Pulmonary-Focused Verticalization Therapy in Patients Experiencing Respiratory Failure.

IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE
Heather Fudala, Shelly Orr, Elisa Winn, Audrey Roberson, Alice Peay, Vishal Yajnik
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引用次数: 0

Abstract

Background: Mechanical ventilation and prone positioning are high-risk procedures for patients and health care team members, increasing patients' risk of secondary infection and pressure injuries, as well as increasing staff workload and risk of injury or contracting infectious diseases. Verticalization therapy is the practice of controlled, in-bed, upright positioning. Previous research showed increases in oxygenation during verticalization therapy, which suggests that verticalization therapy may be beneficial in patients with respiratory failure.

Objectives: To investigate the safety and feasibility of verticalization therapy in patients experiencing respiratory distress, including patients with COVID-19.

Methods: A convenience sample of adult patients in the medical respiratory intensive care unit at a mid-Atlantic urban academic medical center received up to 2 verticalization therapy sessions daily for a goal of 30 to 120 minutes each.

Results: The study aimed to enroll 15 participants, but suspended recruitment after 6 because of clinical team concerns that some participants were experiencing hypotension and decreases in oxygen saturation during verticalization, as well as lack of adequate nursing staff time. Most participants tolerated verticalization therapy, but one participant's initial verticalization therapy session was stopped at 30° because of hypotension and desaturation. The unit lacked nursing staff needed to consistently verticalize participants.

Conclusions: The small number of participants limits interpretation of study findings. Future studies should consider baseline critical illness severity and a slower rate of verticalization. Although it is unclear whether verticalization therapy decreases demands on physicians, advanced practice providers, and respiratory therapists, it clearly increased nursing workload in this study.

肺聚焦垂直治疗在呼吸衰竭患者中的应用。
背景:机械通气和俯卧位是患者和医护人员的高风险操作,增加了患者继发感染和压力损伤的风险,也增加了工作人员的工作量和受伤或感染传染病的风险。垂直疗法是一种有控制的,在床上,直立定位的疗法。先前的研究表明,垂直治疗期间氧合增加,这表明垂直治疗可能对呼吸衰竭患者有益。目的:探讨包括新型冠状病毒感染患者在内的呼吸窘迫患者采用直立疗法的安全性和可行性。方法:在大西洋中部城市学术医疗中心的医学呼吸重症监护病房的成人患者进行方便样本,每天接受多达2次垂直治疗,每次治疗的目标为30至120分钟。结果:本研究计划招募15名参与者,但由于临床团队担心一些参与者在垂直过程中出现低血压和血氧饱和度下降,以及缺乏足够的护理人员时间,因此在6名参与者后暂停招募。大多数参与者耐受垂直化治疗,但一名参与者最初的垂直化治疗在30°时因低血压和去饱和而停止。该单位缺乏护理人员需要始终垂直参与者。结论:受试者数量少限制了对研究结果的解释。未来的研究应考虑基线危重疾病严重程度和较慢的垂直化率。虽然尚不清楚垂直治疗是否会减少对医生、高级执业医师和呼吸治疗师的需求,但在本研究中,它显然增加了护理工作量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.30
自引率
3.70%
发文量
103
审稿时长
6-12 weeks
期刊介绍: The editors of the American Journal of Critical Care (AJCC) invite authors to submit original manuscripts describing investigations, advances, or observations from all specialties related to the care of critically and acutely ill patients. Papers promoting collaborative practice and research are encouraged. Manuscripts will be considered on the understanding that they have not been published elsewhere and have been submitted solely to AJCC.
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