Objective:To identify and integrate the available scientific evidence related to the use of the prone position in patients with acute respiratory distress syndrome for the reduction of the outcome variable of mortality compared to the dorsal decubitus position. Method: Overview of systematic reviews or meta-analyzes of randomized clinical trials. It included studies that evaluated the use of prone positioning in patients with acute respiratory distress syndrome published between 2014 and 2016. The AMSTAR tool was used to determine the methodological quality of studies. The GRADE system was used to establish the overall quality of evidence for the mortality outcome. Results: From the search strategy, were retrieved seven relevant manuscripts of high methodological quality. Conclusion: Scientific evidence supports that combined use of protective ventilatory strategy and prone positioning for periods between 16 and 20 hours in patients with acute respiratory distress syndrome and PaO2/FiO2 ratio lower than 150 mm/Hg results in significant reduction of mortality rate. DESCRIPTORSCritical Care; Prone Position; Respiratory Distress Syndrome, Adult; Evidence-Based Nursing; Evidence-Based Practice; Review.Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviews Efetividade da posição prona na síndrome do desconforto respiratório agudo: overview de revisões sistemáticas Efectividad de la posición prona en el síndrome de dificultad respiratoria aguda: overview de revisiones sistemáticas Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviewsRev Esc Enferm USP · 2017;51:e03251 INTRODUCTIONAcute Respiratory Distress Syndrome (ARDS) is a potentially devastating form of hypoxemic respiratory failure caused by acute inflammatory lung injury (1) . Its characteristics are the sudden onset, presence of a triggering factor (diffuse bilateral pulmonary infiltrate), and normally there is no left heart failure (non-cardiogenic pulmonary edema) or circulatory overload (2) . In 2012, was proposed a new model for the standardization of diagnostic concepts of acute respiratory distress syndrome that took into account the severity of the disease (ARDS Definition Task Force). The name of the recommendation is Berlin Definition, and patients with ARDS are stratified into three categories, namely: mild ( . ARDS is a high incidence phenomenon in the field of intensive care. In this regard, 29,144 patients admitted to intensive care units were evaluated in a multicenter, international and prospective cohort study. It was found that 3,022 patients (10.4%) met the clinical criteria for ARDS. Of these, 2,377 patients developed the disease within the first 48 hours and required invasive ventilatory support to suppress severe acute respiratory failure. The mortality rate was directly proportional to the severity of disease, as follows: 35% among patients with mild ARDS, 40% among patients with moderate ARDS, and 46% for patients with severe ARDS. Incidence r...

Objective: to evaluate the training of nurses in the use of ultrasound in peripheral venipuncture. Method: descriptive research of quantitative approach performed with nurses as part of an analytical cross-sectional study in two patient care centers: an intensive care unit and an adult emergency center. Results: the results showed contributions of training for professional skill and visibility of nurses, requiring, however, more time for complete assimilation of this technological innovation as a safer clinical practice. Conclusion: as the use of this technology represents an innovation aimed to facilitate diffi cult venipuncture and to provide subsidies to the most appropriate clinical decision-making, it is urgent to qualify nurses for its use. Descriptors: Evidence-based Nursing; Technology; Training; Ultrasound; Peripheral Catheterization. RESUMO Objetivo: avaliar a capacitação dos enfermeiros para o uso da tecnologia da ultrassonografi a na punção venosa periférica. Método: pesquisa descritiva de abordagem quantitativa, realizada com enfermeiros como etapa de um estudo transversal analítico em dois centros de atendimento ao paciente crítico: uma unidade de terapia intensiva e uma unidade de pronto atendimento adulto. Resultados: os resultados demonstraram contribuições da capacitação na habilidade e visibilidade profi ssional dos enfermeiros, com necessidade, entretanto, de maior tempo de vivência e aprendizado dos participantes para o domínio e assimilação desta inovação tecnológica enquanto prática clínica mais segura. Conclusão: na medida em que o uso desta tecnologia representa uma inovação destinada a facilitar o procedimento de punção venosa de difícil acesso e prover subsídios à tomada da decisão clínica mais adequada para cada paciente, faz-se premente à enfermagem capacitar-se para o seu uso. Descritores: Enfermagem Baseada em Evidências; Tecnologia; Capacitação; Ultrassonografi a; Cateterismo Periférico. RESUMEN Objetivo: evaluar la capacitación de enfermeros para el uso de la tecnología de la ecografía en la punción venosa periférica. Método: estudio descriptivo con enfoque cuantitativo realizado con enfermeros como una etapa de un estudio analítico transversal en dos centros de atención a pacientes en estado crítico: una unidad de cuidados intensivos y una unidad de emergencia para adultos. Resultados: los resultados mostraron contribuciones de la capacitación en las habilidades y la visibilidad profesional de los enfermeros. Sin embargo, se necesita más tiempo de experiencia y de aprendizaje de los participantes para alcanzar el dominio y asimilar esta innovación tecnológica como una práctica clínica más segura. Conclusión: en la medida en que el uso de esta tecnología es una innovación para facilitar el procedimiento de punción venosa de difícil acceso y proporcionar subsidios para tomar la decisión clínica más adecuada para cada paciente, la capacitación de la enfermería es urgente para utilizar tal tecnología. Descriptores: Enfermería Basada en la Evidencia; Tecnología; Capacitación...

RESUMO: O objetivo deste estudo foi analisar os fatores associados ao sucesso na primeira tentativa de punção venosa periférica guiada por ultrassonografia em adultos. Estudo transversal analítico em uma unidade de pronto atendimento na região sul do Brasil, entre 1º e 30 de abril de 2015. Os participantes foram submetidos à punção venosa periférica guiada por ultrassonografia. Foram incluídos 97 participantes. A razão de prevalência de sucesso foi 43% maior nas veias visíveis e 128% maior nas veias retilíneas. Não foi encontrada relação significativa entre as variáveis analisadas e a diminuição da prevalência de sucesso na primeira tentativa. A presença de veia retilínea e visível foi o principal fator associado ao sucesso na primeira tentativa. DESCRITORES: Enfermagem baseada em evidências; Tecnologia biomédica; Pesquisa em enfermagem clínica; Cateterismo periférico; Ultrassonografia.PUNÇÃO VENOSA PERIFÉRICA GUIADA POR ULTRASSONOGRAFIA:PREVALÊNCIA DE SUCESSO E FATORES ASSOCIADOS* ULTRASOUND-GUIDED PERIPHERAL VENIPUNCTURE: PREVALENCE OF SUCCESS AND ASSOCIATED FACTORSABSTRACT: The objective of this study was to analyze factors associated with a successful first attempt to ultrasound-guided peripheral venipuncture in adults. An analytical cross-sectional study was carried out in an emergency care unit in the South region of Brazil in April 2015. The participants were submitted to ultrasound-guided peripheral venipuncture. Ninety-seven participants were included. The prevalence ratio of success was 43% higher in visible veins and 128% higher in rectilinear veins. No significant association was found between the variables analyzed and the reduction of the prevalence of success at the first attempt. No se encontró diferencia significativa entre las variables analizadas y la disminución de la prevalencia de éxito en el primer intento. La presencia de vena rectilínea y visible fue el principal factor asociado al éxito en el primero intento.

Objetivo: Identificar las evidencias producidas en la literatura sobre la efectividad de la ultrasonografía para el éxito en la punción venosa con relación al método tradicional de punción. <br /><br />Método: Se realizó una revisión integradora de literatura en las bases de datos Lilacs y PubMed, en el período de enero de 2009 a febrero de 2015. Fueron incluidas publicaciones en portugués, inglés o español, que contemplaron los objetivos y/o el tema de la investigación en el título o resumen y que utilizaron revisiones sistemáticas, ensayos clínicos o estudios observacionales como metodología. <br /><br />Resultados: Compuesto por 16 artículos, con alto nivel de evidencia, que refuerzan la efectividad de la ultrasonografía para la punción venosa periférica difícil. Hubo reducción del número de intentos de punción cuando se usó la ultrasonografía. La tasa de éxito con el uso de la ultrasonografía quedó entre 70% y 99% y varió de acuerdo con características demográficas (sexo, edad y color de la piel), clínicas (diámetro y profundidad de la vena) y operacionales (elección del catéter y habilidad del profesional que realiza el procedimiento). <br /><br />Conclusión: La ultrasonografía puede aumentar el éxito de este procedimiento, pero es necesario obtener más evidencias sobre el tiempo gastado y el número de intentos para lograr el éxito. La habilidad del operador del equipo ultrasonográfico, así como las características clínicas, técnicas y operacionales se revelaron como factores importantes que deben ser tenidos en cuenta para una punción venosa más efectiva y segura.<br /><br />

Introduction:The Intensive Care Unit (ICU) is a disembodied place, in which the patient experiences fears and uncertainties about their serious organic disease, with deprivation of sensory stimuli and their autonomy. Therefore, humanizing care in this environment requires multidisciplinary engagement, with patient-centered treatment, based on psychosocial interventions that will complement the medication, extrapolating the biological aspect and alleviating the patient's emotional suffering. Method: This article deals with the ICU experience report of a Brazilian municipal hospital, where professionals work in a humane way with affective stimulation activities, such as affective records, extended family presence, pet visitation and music circles. Observations occurred through family reports during and after hospitalization and through the experience of professionals. Results: Many positive aspects were observed in the evolution of patients, such as: decrease in delirium, use of sedatives, greater control of pain and anxiety, and fewer episodes of depersonalization. There was also greater interaction between staff, patient and family. Conclusion:Bringing humanization to care is essential to help the person recover and return, as much as possible, to their normal conception of life, with integrity of body, soul and spirit. With the purpose of focusing care on respect, empathy and humanization, affective stimulation strategies are increasingly studied and guided within ICUs. The American College of Critical Care Medicine recommends the presence expanded and flexible family as part of the treatment of critically ill patients. Pets are increasingly included in assistance, providing a reduction in pain, suffering and fatigue; and music brings benefits such as calming and reducing anxiety.