A enfermagem nas unidades de terapia intensiva: o aparato tecnológico versus a humanização da assistência

Objetivo: conhecer a percepção dos profissionais de enfermagem de unidade de terapia intensiva sobre as peculiaridades do avanço tecnológico. Método: trata-se de estudo de abordagem qualitativa. Foi realizado na unidade de terapia intensiva de hospital de grande porte de capital brasileira. A entrevista aberta foi utilizada como instrumento de coleta de dados. A população foi constituída por enfermeiros e técnicos de enfermagem que atuam neste setor. A amostra foi definida pelo critério da saturação, alcançada na 19º entrevista. Os dados foram tratados conforme critérios da análise de conteúdo. Resultados: seis categorias emergiram à análise das entrevistas. Foram estas: A dinâmica da UTI como consequência da evolução do aparato tecnológico; As limitações do aparato tecnológico disponível; As vantagens do aparato tecnológico; A relação entre o cuidado e o aparato tecnológico; As dificuldades relacionadas ao domínio do aparato tecnológico e As dificuldades relacionadas ao prontuário informatizado. Conclusão: o cuidado deve ser assessorado por equipamentos, mas conduzido por pessoas. Além disso, o obsoleto é sentido como desvantagem: os profissionais reivindicam melhorias em detrimento do tradicional, na busca não só da qualidade da assistência, mas também do bem-estar dos profissionais. Pode-se harmonizar humanização do cuidado à evolução da tecnologia e da ciência

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN