Tecnologias e práticas avançadas no cuidado em feridas crônicas: revisão integrativa

Introduction: Wounds or skin lesions are breaks in the continuity of the skin, caused by various imbalances that harm the health of people who have them. In recent years, technological progress has provided numerous benefits, improvements and improvements to the health sector. Objective: Evaluate technologies and practices in chronic wound care. Methodology: Integrative literature review research, guided by the following steps: construction of the research question; delimitation of inclusion and exclusion criteria; choice of databases; search and selection of studies; analysis and presentation of results. Results and Discussion: 500 studies were identified, after applying the language inclusion criterion, remaining 150 studies, and then reading the titles, in which 350 articles were excluded, as they were not related to the objective of this article. The abstracts of the 150 articles selected from the analysis of the titles were read and only those that met the inclusion criteria had their abstracts investigated. 10 articles were selected to compose the research. Conclusion: Therefore, it is concluded that professionals, especially those in the nursing field, must remain up to date in this field of activity, which is considered dynamic as it presents new dressings and coverings with increasingly advanced technologies, providing optimization in healing.Introdução: As feridas ou lesões de pele são quebra na continuidade da pele, causada por vários desequilíbrios que prejudicam a saúde das pessoas que as têm, nos últimos anos progresso tecnológico tem proporcionado inúmeros benefícios, aperfeiçoamento e melhorias para a área da saúde. Objetivo: Avaliar tecnologias e práticas e no cuidado em feridas crônicas. Metodologia: Pesquisa de revisão integrativa da literatura, guiada pelas seguintes etapas: construção da questão de pesquisa; delimitação dos critérios de inclusão e exclusão; escolha das bases de dados; busca e seleção dos estudos; análise e exposição dos resultados. Resultados e Discussão: Foram identificados 500 estudos, depois da aplicação do critério de inclusão do idioma, permanecendo os 150 estudos, e em seguida a leitura dos títulos, nos quais foram excluídos 350 artigos, por não estarem relacionados ao objetivo deste artigo. Houve a leitura dos resumos dos 150 artigos selecionados a partir da análise dos títulos e somente aqueles dentro dos critérios de inclusão tiveram os resumos investigados. Sendo selecionados 10 artigos para compor a pesquisa. Conclusão: Sendo assim, conclui-se que o profissional, principalmente da área da enfermagem deve manter-se atualizado nesse campo de atuação, o qual é considerado dinâmico por apresentar novos curativos e coberturas com tecnologias cada vez mais avançadas, propiciando otimização na cicatrização

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status