ObjectiveTo construct and implement an instrument (checklist) to improve safety when
performing the prone maneuver.MethodsThis was an applied, qualitative and descriptive study. The instrument was
developed based on a broad review of the literature pertaining to the
construction of a care protocol using the main electronic databases
(MEDLINE, LILACS and Cochrane).ResultsWe describe the construction of a patient safety tool with numerous
modifications and adaptations based on the observations of the
multidisciplinary team regarding its use in daily practice.ConclusionThe use of the checklist when performing the prone maneuver increased the
safety and reliability of the procedure. The team's understanding of the
tool's importance to patient safety and training in its use are necessary
for its success.
SUMMARY Last year, interest in prone positioning to treat acute respiratory distress syndrome (ARDS) resurfaced with the demonstration of a reduction in mortality by a large randomized clinical trial. Reports in the literature suggest that the incidence of adverse events is significantly reduced with a team trained and experienced in the process. The objective of this review is to revisit the current evidence in the literature, discuss and propose the construction of a protocol of care for these patients. A search was performed on the main electronic databases: Medline, Lilacs and Cochrane Library. Prone positioning is increasingly used in daily practice, with properly trained staff and a well established care protocol are essencial.
BackgroundControl of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level. However, many patients are still diagnosed late with TB at hospitals. The present study aimed to investigate the delay in diagnosis of TB patients at the emergency department.MethodsThis was a prospective study in a general, tertiary care, university-affiliated hospital of a city with a high prevalence of TB in Brazil. New TB patients ≥ 14 years diagnosed with pulmonary TB at the emergency department of Hospital de Clínicas de Porto Alegre were prospectively recruited between February 2010 and January 2012. The consenting patients meeting our inclusion criteria were interviewed using a pre-tested questionnaire. We evaluated the delay in time until diagnosis and identified factors associated with delayed diagnosis (patient and health care system delays).ResultsWe included 153 patients. The median total time of delay, patient delay, and health care system delay were 60 (interquartile range [IQR]: 30–90.5 days), 30 (lQR: 7–60 days), and 18 (IQR: 9–39.5 days) days, respectively. The factors that were independently associated with patient delay (time ≥ 30 days) were crack (odds ratio [OR] = 4.88, p = 0.043) and cocaine (OR = 6.68, p = 0.011) use. The factors that were independently associated with health care system delay (time ≥ 18 days) were weight loss (OR = 2.76, p = 0.025), miliary pattern (OR = 5.33, p = 0.032), and fibrotic changes (OR = 0.12, p = 0.013) on chest X-ray.ConclusionsPatient delay appears to be the main problem in this city with a high prevalence of TB in Brazil. The main factor associated with patient delay is drug abuse (crack and cocaine). Our study shows substance abuse programs need to be aware of control of TB, with health interventions focusing on TB education programs.
To compare the effects of vibrocompression and hyperinflation with mechanical
ventilator techniques alone and in combination (hyperinflation with
mechanical ventilator + vibrocompression) on the amount of aspirated
secretion and the change in hemodynamic and pulmonary parameters.
A randomized clinical trial with critically ill patients on mechanical
ventilation conducted in the intensive care unit of a university hospital.
The patients were randomly allocated to receive one of the bronchial hygiene
techniques for 10 minutes (vibrocompression or hyperinflation with
mechanical ventilator or hyperinflation with mechanical ventilator +
vibrocompression). Afterwards, the patients were again randomly allocated to
receive either the previous randomly allocated technique or only tracheal
aspiration. The weight of aspirated secretions (in grams), ventilatory
mechanics and cardiopulmonary data before and after the application of the
techniques were analyzed. The tracheal reintubation frequency and time and
mortality on mechanical ventilation were also evaluated.
A total of 93 patients (29 vibrocompression, 32 hyperinflation with
mechanical ventilator and 32 hyperinflation with mechanical ventilator +
vibrocompression) on mechanical ventilation for more than 24 hours were
included. The hyperinflation with mechanical ventilator + vibrocompression
group was the only one that presented a significant increase in aspirated
secretions compared to tracheal aspiration alone [0.7g (0.1 - 2.5g)
0.2g (0.0 - 0.6g), p value = 0.006].
Compared to tracheal aspiration alone, the combination of hyperinflation with
mechanical ventilator + vibrocompression techniques was most efficient for
increasing the amount of aspirated secretions.
OBJECTIVE: To evaluate the prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients, describing the major clinical syndromes diagnosed and the outcomes of the patients. METHODS: A cross-sectional study conducted in the emergency room of a tertiary care university hospital. Between November of 2008 and November of 2009, we reviewed the total number of emergency room visits per day. Children and adults who presented with at least one respiratory symptom were included in the study. The electronic medical records were reviewed, and the major characteristics of the patients were recorded. RESULTS: During the study period, there were 37,059 emergency room visits, of which 11,953 (32.3%) were motivated by respiratory symptoms. The prevalence of emergency room visits due to respiratory symptoms was 28.7% and 38.9% among adults and children, respectively. In adults, the rates of hospitalization and mortality were 21.2% and 2.7%, respectively, compared with 11.9% and 0.3%, respectively, in children. Among the adults, the time from symptom onset to emergency room visit correlated positively with the need for hospitalization (p < 0.0001), the length of the hospital stay (p < 0.0001), and the mortality rate (p = 0.028). CONCLUSIONS: We found a high prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients. Our results could inform decisions regarding the planning of prevention measures. Further epidemiological studies are needed in order to clarify the risk factors for severe respiratory symptoms.
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