Abstract Introduction: Nursing staffing in adult intensive care has been at a ratio of two patients per nurse or one patient for one nurse. Currently, patients require complex and specialized care that provides safety and reduces Healthcare-Associated Infections. Objective: Evidencing the importance of equipping nursing personnel according to the severity of the patient compared to the nurse-patient ratio in order to reduce Healthcare-Associated Infections in patients in the adult intensive care unit. Methodology: This is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted from September 2021 to March 2022. The databases PubMed, ScienceDirect, Epistemonikos and CUIDEN were used, and the following terms were utilized, i.e., nursing personnel, patient severity, nurse-patient ratio, healthcare-associated infections, and the Boolean operators AND, OR, and WITH. The sample consisted of 8 studies that were assessed using the Critical Reading Cards (FLC 3.0) and graded according to the National Institute for Health and Care Excellence. Results: Staffing according to patient severity compared to the nurse-patient indicator reduced healthcare-associated infections, mortality, sepsis occurrence, and medication errors. The impact on patients and nursing personnel showed improved quality of care and reduced burnout and work stress, which benefited the patient. Conclusion: It is important to provide nursing personnel according to the severity of the patient and with personnel having an academic level of at least a bachelor's degree in order to improve the quality of care and reduce healthcare-associated infections.

Abstrato Introdução: A equipe de enfermagem na terapia intensiva de adultos tem estado em uma proporção de dois pacientes para um enfermeiro ou um paciente para um enfermeiro. Atualmente, os pacientes que chegam exigem cuidados complexos e especializados que ofereçam segurança e reduzam as infecções associadas à assistência à saúde. Objetivo: Demonstrar a importância do dimensionamento do pessoal de enfermagem de acordo com a gravidade do paciente em comparação com o indicador enfermeiro-paciente, para reduzir as infecções associadas à assistência à saúde em pacientes adultos internados em unidades de terapia intensiva. Metodologia: Revisão sistemática com base nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses, realizada entre setembro de 2021 e março de 2022, mediante os bancos de dados PubMed, ScienceDirect, Epistemonikos e CUIDEN, e usando os seguintes termos: pessoal de enfermagem, gravidade do paciente, relação enfermeiro-paciente, infecções associadas à assistência à saúde, operadores AND, OR, WITH. A amostra consistiu em 8 estudos, avaliados usando os programas Critical Reading Card e classificados de acordo com o Instituto Nacional de Excelência em Saúde e Cuidados. Resultados: O dimensionamento de profissionais de acordo com a gravidade do paciente, em comparação com o indicador enfermeiro-paciente, reduziu as infecções associadas à assistência à saúde, mortalidade, ocorrência de sepse e erros de medicação. O impacto sobre os pacientes e o pessoal de enfermagem mostrou uma melhor qualidade de atendimento, redução do esgotamento e do estresse no trabalho, o que beneficiou o paciente. Conclusão: É importante fornecer pessoal de enfermagem de acordo com a gravidade do paciente e com pessoal com nível acadêmico de, no mínimo, bacharelado, a fim de melhorar a qualidade do atendimento e reduzir as infecções associadas à assistência à saúde.

Resumen Introducción: Dotar al personal de enfermería en la terapia intensiva adultos ha sido en proporción dos pacientes por enfermera o 1:1. Actualmente, los pacientes que ingresan requieren cuidados complejos y especializados que proporcionen seguridad y disminución de infecciones asociadas a la atención en salud. Objetivo: Evidenciar la importancia de dotar al personal de enfermería según gravedad del paciente comparado con indicador enfermera-paciente para disminuir infecciones asociadas a la atención en salud en pacientes de la unidad de terapia intensiva adultos. Metodología: Revisión sistemática, basada en la declaración Preferred Reporting Items for Sistematyc Reviews and Meta-analyses, realizada en septiembre 2021 a marzo 2022, se utilizaron las bases de datos PubMed, ScienceDirect, Epistemonikos y CUIDEN, empleando términos: personal de enfermería, gravedad del paciente, relación enfermero-paciente, infecciones asociadas a la atención a la salud, operadores boléanos AND, OR, WITH. La muestra fue de 8 estudios, evaluados mediante los programas de Fichas de Lectura Crítica y gradados según el National Institute for Health and Care Excellence. Resultados: Dotar de personal según gravedad del paciente comparado con indicador enfermera-paciente disminuyó infecciones asociadas a la atención en salud, mortalidad, aparición de sepsis y errores en la medicación. Las repercusiones en pacientes y personal de enfermería mostraron mejor calidad de la atención, disminución de agotamiento y estrés laboral lo que benefició al paciente. Conclusión: Es importante dotar al personal de enfermería según gravedad del paciente, con personal de nivel académico licenciatura para mejorar la calidad de atención y disminuir las infecciones asociadas a la atención en salud.

Resumen El presente es un estudio retrospectivo, observacional, cuantitativo y descriptivo. Se evaluó la utilidad de la proteína C reactiva (PCR), la procalcitonina (PCT) y la relación PCR/PCT como marcadores de riesgo de sepsis, sumados al aclaramiento a las 72 h, como pronóstico de mortalidad y permanencia en unidades de cuidados intensivos (UCI). Se incluyeron 23 pacientes. Se clasificaron según qSOFA y se elaboraron curvas ROC. Se obtuvo un área bajo la curva de 0,79 para PCT. El valor umbral de PCT>0,88 ng/mL predice riesgo de sepsis con 77,78% de sensibilidad y 83,33% de especificidad. Utilizando PCR<31,23 mg/dL se obtuvo como parámetros destacados un 88,89% de sensibilidad y 83,33% de valor predictivo negativo, sin diferencias significativas (Mann-Whitney p<0,05) entre los grupos de sobrevivientes y óbitos y estadía prolongada vs. no prolongada. Se postula PCR como screening y PCT como marcador de riesgo de sepsis.

Resumo Este é um estudo retrospectivo, observacional, quantitativo e descritivo. Foi avaliada a utilidade da proteína C reativa (PCR), da procalcitonina (PCT) e da relação PCR/PCT como marcadores de risco de sepse junto com o clareamento em 72 horas, como preditores de mortalidade e permanência em unidades de terapia intensiva (UTI). Vinte e três pacientes foram incluídos. Eles foram classificados de acordo com o qSOFA e foram elaboradas curvas ROC, destacando uma área sob a curva de 0,79 para PCT. O valor limite de PCT>0,88 ng/mL prediz o risco de sepse com sensibilidade de 77,78% e especificidade de 83,33%. Utilizando PCR>31,23 mg/dL, obtiveram-se como parâmetros em destaque 88,89% de sensibilidade e 83,33% de valor preditivo negativo. Não houve diferenças significativas (Mann-Whitney p<0,05) entre os grupos de sobreviventes e óbitos e permanência prolongada vs. não prolongada. A PCR é postulada como triagem e a PCT como marcador de risco de sepse.

Abstract This is a retrospective, observational, quantitative and descriptive study. The utility of C reactive protein (CRP), procalcitonin (PCT) and the CRP/PCT ratio as sepsis risk markers was evaluated and these, added to clearance at 72 hours, as predictors of mortality and permanence in intensive care units (ICU). Twenty-three patients were included. They were classified according to qSOFA, and ROC curves were prepared, highlighting an area under the curve of 0.79 for PCT. The threshold value of PCT>0.88 ng/mL predicts the of sepsis with 77.78% sensitivity and 83.33% specificity. Using CRP>31.23 mg/dL, 88.89% sensitivity and 83.33% negative predictive value were obtained as outstanding parameters. No significant differences (Mann-Whitney p<0.05) were found between survivors and dead and prolonged vs. non-prolonged stay groups. CRP is postulated for screening and PCT as a sepsis risk marker.

Resumen Introducción : Los pacientes críticamente enfermos a menudo desarrollan el Síndrome Post-Cuidados Inten sivos (PICS). Las pautas actuales de sedación se basan principalmente en agentes intravenosos. Los sedantes inhalados son una alternativa prometedora con farma cocinética favorable y beneficios potenciales en entor nos de cuidados críticos. Sin embargo, su aplicación en América Latina sigue sin explorarse. Métodos : Estudio de serie de casos que incluyó a pa cientes adultos de UCI que recibieron sedación profunda con sevoflurano utilizando el dispositivo conservador anestésico SEDANA. Se recopilaron datos demográficos, protocolos de sedación, eventos adversos y resultados. El análisis estadístico evaluó los cambios en el tiempo en los parámetros de laboratorio. Resultados : Se incluyeron once pacientes, a quienes se les administró sevoflurano a través de vías respi ratorias artificiales. Se incluyeron once pacientes, a quienes se les administró sevoflurano a través de vías respiratorias artificiales. La sedación inhalada llevó a la cesación exitosa de sedantes intravenosos en 10 de los 11 pacientes, con una reducción de al menos 30% la dosis de opioides. No se observaron efectos adversos significativos. Las barreras para la adherencia incluyeron problemas relacionados con el dispositivo y desafíos en la capacitación del personal de salud. Conclusión : El sevoflurano logró de manera efectiva los objetivos de sedación en pacientes de UCI, redu ciendo la necesidad de sedantes y opioides adicionales. Nuestros hallazgos respaldan la seguridad y eficacia de los sedantes inhalados en entornos de UCI y resaltan la importancia de una mayor investigación en esta área. Se necesitan estudios a más largo plazo para determinar completamente el impacto de los sedantes inhalados en pacientes de UCI.

Abstract Introduction : Critically ill patients often develop the Post-Intensive Care Syndrome (PICS). Current se dation guidelines mainly rely on intravenous agents. Inhaled sedatives are a promising alternative with favorable pharmacokinetics and potential benefits in critical care settings. However, their application in Latin America remains unexplored. Methods : Case-series study that included adult ICU patients who underwent deep sedation with se voflurane using the SEDANA anesthetic conserving device. Data on demographics, sedation protocols, adverse events, and outcomes were collected. Statisti cal analysis assessed changes over time in laboratory parameters. Results : Eleven patients were included, with sevoflu rane administered via artificial airways. Inhaled sedation led to the successful cease of intravenous sedatives in 10 of 11 patients, and reduction of at least 30% in opioid dose. No significant adverse effects were observed. Ba rriers to adherence included device-related issues and challenges in healthcare staff training. Conclusion : Sevoflurane effectively achieved sedation goals in ICU patients, reducing the need for additional sedatives and opioids. Our findings support the safety and efficacy of inhaled sedatives in ICU settings and highlight the importance of further research in this area. Longer-term studies are needed to fully determine the impact of inhaled sedatives in ICU patients.

Abstract This research arises from the Final Graduation Project to opt for the Bachelor's degree in Teaching Social Studies and Civic Education at the University of Costa Rica. This seeks to describe the role of Human Rights Education in the imprisonment experience of ninth-year incarcerated students based on the knowledge of their rights, duties and norms, in the Reynaldo Villalobos Zúñiga Comprehensive Care Unit, in Alajuela, Costa Rica, during the 2021-2022 school year. For this, a qualitative approach of exploratory scope is carried out through the use of the in-depth interview information collection technique, with three students from the Integrated Center for Adult Education (CINDEA), located within the Reynaldo Villalobos Zúñiga penitentiary center. The main results show the positive impact of human rights education for the student deprived of liberty, promoting the development of theoretical and coexistence tools, development of values and attitudes in the search for the defense of their rights, healthy coexistence and skills to reintegration process. It is concluded that the role of the EDH has been notably positive since it promotes a critical position towards respect for rights within the penal center.

Resumen La presente investigación surge a partir del Trabajo Final de Graduación para optar por el grado de Licenciatura en la Enseñanza de los Estudios Sociales y la Educación Cívica en la Universidad de Costa Rica. En este se busca describir el papel de la Educación en Derechos Humanos en la experiencia en reclusión de estudiantes privados de libertad de noveno año, a partir del conocimiento de sus derechos, deberes y normas, en la Unidad de Atención Integral Reynaldo Villalobos Zúñiga, en Alajuela, Costa Rica, durante el ciclo lectivo 2021- 2022. Para esto, se realiza un abordaje desde lo cualitativo de alcance exploratorio mediante la utilización de la técnica de recolección de información de entrevista a profundidad con tres estudiantes del Centro Integrado de Educación para Adultos (CINDEA), ubicado dentro del centro penitenciario Reynaldo Villalobos Zúñiga. Los principales resultados evidencian el impacto positivo de la educación en derechos humanos para el estudiante privado de libertad, al promover el desarrollo de herramientas teóricas y de convivencias, desarrollo de valores y actitudes en la búsqueda de la defensa de sus derechos, convivencia sana y habilidades para proceso de reinserción. Se concluye que el papel de la EDH ha sido positivo de manera notable ya que promueve un posicionamiento crítico hacia el respeto de los derechos dentro del centro penal.

Abstract: High-frequency oscillatory ventilation with volume guarantee (HFOV-VG) is a ventilatory mode that controls small tidal volumes at supraphysiological frequencies, potentially beneficial for preterm infants with respiratory distress syndrome (RDS). Objective: To identify the physiological and clinical effects of HFOV-VG in preterm newborns with RDS, compared with conventional HFOV. Method: Exploratory review of studies published between 2019 and 2023 of preterm newborns from 23 to 36 weeks of gestation with RDS, weighing ≥ 450g, with invasive HFOV support, using PRISMA flow diagram. For their critical evaluation, the MINORS and PEDro scales were used. Results: 1,386 articles were initially identified, of which 7 articles were selected. Compared with conventional HFOV, the use of lower tidal volumes (VThf) and higher respiratory rate stands out, as well as better and more stable gas exchange, both as an elective or early rescue strategy in preterm newborns with RDS. Furthermore, an inverse relationship is observed between VThf and respiratory rate. Conclusion: HFOV-VG, used in preterm neonates with RDS, consistently improves oxygenation and ventilation compared with conventional HFOV. Control and reduction of VThf could provide additional lung protection.

Resumen: La ventilación de alta frecuencia (VAF) con volumen garantizado es un modo ventilatorio que controla pequeños volúmenes corriente a frecuencias suprafisiológicas, potencialmente beneficioso para prematuros con síndrome de dificultad respiratoria (SDR). Objetivo: Identificar los efectos fisiológicos y clínicos de la VAF con volumen garantizado en recién nacidos pretérmino con SDR, en comparación con VAF convencional. Método: Revisión exploratoria de estudios publicados entre 2019 y 2023, de recién nacidos prematuros de 23 a 36 semanas de gestación con SDR, con un peso ≥ 450 g soportados con VAF invasiva, utilizando diagrama de flujo PRISMA. Para su evaluación crítica se utilizaron las escalas MINORS y PEDro. Resultados: Se identificaron inicialmente 1,386 artículos, de los cuales se seleccionaron 7 artículos. En comparación con VAF convencional destaca el uso de menores volúmenes corriente (VThf) y mayores frecuencias respiratorias, un intercambio de gases mejor y más estable, tanto como estrategia electiva o de rescate temprano en recién nacidos prematuros con SDR. Además se observa una relación inversa entre VThf y frecuencia respiratoria. Conclusión: La VAF con volumen garantizado, aplicada en recién nacidos prematuros con SDR, consistentemente mejora la oxigenación y ventilación en comparación con la VAF convencional. El control y la reducción de VThf pudiera proporcionar una protección pulmonar adicional.

BACKGROUND. Mental health conditions such as depression, anxiety and post-traumatic stress disorder (PTSD) are being increasingly recognised as common adverse outcomes for critical illness survivors. These conditions can have lasting consequences on their wellbeing, ability to return to their pre-illness level of functioning and health-related quality of life. There is a paucity of South African data in terms of the psychological aspects of the post-intensive care unit (ICU) syndrome. OBJECTIVE. To identify and characterise patients who suffered from significant symptoms of mental health disease and poor mental health-related quality of life after ICU admission and who may benefit from appropriate referral, further investigation and medical intervention. METHODS. Critically ill patients in a multidisciplinary tertiary ICU were prospectively enrolled upon ICU discharge. Survivors were screened for anxiety, depression and post-traumatic stress syndrome at 6 weeks and 6 months after hospital discharge. The Hospital Anxiety and Depression Score (HADS) and the Impact Of Events Scale - Revised (IES-R) were used as screening tools. The mental component summary score (MCS) of the RAND short form-36 was used to determine the effect of psychological symptoms on health-related quality of life (HRQOL). RESULTS. The median age of the 107 ICU survivors was 42 years, and half of them were admitted for complications of COVID-19. Six out of every 10 ICU survivors experienced significant symptoms of anxiety, depression and/or PTSD at follow-up. At the 6-month study visit, 4 out of every 10 patients were experiencing significant psychological symptoms. Those affected had a significantly lower mental HRQOL when compared with those who were unaffected. More than half of those affected had co-occurrence of psychological symptoms. Significant symptoms of anxiety were common, with 5 out of every 10 participants experiencing significant symptoms at either, or both, of the study visits. More than 3 out of 10 of affected patients' symptoms only occurred after the 6-week visit. Associations for significant psychological symptoms comprised female sex, younger age, a diagnosis of trauma and frightening memories of the ICU admission. CONCLUSION. The burden of mental health disease in ICU survivors is substantial, affecting their HRQOL. Six out of 10 patients experienced symptoms of anxiety, depression and PTSD, and more than half of those affected experienced co-occurrence of the conditions. A third of those affected developed these symptoms only beyond 6 weeks after hospital discharge. A potentially modifiable association with psychological symptoms was frightening memories of the ICU stay.

BACKGROUND. Healthcare-associated infections (HAI) are a major problem globally, contributing to prolonged hospital admissions and poor outcomes. OBJECTIVE. To examine HAI incidence and risk factors in an intensive care unit (ICU) during high v. low occupancy periods. METHODS. This retrospective, descriptive analysis investigated HAI incidence among adult patients admitted to the ICU at Chris Hani Baragwanath (CHBH) during a high (H2019) and low (L2020) occupancy. Data were extracted from the clinical records of 440 eligible patients. RESULTS. We found an increased risk of HAI during H2019 compared with L2020 (relative risk (RR) 1.42, 95% confidence interval (CI) 1.03 - 1.94). The overall frequency density of HAI was 25/1 000 ICU days. There was no difference in the distribution of the site of infection (blood v. other) (p=0.27) or bacterial category (Gram stain) (p=0.62). Five organisms accounted for 89% of pathogens: Klebsiella (26%), Staphylococcus (21%), Acinetobacter (16%), Candida (16%) and Enterobacter (10%). The incidence of multidrug-resistant/extensively drug-resistant (MDR/XDR) organisms was 4.2-fold higher (95% CI 1.3 - 13.4) during H2019 compared with L2020. Logistic regression analysis revealed two independent predictors of nosocomial infection: ICU length of stay (odds ratio (OR) 1.12, 95% CI 1.02 - 1.22) and intercostal drain duration in days (OR 1.27, 95% CI 1.09 - 1.47). CONCLUSION. High occupancy in the ICU was associated with an increased risk of HAI and a greater incidence of MDR and XDR pathogens. Increasing ICU length of stay and invasive device duration were independent predictors of HAI.

BACKGROUND. Melioidosis cases are increasing in Southeast Asia, posing a significant challenge owing to the rising number of diabetic and immune-compromised patients. Pneumonia is the most common presentation of melioidosis, while cutaneous melioidosis is rare. OBJECTIVE. We report a case of primary cutaneous melioidosis (PCM) that eventually required intensive care unit (ICU) management. METHOD. We describe the case of a 33-year-old male with uncontrolled diabetes mellitus who initially presented with a skin lesion, which was followed by gradual multiorgan involvement diagnosed as melioidosis based on culture-positive results from blood and synovial fluid, and needed ICU admission. RESULTS. He was successfully treated with intravenous antibiotics and invasive mechanical ventilation after ICU admission. CONCLUSION. Cutaneous melioidosis can lead to ICU admission and, if untreated, has a high fatality rate. Faster diagnostic methods like VITEK 2 Compact and MALDI TOF substantially reduce delays in initiating required treatment.

BACKGROUND. Nurses working in intensive care units (ICUs) must incorporate new knowledge and evidence-based practice (EBP) into their daily routines to enhance patient outcomes. However, this integration often falls short in ICU settings. Weekly clinical audits reveal incidents where ICU nurses neglect evidence-based interventions, impacting patient outcomes and ICU stays. OBJECTIVE. To explore the factors influencing the translation of knowledge into ICU practice. METHODS. We conducted exploratory, qualitative research to investigate ICU nurses' perspectives on knowledge translation into ICU practices. The study employed purposive sampling to select ICU nurses. We used paired interviews and group discussions to gather insights from ICU nurses regarding the factors influencing the translation of knowledge into ICU practices. Data analysis was performed using Boomer and McCormack's nine steps of creative hermeneutic data analysis. RESULTS. One main theme, 'We are just surviving' emerged, encompassing two sub-themes: management and workplace culture. Under management, participants described barriers, such as resource scarcity, behaviour, outdated evidence-informed protocols and workload. Under workplace culture, participants mentioned negative attitudes and a lack of teamwork, contributing to poor-quality care. CONCLUSION. In ICUs, nurses are expected to integrate new knowledge and scientific evidence into their daily practice, yet they face challenges in doing so. Interventions should be implemented to address management and workplace culture.

RESUMEN Introducción: La creciente ocupación de la unidad de cuidados intensivos (UCI) y los avances en la medicina de cuidados críticos han dado como resultado una población de sobrevivientes en constante expansión. La discapacidad experimentada puede retrasar el regreso a las actividades laborales y modificar la dinámica familiar habitual, lo que conlleva importantes consecuencias financieras y sociales. Presentación: Trece pacientes ingresaron a la UCI de nuestro centro con requerimiento de ventilación mecánica invasiva, recibieron seguimiento en la sala de internación general hasta su externación y continuaron con un seguimiento telefónico a los tres, seis y doce meses del alta. Los datos corresponden a un subanálisis sobre calidad de vida y capacidad funcional en 101 pacientes pos-UCI (Clinical trials: NCT05149430). Conclusión: En un año, solo 4 de 10 pacientes regresaron a una situación laboral activa. La literatura reporta que el tiempo durante el cual sostienen sus nuevos trabajos es breve, y se estima que vuelvan a quedar desempleados en pocos meses. En cuanto al grupo familiar, no hemos encontrado reportes similares; sin embargo, observamos que 4 pacientes requirieron un cuidador o centro de rehabilitación a los seis meses.

ABSTRACT Introduction: The increasing admission to the intensive care unit (ICU) and advancements in critical care have resulted in an ever-expanding population of survivors. Disability can delay the return to work and change the usual family dynamics, leading to important financial and social consequences. Case presentation: Thirteen patients were admitted to the ICU of our center with a requirement for invasive mechanical ventilation, received follow-up in the general ward until discharge, and continued with telephone follow-up at three, six, and twelve months after discharge. The data pertain to a sub-analysis of quality of life and functional capacity in 101 post-ICU patients (Clinical trials: NCT05149430). Conclusion: Within one year, only 4 out of 10 patients returned to an active work situation. The literature reports that the duration for which they hold their new jobs is brief, and it is estimated that they will become unemployed again in a few months. Regarding the family group, we have not found similar reports; however, we observed that 4 patients required a caregiver or rehabilitation center at six months.

Resumen Introducción: El Síndrome de Burnout se ha vuelto expresivo en la pandemia de la Covid-19, con consecuencias en la vida personal y profesional de los enfermeros. Objetivo: Reconocer la percepción de los comportamientos de Síndrome de Burnout por parte de enfermeros en Medicina Intensiva, después de la pandemia de Covid-19; estudiar las relaciones entre las variables independientes y el nivel de Síndrome de Burnout. Métodos: Estudio transversal y analítico basado en los resultados del Inventario de Burnout de Copenhague, en una muestra de 61 enfermeros, en su mayoría mujeres (70,5%) y con edades comprendidas entre los 21 y los 45 años. Resultados: Se reconocieron conductas de Síndrome de Burnout, según la percepción de las enfermeras de Medicina Intensiva: el 42,6% de la muestra percibió un elevado Síndrome de Burnout. Existieron relaciones estadísticamente significativas entre las variables sociodemográficas y profesionales y el nivel de Síndrome de Burnout percibido. El 73,8% percibió conductas de Síndrome de Burnout relacionadas con el trabajo, el 60,7% percibió Síndrome de Burnout a nivel personal y el 19,7% de la muestra percibió Síndrome de Burnout relacionado con la interacción con el paciente. Conclusión: El alto nivel de Síndrome de Burnout percibido por los enfermeros en el contexto laboral y personal e, incluso, en la interacción con el enfermo, fundamenta aquí la propuesta: la experiencia de intensidad y cercanía personal con el enfermo merece especial atención, en términos de formación y, sobre todo, asistencia específica para el cribado de la evolución de Síndrome de Burnout y de cualquier signo predepresivo.

Resumo Introdução: A Síndrome de Burnout, tornou-se expressiva, na pandemia de Covid-19, com consequências na vida pessoal e profissional dos enfermeiros. Objetivo: Reconhecer a perceção de comportamentos da Síndrome de Burnout, por enfermeiros em Medicina Intensiva, pós pandemia Covid-19; analisar as relações entres as variáveis sociodemográficas e profissionais e o nível da Síndrome de Burnout. Método: Estudo transversal e analítico, a partir dos resultados da aplicação Copenhagen Burnout Inventory, numa amostra de 61 enfermeiros, maioritariamente do sexo feminino (70.5%) e com idades entre 21 e 45 anos. Resultados: Foram reconhecidos comportamentos da Síndrome de Burnout, segundo a perceção dos enfermeiros em Medicina Intensiva: 42.6% da amostra percecionou Síndrome de Burnout elevado. Verificaram-se relações estatisticamente significativas entres as variáveis sociodemográficas e profissionais e o nível da Síndrome de Burnout percecionado. 73.8% perceciona comportamentos da Síndrome de Burnout relativos ao trabalho, 60.7% percecionam Síndrome de Burnout a nível pessoal e 19.7% da amostra perceciona Síndrome de Burnout relativo à interação com o doente. Conclusão: O nível elevado da Síndrome de Burnout percecionado pelos enfermeiros em contexto laboral e pessoal e, até na interação com o doente, fundamentam a proposta que aqui se coloca: a experiência de intensidade e proximidade pessoal com o doente, merece neste momento uma atenção especial em termos de formação e, sobretudo, atendimento específico para despiste de evolução da Síndrome de Burnout e quaisquer sinaléticas pré depressivas.

Abstract Introduction: The Burnout Syndrome has become expressive during COVID-19 pandemic, with consequences for nurses in their personal and professional lives. Objective: To recognize the perception of Burnout Syndrome behaviors among intensive care unit nurses in the post-pandemic period; to study the relationship between independent variables and the level of Burnout Syndrome. Methods: Cross-sectional, analytic study based on the results of the Copenhagen Burnout Inventory application in a sample of 61 nurses, mostly female (70.5%) and aged between 21 and 45 years old. Results: Burnout Syndrome behaviors were recognized, according to the perception of Intensive Care Medicine nurses: 42.6% of the sample perceived high Burnout Syndrome. There were statistically significant relationships between sociodemographic and professional variables and the level of Burnout Syndrome perceived. 73.8% perceived Burnout Syndrome behaviors related to work, 60.7% perceived Burnout Syndrome at a personal level, and 19.7% of the sample perceived Burnout Syndrome related to interaction with the patient. Conclusion: Nurses precepted high Burnout Syndrome levels in their work and personal lives and even related to interaction with patients, which substantiates the proposal presented in this study: the experience of intensive and personal proximity with patients deserves special attention in terms of training at this point, and, above all, specific assistance needs to be addressed to identify Burnout Syndrome and other pre-depressive signs.

Resumen Introducción: La comunicación es la base de la interacción humana, y por consiguiente una herramienta fundamental en cualquier institución. Los profesionales de la salud que proporcionan cuidado en los Servicios de Medicina Intensiva (UCI) a veces tienen dificultades para comunicarse con los pacientes críticos, por lo que es fundamental adaptar estrategias que faciliten el proceso de comunicación, como la Comunicación Aumentativa y Alternativa (CAA). Objetivo: Evaluar el conocimiento de los profesionales sanitarios sobre la comunicación con el enfermo crítico, identificando las barreras y los facilitadores de la comunicación. Métodos: Se realizó una revisión de la literatura científica y se elaboró un cuestionario sobre “Comunicación con el Enfermo Crítico”, que luego se aplicó a una muestra de 46 profesionales de la salud de la UCI. Resultados: 89% de los profesionales de la muestra consideran la comunicación un recurso primario en la prestación de cuidados, 63% desconocen la CAA, 91% tienen dificultad para entender lo que transmite el paciente y 52% se sienten frustrados por no poder establecer una comunicación bidireccional. Las principales barreras a la comunicación mencionadas fueron la falta de formación en técnicas de comunicación, la falta de recursos materiales y el estado de conciencia del paciente. Conclusión: Los profesionales de la salud tienen lagunas de conocimiento al comunicarse con los enfermos críticos, sin embargo, según la literatura, la adopción de herramientas y estrategias de CAA, así como acciones de capacitación, se han confirmado como una importante estrategia de aprendizaje en la transmisión de conocimientos.

Resumo Introdução: A comunicação é a base da interação humana sendo uma ferramenta essencial em qualquer instituição. Os profissionais de saúde que prestam cuidados em Serviços de Medicina Intensiva (SMI) deparam-se com dificuldades na comunicação com o doente crítico sendo essencial a adaptação de estratégias facilitadoras do processo comunicativo, tal como a Comunicação Aumentativa e Alternativa (CAA). Objetivo: Avaliar os conhecimentos dos profissionais de saúde sobre comunicação com o doente crítico e identificar as barreiras e os facilitadores comunicativos. Métodos: Elaborada uma revisão da literatura científica e desenvolveu-se e aplicou-se um questionário sobre “Comunicação com o Doente Crítico” a uma amostra constituída por 46 profissionais de saúde do SMI. Resultados: Constatou-se que 89% considera a comunicação uma ferramenta chave na prestação de cuidados, 63% desconhece a CAA, 91% sentem dificuldade em compreender o que o doente transmite e 52% sentem-se frustrados por não conseguir estabelecer uma comunicação bidirecional. As principais barreiras à comunicação referidas foram a falta de formação sobre técnicas comunicacionais, a inexistência de recursos materiais e o estado de consciência do doente. Conclusão: Os profissionais de saúde apresentam lacunas no conhecimento sobre comunicação com o doente crítico, contudo segundo a literatura a adoção de ferramentas e estratégias de CAA e ações de formação confirmam-se como uma estratégia de aprendizagem importante na transmissão de conhecimentos.

Abstract Introduction: Communication is the basis of human interaction and, therefore, an essential tool in any institution. Health professionals who provide care in Intensive Medicine Services (ICU) sometimes struggle to communicate with critically ill patients, making it essential to adopt strategies that facilitate the process of communication, such as Augmentative and AlternativeCommunication(AAC). Objective: Evaluate the knowledge of health professionals about communication with the critically ill while identifying barriers and communication facilitators. Methods: A review of the scientific literature was carried out, and a questionnaire on “Communication with the Critically Ill” was developed and then applied to a sample of 46 health professionals from the ICU. Results: 89% of the sample professionals consider communication a primary resource in providing care, 63% are unaware of the AAC, 91% struggle with understanding what the patient transmits, and 52% feel frustrated for being unable to establish bidirectional communication. The main barriers to communication mentioned were the lack of training in communication techniques, the lack of material resources, and the patient's state of consciousness. Conclusion: Health professionals have knowledge gaps when communicating with the critically ill; however, according to the literature, the adoption of AAC tools and strategies, as well as training actions, have been confirmed as an important learning strategy in the transmission of knowledge.

ABSTRACT Objective: To evaluate the effect of early active mobilization (EAM) compared to active usual care (AUC) in critically ill adult subjects regarding muscle strength and functional status. Materials and methods: A systematic review with meta-analysis were conducted. Randomized clinical trials comparing EAM with AUC in subjects >18 years of age, of both sexes, in critical condition during or after the period of mechanical ventilation in the intensive care unit (ICU) were included. The search was performed in the Cochrane, Medline/Pubmed, Embase (Elsevier), SciELO, LILACS/BVS, www.controlled-trials.com/, clinicaltrials.gov/, and www.who.int/ictrp/en/ databases. Bias risk was assessed using the RoB 1 tool. A qualitative and quantitative synthesis (meta-analysis) of the results was generated. Registration: OSF: https://bit.ly/430fF72. Results: Seven studies were included in this review, comprising a total of 1905 subjects. The majority of subjects were male (57 %) and aged between 54 and 66 years. The reported outcomes showed low certainty of evidence, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. In the meta-analysis of functional status at hospital discharge, a favorable effect was observed in the EAM group, with a standardized mean difference of 0.26 (95 % CI 0.11 - 0.41) and low heterogeneity (I2 = 0 %). Conclusion: With low certainty of evidence, the effect of EAM on critically ill adult subjects in the ICU may improve functional status at hospital discharge compared to AUC.

RESUMEN Objetivo: Evaluar el efecto de la movilización activa temprana (MAT) en comparación con el cuidado habitual activo (CHA) en sujetos adultos críticamente enfermos respecto de la fuerza muscular y del estado funcional. Materiales y métodos: Se realizó una revisión sistemática con metaanálisis. Se incluyeron ensayos clínicos aleatorizados que compararon la MAT con el CHA en sujetos >18 años, de ambos sexos, en estado crítico durante o después del período de ventilación mecánica en la unidad de cuidados intensivos (UCI). La búsqueda se realizó en las bases de datos Cochrane, Medline/Pubmed, Embase (Elsevier), SciELO, LILACS/BVS, www.controlled-trials.com/, clinicaltrials.gov/ y www.who.int/ictrp/en/. Se analizó el riesgo de sesgo mediante la herramienta RoB 1. Se generó una síntesis cualitativa y cuantitativa (metaanálisis) de los resultados. Registro: OSF: https://bit.ly/430fF72. Resultados: Se incluyeron siete estudios, con un total de 1905 sujetos. La mayoría de los sujetos eran del sexo masculino (57 %) y tenían entre 54 y 66 años. Los desenlaces reportados mostraron baja certeza de evidencia, según la Clasificación de la valoración, desarrollo y evaluación de las recomendaciones (GRADE, por sus siglas en inglés). En el metaanálisis del estado funcional al alta hospitalaria, se observó un efecto a favor del grupo MAT, con una diferencia de medias estandarizada de 0,26 (IC 95 % 0,11 - 0,41) y baja heterogeneidad (I2 = 0 %). Conclusión: Con una baja certeza de evidencia, el efecto de la MAT en sujetos adultos críticamente enfermos en la UCI podría mejorar el estado funcional al alta hospitalaria en comparación con el CHA.

BACKGROUND. In South Africa (SA), an unacceptably high institutional maternal mortality rate persists due to failure to recognise critically ill patients. Early warning systems could assist in identifying these patients sooner. OBJECTIVES. We evaluated the Obstetric Early Warning Score (OEWS) as a predictor of maternal outcomes in an intensive care unit (ICU) and compared its prognostic validity with the Acute Physiology and Chronic Health Evaluation (APACHE) II and the quick Sequential Organ Failure Assessment score (qSOFA). METHODS. Data were extracted on pregnant and post-partum ICU-admitted patients at a tertiary and regional centre in SA between October 2015 and April 2020. Clinical characteristics and outcomes were used to compare the three scoring systems. RESULTS. Among 251 eligible patients, the mortality rate was 8.5%. The OEWS score failed to differentiate between survivors and non-survivors (odds ratio 1.13, 95% confidence intervals (CI) 0.972 - 1.311, p=0.113). APACHE II outperformed the OEWS (area under the receiver operating characteristics curve (AUROC) 0.69, 95% CI 0.540 - 0.846 v. 0.55, 95% CI 0.430 - 0.674). The OEWS (AUROC 0.55, 95% CI 0.430 - 0.674) and qSOFA (AUROC 0.60, 95% CI 0.500 - 0.703) showed no differences. Further analysis revealed that positive scoring for diastolic blood pressure and high systolic blood pressure weakened OEWS performance. Removing these variables improved OEWS prediction (AUROC 0.68). CONCLUSION. In a SA obstetric population, OEWS did not predict mortality in ICU-admitted patients and offered no advantages over APACHE II or qSOFA scores. Further research should identify critical outcome predictors for low-resource populations.

RESUMEN Actualmente, las investigaciones hacen énfasis en el apoyo psicológico a las familias y proveedores de salud en la unidad de cuidados críticos, más que la atención al paciente en cada una de las fases asociadas a la enfermedad. En este artículo, utilizamos un caso clínico de un paciente con COVID-19 que se encontraba en estado crítico con múltiples complicaciones para discutir y proponer protocolos de atención psicológica integral a pacientes, sus familias y proveedores de salud en unidades de cuidados intensivos. Se evidenció que, para lograr la recuperación y el alta médica del paciente, es de mucha utilizad la atención psicológica para él, los proveedores de salud y sus familiares. Muchas de las sensaciones y emociones vividas en la UCI pueden producir reacciones físicas que dificulten la estabilidad hemodinámica y el proceso de recuperación del paciente. Se han encontrado pocos estudios sobre la utilidad de la atención psicológica o psiquiátrica a pacientes con COVID-19 grave o crítico. La mayoría de los estudios informados recientemente se centran en la atención psicológica para familias y proveedores de atención médica.

ABSTRACT Currently, research emphasizes psychological support for families and health care providers in the critical care unit, rather than patient care in each of the phases associated with the disease. In this article, we use the clinical case of a patient with COVID-19, critically ill, with multiple complications that lead to the discussion and proposal of protocols for comprehensive psychological care to patients, their families, and health care providers in critical care units. It is crucial, in the efforts required to achieve patient's recovery and medical discharge, to integrate the patient into psychological care programs. Many of the sensations and emotions experienced in the ICU could produce physical reactions that hinder the patient's hemodynamic stability and recovery process. Few studies have been found on the usefulness of psychological or psychiatric care for patients with severe or critical COVID-19. Most of the recently reported studies are focused on psychological care for families and health care providers.