How different helmet fixing options could affect patients' pain experience during helmet-continuous positive airway pressure.

Autor: Lucchini A; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy., Elli S; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy., Bambi S; Emergency, ECMO and Trauma Intensive Care Unit, Azienda Ospedaliero Careggi University Hospital, Florence, Italy., De Felippis C; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy., Vimercati S; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy., Minotti D; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy., Pasquali S; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy., Cannizzo L; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy., Fumagalli R; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, University Hospital of Milano-Bicocca, Milan, Italy., Foti G; General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy.
Jazyk: angličtina
Zdroj: Nursing in critical care [Nurs Crit Care] 2019 Nov; Vol. 24 (6), pp. 369-374. Date of Electronic Publication: 2018 Nov 20.
DOI: 10.1111/nicc.12399
Abstrakt: Background: Prolonged application time of helmet continuous positive airway pressure (CPAP) leads to better outcomes, but its timing can be influenced by the patient's tolerance.
Aims and Objectives: To investigate patients' pain and tolerance experience related to different options of helmet fixing system: 'armpits strap' versus 'counterweights system'.
Design: This was a non-randomized crossover study performed in a 10-bed intensive care unit and referral extra corporeal membrane oxigenation (ECMO) centre of an Italian university hospital.
Results: Twenty patients were enrolled. For helmet-CPAP cycles performed with the armpit straps option, the mean pain numerical rate on a 0-10 scale was: 0·5 ± 1·4 at T 0 (baseline) , 1·5 ± 2·0 at T 1 (after 1 h) and 2·6 ± 2·5 at T 2 (end of cycle) (p = 0·023). The same analysis was performed for the counterweights fixing option. The mean score was 0·3 ± 0·6 at T 0 , 0·3 ± 0·2 at T 1 and 0·5 ± 0·7 at T 2 (p = 0·069). The mean duration for CPAP cycles performed with armpits strap and counterweights system was 3·0 ± 1·0 and 3·9 ± 2·3 h, respectively (p < 0·001). The mean section of the Basilic vein that was investigated before wearing the helmet was equal to 0·23 ± 0·20 cm 2 . After 1 h of therapy with the counterweight option and armpit straps, the mean increase of the vein's section was 0·27 ± 0·21(p = 0·099) and 0·30 ± 0·25, respectively (p = 0·080).
Conclusions: The fixing system options in use to anchor the helmet during CPAP could worsen the pain experience level and cause device-related pressure ulcers. When compared with the armpit straps option, the counterweights system appears to be a suitable approach to minimize the risks of pressure sores and pain during the treatment.
Relevance to Practice: The helmet CPAP is a reliable therapy to manage acute respiratory failure. Major improvements regarding pulmonary alveolar recruitment and oxygen levels are strictly related to a prolonged time of helmet CPAP cycles. Using a counterweight fixing system, where the armpits straps are not necessary, could be helpful in reducing patients' pain experience.
(© 2018 British Association of Critical Care Nurses.)
Databáze: MEDLINE
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