif S, Ismail KB, Bouattour A, Daly F, Nasri R, Lakhal SB, Beurton A, Teboul JL, Girotto V, Galarza L, Richard C, Monnet X, Beurton A, Teboul JL, Girotto V, Galarza L, Richard C, Monnet X, Girotto V, Teboul JL, Beurton A, Galarza L, Guedj T, Monnet X, Galarza L, Mercado P, Teboul JL, Girotto V, Beurton A, Richard C, Monnet X, Iliæ MK, Sakic L, NN V, Stojcic L, Jozwiak M, Depret F, Teboul JL, Alphonsine J, Lai C, Richard C, Monnet X, Tapanwong N, Chuntupama P, Wacharasint P, Huber W, Hoellthaler J, Lahmer T, Schmid R, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Skladzien T, Cicio M, Garlicki J, Serednicki W, Wordliczek J, Vargas P, Salazar A, Mercado P, Espinoza M, Graf J, Kongpolprom N, Sanguanwong N, Jonnada S, Gerrard C, Jones N, Morley T, Thorburn PT, Trimmings A, Musaeva T, Zabolotskikh I, Salazar A, Vargas P, Mercado P, Espinoza M, Graf J, Horst S, Lipcsey M, Kawati R, Pikwer A, Rasmusson J, Castegren M, Shilova A, Yafarova A, Gilyarov M, Shilova A, Yafarova A, Gilyarov M, Stojiljkovic DLL, Ulici A, Reidt S, Lam T, Jancik J, Ragab D, Taema K, Farouk W, Saad M, Liu X, Holmberg MJ, Uber A, Montissol S, Donnino M, Andersen LW, Perlikos F, Lagiou M, Papalois A, Kroupis C, Toumpoulis I, Osawa E, Carter D, Sardo S, Almeida J, Galas F, Rizk S, Franco R, Hajjar L, Landoni G, Kongsayreepong S, Sungsiri R, Wongsripunetit P, Marchio P, Guerra-Ojeda S, Gimeno-Raga M, Mauricio MD, Valles SL, Aldasoro C, Jorda A, Aldasoro M, Vila JM, Borg UB, Neitenbach AM, García M, González PG, Romero MG, Orduña PS, Cano AG, Rhodes A, Grounds RM, Cecconi M, Lee C, Hatib F, Jian Z, Rinehart J, De Los Santos J, Canales C, Cannesson M, García MIM, Hatib F, Jian Z, Scheeren T, Jian Z, Hatib F, Pinsky M, Chantziara V, Vassi A, Michaloudis G, Sanidas E, Golemati S, Bateman RM, Mokhtar A, Omar W, Aziz KA, El Azizy H, Nielsen DLL, Holler JG, Lassen A, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Capoletto C, Almeida J, Ferreira G, Fukushima J, Nakamura R, Risk S, Osawa E, Park C, Oliveira G, Galas F, Franco R, Hajjar L, Dias F, D’Arrigo N, Fortuna F, Redaelli S, Zerman L, Becker L, Serrano T, Cotes L, Ramos F, Fadel L, Coelho F, Mendes C, Real J, Pedron B, Kuroki M, Costa E, Azevedo L. 37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3). Crit Care 2017. [PMCID: PMC5374603 DOI: 10.1186/s13054-017-1628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
45
|
Galazzi A, Rancati S, Milos R. [A survey of accidents during the clinical rotation of students in a nursing degree program]. G Ital Med Lav Ergon 2014; 36:25-31. [PMID: 24665625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Like Registered Nurses, students too should be considered a risk category during the period of their clinical training. Their lack of experience and the anxiety linked to the first impact with healthcare techniques may lead to accidents. The present study aims to investigate the number, the type, the mode, the cause of occupational injuries, when and where they happened. It also wants to check the level of knowledge of procedures to follow in case of contamination with organic material, the reporting of the event, the level of concern felt by the student and which of the people he/she turned to were supportive. The survey realized through a questionnaire given to 142 undergraduate nursing students at the University of Milan, all attending the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan. Out of the 127 who replied to the questionnaire, 32 had been directly involved in a total of 38 accidents. The figure shows percentage (25.2%) stating that the sample of nursing students described arises at a lower level of involvement in accidents than reported in the literature for similar series. Preventive measures and specific formative interventions should be implemented in order to reduce the incidence of accidents involving nursing students, especially where cutting devices are used.
Collapse
MESH Headings
- Accidental Falls/prevention & control
- Accidental Falls/statistics & numerical data
- Accidents, Occupational/prevention & control
- Accidents, Occupational/statistics & numerical data
- Adult
- Air Pollution, Indoor
- Ambulatory Care Facilities
- Blood-Borne Pathogens
- Education, Nursing, Baccalaureate
- Female
- Health Knowledge, Attitudes, Practice
- Health Surveys
- Humans
- Italy/epidemiology
- Male
- Middle Aged
- Needlestick Injuries/epidemiology
- Needlestick Injuries/prevention & control
- Occupational Exposure/prevention & control
- Prevalence
- Risk Factors
- Students, Nursing/statistics & numerical data
- Surveys and Questionnaires
- Wounds, Penetrating/epidemiology
- Wounds, Penetrating/prevention & control
Collapse
|