Ventilator Research Articles

Benefits of Virtual Reality Training for Cardiopulmonary Resuscitation Skill Acquisition and Maintenance

Objectives To investigate the benefits of virtual reality (VR) first-aid training in acquiring cardiopulmonary resuscitation (CPR) skills. Methods A total of 100 non-medical professional volunteers from Nanchang were selected in March 2021 using the convenience sampling method. They were randomly divided into two groups: the VR training group (VR group) and the traditional simulation scenario training group (traditional group). The VR Group underwent immersive virtual reality CPR training with interactive feedback, while the Traditional Group received standard simulation-based CPR training using mannequins and instructor guidance. After training, relevant data were collected for comparative analysis. Results The study revealed that the VR group consistently outperforming the traditional group in theoretical knowledge test (cardiac arrest recognition, chest compressions, airway management, and artificial respiration) scores at 1, 3, 6, and 12 months post-training (p < 0.05). Similarly, the VR group showed superior performance in overall skills test scores and individual CPR quality metrics at all post-training assessments. The VR group scored higher in total skills, assessment, post-resuscitation assessment, chest compressions (at 1, 3, and 6 months), airway opening, and artificial respiration compared to the traditional group (p < 0.05). Despite these findings, both groups exhibited a gradual decrease in skills test scores over time. Conclusions Virtual reality training can significantly improve non-medical professional volunteers’ CPR knowledge and skill levels, helping them master and maintain these competencies. However, a decrease in CPR knowledge and skills among the participants over time was observed after VR training, suggesting the need for further retraining sessions.

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge regarding Cardio Pulmonary Resuscitation among Higher Secondary School Students in Selected Schools, Aizawl, Mizoram

Background: Cardio pulmonary resuscitation is a process of oxygenating heart, lung through external cardiac massage and artificial respiration until the definite medical treatment can restore the normal functioning of heart, lung and brain. Cardio pulmonary resuscitation (CPR) is a lifesaving technique that is useful in many emergencies in which someone's breathing or heartbeat has stopped. The purpose of this study is to assess the knowledge and effectiveness of Structured Teaching Programme regarding cardio pulmonary resuscitation among higher secondary school students. Methods: The research design used in the study was one group pre-test post-test design, in which stratified random sampling technique was used to select 100 students of Govt. Chaltlang Higher Secondary School. Self-Structured Knowledge Questionnaires was used to collect the Data. Post test was conducted after 7 days using the same self-structured knowledge questionnaires used for the pre- test. Results: The mean difference between the pre - test and post- test knowledge score was found to be 12.29 with t-value=-24.82, &amp; p value =0.05 which indicates that indicates that Structured Teaching Programme regarding cardio pulmonary resuscitation was effective. Thus, the research Hypothesis H 1 is accepted. Conclusion: The overall findings of the study suggested that Structured Teaching Programme on Cardio pulmonary resuscitation was significantly effective in improving the knowledge of students regarding Cardio pulmonary resuscitation technique.

Learning Effects of Mechanical Ventilator/Tracheal Suctioning XR Simulators and Extracting Decision Making Criteria to Introduce a Novel Simulator

Researchers have developed Simmar+ESTE-SIM, a XR simulator that can train the multitask of “endotracheal suctioning for a patient with a mechanical-ventilator’’ as part of support for Technology-dependent children in the community. In this study, we conducted a questionnaire after using the simulator with the aim of extracting the learning effects of the simulator and judgment indicators when introducing a new simulator, based on feedback from 4th grade university students and the faculty members. As a result, both groups tended to score low on the question of whether the content was appropriate for learning in the third year, but the scores were generally high, at 3.0 or higher. The training task “endotracheal suctioning for a patient with mechanical respirator” was slightly early in 3rd grade students, and the appropriate timing was shown to be for 4th grade students. Principal component analysis extracts two principal components: “Balance between learning content difficulty and motivation (Achievability)” and “Balance between learning time, cost, and learning effect (Feasibility)”. These two factors were thought to be the promoting and inhibiting factors when introducing a simulator. The future challenge is to popularize the simulator education program which is both achievable and feasible to improve the quality of care for children with home-ventilators and their families.

Measurement of inward leakage of full-face masks in EN and ISO standards: comparison of gas and aerosol test agents.

In Europe, respiratory protective devices must be certified before they can be marketed. Among the parameters of interest, inward leakage (IL) characterizes the tightness between the face seal and the face, to verify that the device is well-designed. European standard EN 13274-1 (2001) and International Organization for Standardization (ISO) standard ISO 16900-1 (2019) specify that IL should be measured using sodium chloride (NaCl) aerosol or sulfur hexafluoride (SF6) gas. For reusable masks made of nonporous materials, both test agents are considered equally acceptable. However, the few studies that have compared IL values measured with various aerosols and gases have come to divergent conclusions. This work then aimed to measure IL with the test agents recommended by the standards to determine whether they are really equivalent. Since krypton (Kr) is an interesting candidate for replacing SF6 in standard tests, IL was assessed with SF6 and Kr simultaneously, and with NaCl aerosol using various calculation methods. Tests were carried out on 5 models of full-face masks donned on a headform connected to a breathing machine simulating 3 sinusoidal breathing rates of various intensities. The respirator fit on the headform was evaluated using a controlled negative pressure method to determine a manikin fit factor. Four scenarios were then tested to represent very poor, bad, good, and excellent fit. Gas concentration was measured using a mass spectrometer, and IL was calculated for SF6 and Kr. A combination of 3 devices allowed the determination of the number-based concentration of particles with diameters between 20 nm and 2 µm, and IL was calculated for each of the 33 channels, as well as using a cumulative number concentration. In addition, to comply with standards, a conversion was carried out to calculate IL using a cumulative mass concentration. The results of this work evidenced that the IL values measured with NaCl were systematically lower than those determined with gases. IL was also shown to vary with particle size, with a maximum value exceeding that calculated with cumulative concentrations (in number or mass). As part of the revision of the standards, protocols for measuring inward leakage should be redefined. On the one hand, acceptability thresholds should be re-evaluated according to the nature of the test agent (gas or aerosol), as it is clear that the 2 options do not give the same results for a given configuration. On the other hand, the aerosol leakage measurement protocol needs to be reworked to enable the measurement of a well-defined, robust, and reproducible inward leakage value.

Assessment of the Oral Health Status of Patients Admitted to Pediatric Intensive Care Units: A Cross-Sectional Study.

It is important to detect oral health problems early among patients admitted to pediatric intensive care units to establish the diagnosis and consequently allow nurses to plan appropriate oral care practices. The study aimed to assess the oral health status of patients admitted to pediatric intensive care units. This descriptive cross-sectional study was conducted from June to September 2021 in the pediatric intensive care units of 3 hospitals. A total of 88 children were included in the study. An intraoral assessment was performed using a tongue depressor and a flashlight, and data were collected using a patient information form and the Oral Assessment Guide (OAG). The mean OAG score was 8.45 ± 2.876 points. A significant difference was found in the OAG score between the patients 60 months or younger and those 61 months or older (P < .05). The OAG score was significantly associated with the use of diuretics (P < .05) and the frequency of oral care (P < .05). A negative relationship was found between the OAG score and the Glasgow Coma Scale score (P < .05). The oral health status of the patients worsened as their age increased, and their state of consciousness decreased. Oral care was more frequently applied to the patients who received artificial respiration. The study provides evidence-based data regarding the early detection of the factors threatening oral health and the necessary precautions.

The effect of pocket mask training on the self-efficacy and willingness to perform artificial respiration in cardiac arrest patients: A randomized control trial

Background: Out-of-hospital cardiac arrest due to hypoxia, it is necessary to provide adequate oxygen for correction of the cause. So, the purpose of this study was to compare the overall quality of CPR, willingness to perform ventilation using ventilation aids, and self-efficacy compared to the enlisted ventilation method (MMV) by educating the general public on pocket masks (MPV), which are respiratory aids. Methods: This study was a randomized controlled comparative study, in which 110 study subjects were listed with numbered names in the order in which they applied for training, and random numbers were named A (MMV method) and B (MPV method) in that order. Randomization generated a random number order using the SAS program, and the generated random numbers A and B were arranged from 1 to 110 in the order in which they applied for training, through this, they were classified into A groups (N = 57) and B groups (N = 53). The study subjects classified into Group A received CPR training including enlistment ventilation on April 22, 2023, and the trainees in Group B received CPR training using a ventilator on April 29, 2023. Results: The primary outcome is that the result of the comparison of ventilation quality is the mean Tidal Volume (TV) before training for MPV is 1076 ± 422, whereas the mean TV for MMV is 1015 ± 510 (p &lt; 0.05). After training, the mean tidal volume (TV) for MPV is 876ml ± 422, whereas the mean TV for MMV is 1001 ± 516, indicating that MMV resulted in a significantly higher tidal volume than the ILCO guidelines. After training, comparing the time per ventilation cycle, the MPV group showed 0.923sec ± 0.432, while the MMV group showed 1.021sec ± 0.535 (p &lt; 0.05). After completing two ventilations, it is evident that there is a delay in starting the next chest compression in the MMV group compared to the MPV group (MMV: 10.21 ± 4.112 vs. MPV: 9.88 ± 2.831, p &lt; 0.05). Conclusion: As a result of this study, the researcher recommends adding training on pocket masks when educating artificial respiration in CPR training conducted in Korea, given that the performance accuracy of pocket masks is high and the efficient ventilation rate is high.

Phosgene Toxicity Clinical Manifestations and Treatment: A Systematic Review.

Exposure to phosgene, a colourless poisonous gas, can lead to various health issues including eye irritation, a dry and burning throat, vomiting, coughing, the production of foamy sputum, difficulty in breathing, and chest pain. This systematic review aims to provide a comprehensive overview of the clinical manifestations and treatment of phosgene toxicity by systematically analyzing available literature. The search was carried out on various scientific online databases to include related studies based on inclusion and exclusion criteria with the use of PRISMA guidelines. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Thirteen articles were included in this study after the screening process. Inhalation was found to be the primary health problem of phosgene exposure with respiratory symptoms such as coughing and dyspnea. Chest pain and pulmonary oedema were also observed in some cases. Furthermore, pulmonary crackle was the most common reported physical examination. Beyond respiratory tract health issues, other organs involvements such as cardiac, skin, eye, and renal were also reported in some studies. The symptoms can occur within minutes to hours after exposure, and the severity of symptoms depends on the amount of inhaled phosgene. The findings showed that bronchodilators can alleviate symptoms of bronchoconstriction caused by phosgene. Oxygen therapy is essential for restoring oxygen levels and improving respiratory function in cases of hypoxemia. In severe cases, endotracheal intubation and invasive mechanical ventilation are used for artificial respiration, along with the removal of tracheal secretions and pulmonary oedema fluid through suctioning as crucial components of supportive therapy.

The association of medical, social, and normative factors with the implementation of end-of-life care practices

BackgroundEnd-of-life (EoL) care practices (EoLCP) are procedures carried out at the EoL and bear directly on this stage in the patient’s life. Public support of these practices in Israel is far from uniform. Previous studies show that while ∼30% of participants support artificial respiration or feeding of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. This study aimed to create a typology of six end-of-life care practices in Israel and assess the association of medical, social, and normative factors with the implementation of those practices. These practices included mechanical ventilation, artificial feeding, deep sedation, providing information to the patient and family caregivers, including family caregivers in EoL decision-making, and opting for death at home.MethodsThis cross-sectional study was performed as an online survey of 605 adults aged 50 or more in Israel, of which ~ 50% (n = 297) reported supporting a dying terminally ill relative in the last 3 years. Participants were requested to provide their account of the EoL process of their relative dying from a terminal illness in several aspects, as well as the EoL care practices utilized by them.ResultsThe accounts of the 297 interviewees who supported a dying relative reveal a varied EoL typology. The utilization of end-of-life care practices was associated with the socio-normative beliefs of family caregivers but not with their socioeconomic status. Strong correlations were found between family caregiver support for three key practices (mechanical ventilation, artificial feeding, and family involvement in EoL) and the actual utilization of these practices in the care of dying patients.ConclusionsThe findings portray an important image of equity in the utilization of EoLCP in Israel, as the use of these practices was not associated with socioeconomic status. At the same time, the study found substantial diversity in family caregivers’ preferences regarding EoL care practices use not related to socioeconomic status. We believe that differences in preferences that do not lead to problems with equity or other important societal values should be respected. Accordingly, policymakers and health system leaders should resist calls for legislation that would impose uniform EoL practices for all Israelis. Instead, they should take concrete steps to preserve and enhance the widespread current practice of practitioners to adapt EoL care to the varied needs and preferences of Israeli families and cultural, social, and religious subgroups. These steps should include providing frameworks and tools for family caregivers to support their loved ones close to their deaths, such as educational programs, seminars, supportive care before and during the end of life of their loved ones, etc.

Features of conducting some investigative actions in a fraud investigation in conditions of extraordinary legal regimes (epidemics, pandemics, martial state)

The article is devoted to some aspects of conducting investigative (search) actions, in particular, interrogation, simultaneous interrogation of two or more previously interrogated persons, and presentation for identification in conditions of epidemic, pandemic and martial law in fraud proceedings.&#x0D; It is noted that criminals who, adapting to the conditions of emergency legal regimes, find new ways of committing criminal offenses. Medicines, respirator masks, artificial respiration devices, household items, etc. became the subject of fraudulent operations under the conditions of the pandemic. During martial law, generators and other energy equipment, as well as things necessary for service in war zones, became the object of encroachment. The level of fraudulent activities related to embezzlement of humanitarian aid has become critical.&#x0D; The author emphasizes the importance of implementing the functions of criminal justice in the conditions of special legal regimes, due to interrogation, simultaneous interrogation of two or more previously interrogated persons and presentation for identification in a remote mode.&#x0D; The disadvantages of remote pre-trial investigation are emphasized, in particular, it is necessary to more clearly regulate procedural issues regarding the use of technical means, the legal status of persons and specialists who ensure the quality of communication, etc. During such proceedings, in order to avoid abuse and ambiguous interpretation by the specified participants in the process, it is necessary for the legislator to explain: “what other grounds are considered sufficient for the use of videoconferencing”, “when the quality of the image and sound is adequate”, “when information security regarding the conduct of a videoconference is considered complied with”. Measures to ensure the stability of communication channels and technical protection of such information at the state level are very necessary.

Measuring whole body inert gas wash-out.

Quantifying inert gas wash-out is crucial to understanding the pathophysiology of decompression sickness. In this study, we developed a portable closed-circuit device for measuring inert gas wash-out and validated its precision and accuracy both with and without human subjects. We developed an exhalate monitor with sensors for volume, temperature, water vapor and oxygen. Inert gas volume was extrapolated from these inputs using the ideal gas law. The device's ability to detect volume differences while connected to a breathing machine was analysed by injecting a given gas volume eight times. One hundred and seventy-two coupled before-and-after measurements were then compared with a paired t-test. Drift in measured inert gas volume during unlabored breathing was evaluated in three subjects at rest using multilevel linear regression. A quasi-experimental cross-over study with the same subjects was conducted to evaluate the device's ability to detect inert gas changes in relation to diving interventions and simulate power. The difference between the injected volume (1,996 ml) and the device's measured volume (1,986 ml) was -10 ml. The 95% confidence interval (CI) for the measured volume was 1,969 to 2,003 ml. Mean drift during a 43 min period of unlaboured breathing was -19 ml, (95% CI, -37 to -1). Our power simulation, based on a cross-over study design, determined a sample size of two subjects to detect a true mean difference of total inert gas wash-out volume of 100 ml. We present a portable device with acceptable precision and accuracy to measure inert gas wash-out differences that may be physiologically relevant in the pathophysiology of decompression sickness.

Clinical case of lightning injury

Atmospheric electricity damage as a result of lightning strike is a relatively rare condition in intensive care medicine, however it can be accompanied by high mortality and serious complications in the majority of survived patients.The objective was to demonstrate a clinical case of lightning injury and discussion of diagnostic and treatment aspects in this condition.Materials and Methods. 18-yr old patient was delivered to hospital after lightning strike. She lost consciousness, there was no breathing for a short time, and the witnesses provided artificial respiration and external cardiac compressions. On admission, the signs of shock were present in parallel with dopamine infusion, the skin was pale-grey and cold, with traces of thermal damage according to the type of contact with metal of various localization on the neck, scalp, front surface of the chest and abdominal wall, in the groin, on the left foot. The patient was hospitalized to ICU, therapeutic and diagnostic measures were started. We revealed decompensated lactic acidosis, biochemical signs of myocardial and muscle damage. The infusion therapy, analgesics, antibiotics, proton pump inhibitors, anticoagulants were administered. During the therapy in the first 6 hours, the signs of shock were attenuated, in 4 days, the patient was transferred to traumatological department in a stable state. After the transfer from the ICU, hearing decline as well as pain and sensory disturbances in the left foot are persisting.Conclusion. An integrated approach is required in the diagnosis, treatment, and rehabilitation of patients with lightning injury.

The Role of Dietary Proteins During Infection with Covid-19 and the Effect of Infection on the Balance of Oral Microbiota in Different Regions of Iraq

This study was conducted in the laboratories of the Department of Life Sciences - College of Sciences - Tikrit University and laboratories of the Department of Food Sciences - College of Agriculture - University of Anbar and public health laboratories - Anbar for the period from December 2021 to February 2022 AD. The study included 150 people from three Iraqi governorates (Baghdad, Anbar, and Erbil). (30 infected people and 20 healthy people from each governorate, with ages ranging from 18-80 years, randomly, men and women. The results of the blood biochemical parameters values when infected with the SARS-COV2 virus showed a significant decrease at the probability level (p<0.05) in the concentration of albumin in the group of patients who were in quarantine and using artificial respiration, compared with the group of patients outside the quarantine and the healthy group from the mentioned governorates. The concentrations are 26.3, 30.4, and 34.7 (g/l). It also caused a significant decrease in the total protein and albumin concentration in all patients compared to the healthy subjects. In contrast, globulin concentration decreased slightly to be close to its value in the healthy group. Cultural, phenotypic, biochemical, and confirmatory tests through the Vitec2 compact diagnostic system showed that oral bacterial isolates purified from patients in the three provinces were Gram-positive Staphylococcus and Enterococcus versus four Gram-negative genera: Sphingomonas, Rhizobium, Aeromonas, and Ochrobactrum, compared with isolates purified from healthy subjects, which belongs to four genera of Gram-positive Staphylococcus, Enterococcus, Kocuria, and Leuconostoc, and one genus of Gram-negative Pseudomonas.

Patient and Caregiver Outcomes After Onasemnogene Abeparvovec Treatment: Findings from the Cure SMA 2021 Membership Survey.

Onasemnogene abeparvovec (OA) is the only gene replacement therapy currently approved for spinal muscular atrophy (SMA) treatment. We sought to assess real-world patient and caregiver outcomes after OA treatment for SMA. Patients who received OA were identified from the 2021 Cure SMA Membership Survey. Those treated at 6-23months of age were matched to non-patients treated with OA on the basis of age at the time of survey and survival motor neuron2 gene copy number. Patient characteristics, motor milestones, and resource and supportive care use, as well as caregiver proxy-reported health-related quality of life (HRQOL), were described. Caregiver unmet needs and HRQOL were also assessed. Of the 614 patients in the survey, 64 received OA, and 17 were matched with 28 non-OA-treated patients. In general, a greater percentage of OA-treated patients achieved various motor milestones, including 100% sitting without support and 58.8% walking with assistance. OA-treated patients also had numerically lower rates of hospitalization and surgery. None required tracheostomy with a ventilator. The rate of using oxygen or a breathing machine for more than 16h was also lower for OA-treated patients. OA-treated patients had less frequent trouble swallowing. HRQOL was reported to be similar to non-OA-treated patients. Caregivers of OA-treated patients reported better patient mobility scores and less work impairment. The study suggests that treatment with OA is associated with greater rates of motor milestone achievements and less resource and supportive care use for patients with SMA treated at 6-23months of age in the real world. For caregivers, it may also potentially reduce unmet needs, improve HRQOL, and reduce work impairment.

Management of pain reduction in mechanically ventilated care subjects

Introduction: Pain is an unpleasant emotional experience linked to actual or potential injuries, concerns in intensive care units (ICU), affecting life and recovery of patients. It is essential to address this pain, classifying it with WHO criteria and guidelines. The approach is to explore types of pain and strategies for its management, seeking to improve quality of life during ICU hospitalization. Methods: A PubMed search was performed with "Pain Management" AND "nursing" AND "Artificial Respiration", filtering for studies between 2018 and 2023. After review, 11 irrelevant articles were discarded, selecting 8 that met criteria. Results: The outcome focuses on an independent approach to pain management in nursing, involving non-pharmacological measures and quality standards. This brings with it the responsibility to look for better alternatives to optimize nursing care in adequate pain management. Conclusion: The data from these studies expose relevant information highlighting the importance of adequate independent pain management and sedation by nurses in critically ill ICU patients. The opportunity to implement more effective and patient-centered approaches to improve the well-being and recovery of critically ill patients is emphasized.

Retrospective Analysis of Our Experience with Percutaneous Tracheostomy in Our Intensive Care Unit

Aim: Percutaneous tracheostomy (PT) application has advantages such as being able to be applied at the bedside in a short time and less bleeding. It is frequently preferred in intensive care units with indications such as prolonged artificial respiration requirement, facilitating weaning, and providing emergency airway. It is an alternative method to surgical tracheostomy. In this study, we aimed to retrospectively evaluate the percutaneous tracheostomy cases we performed in the Intensive Care Unit (ICU) in the last three years.&#x0D; Material and Methods: Patients who underwent percutaneous tracheostomy in the 3rd Level our Hospital between January 2018 and December 2022 were examined. Demographic data of the patients, diagnosis of hospitalization, Acute Physiology and Chronic Health Evaluation II Score (APACHE II score), hospitalization time, intubation time, time from intubation to tracheostomy, early and late complications of tracheostomy were retrospectively analyzed.&#x0D; Results: Ninety-seven patients were analyzed. The mean age of the patients was 77.6±10.9 (range, 41-100) years and the female-male ratio was 40/57. The most common hospitalization diagnosis was neurological reasons (54.6%). The patients were intubated for 20.3±7.9 (range, 7-48) days and the total length of stay in the ICU 65.3±30.3 (range, 17-175) days. The number of patients who developed complications related to the PT procedure was 17 (12.9%).&#x0D; Conclusion: Percutaneous tracheotomy, which is performed in the ICU with indications such as the need for prolonged mechanical ventilation, facilitating weaning, and providing an emergency airway, is a simple, minimally invasive procedure with a low complication rate.

Polarization in public attitudes toward end-of-life decisions in Israel - A cross-sectional study.

End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This study aimed to generate a database of public opinion in Israel concerning EoL processes and decisions and to identify differences in attitudes across subgroups in the population, particularly based on experience as a family caregiver of a dying patient. This cross-sectional study was performed in late March 2022. The study utilized an online sample of 605 adults over the age of 50 including those who accompanied a loved one to their death in the last 3 years. Participants were requested to provide their opinions and attitudes on several aspects of EoL decisions, including truth-telling, medically assisted dying, EoL procedures, pre-death actions, and family caregivers' engagement. While only 27% and ∼30% of participants support artificial respiration or feeding (respectively) of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. The data show an association between religiosity and agreement with life-extending procedures. For example, while 83% of seculars support medically assisted dying, only 59% and 26% of traditional and religious respondents support it. However, no statistically significant differences were observed in support of family involvement in EoL process in any sociodemographic variable. The results of this study suggest that the Israeli public is relatively polarized on several issues about EoL processes, specifically patient autonomy and medically assisted dying. Yet, at the same time, there is a consensus among the Israeli public about certain EoL elements, particularly the importance of family caregivers in the EoL decision-making process.

Education needs for clinical nursing practice using an Importance-Performance Analysis and Borich needs assessment model: Focused on nurses in the general wards of a tertiary hospital

Purpose: This study’s aim was to confirm the importance and performance of the clinical practice of nurses working in the general wards of a tertiary hospital and to analyze their educational needs.Methods: The study employed a descriptive research design, and a self-reported questionnaire was developed and used for nurses in a tertiary hospital. Data were collected from July 22 to July 29, 2022, analyzed by an independent t-test, paired t-test, and one-way ANOVA for the importance and performance of each clinical nursing practice according to general characteristics, and then a post hoc verification was performed by Scheffé’s test. An Importance-Performance Analysis and Borich needs assessment model were used to analyze clinical nursing education needs.Results: Clinical nursing practice performance showed a significant difference according to length of total clinical career, time working in current department, and preceptor experience. According to the results of the Importance-Performance Analysis, neurological evaluation, and nursing intervention, artificial respirator and high-flow oxygen inhalation nursing, chemotherapy, emergency nursing, and cardiopulmonary resuscitation were identified as belonging to the “concentrate here” quadrant. All these items ranked in the top 10 in the Borich needs assessment model.Conclusion: Based on these results, the current education system should be reviewed, and short and long term education strategies based on educational needs should be established to strengthen the competence of nurses.

A life-saving collaborative network: repairing ventilators in Brazil

PurposeThis paper aims to investigate the formation of an inter-organizational collaboration network that made it possible to repair 2,516 mechanical respirators that were inoperative in Brazil during the first wave of the COVID-19 pandemic.Design/methodology/approachA qualitative approach was used in a single case study with semi-structured interviews. The interviewee selection process was non-probabilistic through snowball sampling.FindingsThe results suggest that society, through different social groups with their different roles, can organize itself quickly through the formation of collaborative networks, and this organizational configuration can be an alternative for facing crises where actions isolated would be insufficient or slow to urgently address complex situations.Practical implicationsThis paper aims to (1) demonstrate that society, through different social groups with their different roles, can organize itself quickly through the formation of collaborative networks; (2) favor the understanding and dynamics of the formation of a network; and (3) contribute to a possible replication of this initiative in future contexts.Originality/valueThe case portrays an unprecedented formation of a collaboration network involving more than 144 organizations that mobilized quickly in a complex context of a pandemic and that generated remarkable results through the reintroduction of equipment that were responsible for the preservation of thousands of lives during the year from 2020.

Respiratory protective device: One size to fit them all?

When exposed to hazardous or toxic substances, workers may be required to wear respiratory protective devices, selected in accordance with the pollutant, required protection level, individual characteristics, and work conditions. To emphasize the importance of the selection procedure, this study aimed to investigate the effects of the facial dimensions and breathing rate on the fit and the protection efficiency provided by full-face respirators. Manikin total efficiency measurements (mTEs) were then conducted on five head forms of various facial dimensions equipped with nine respirators of different models and sizes. A breathing machine simulating sinusoidal breathing rates was used to represent seven work rates, from rest to maximal intensity. For each experiment, the manikin fit factor (mFF), characterizing the respirator fit on the head form, was measured by a controlled negative pressure method. By varying the head form, respirator, breathing rate, and mFF, a total of 485 values of mTE were measured. Findings indicate that even if the respirator was equipped with a high-efficiency filter, mTE strongly decreases if the respirator does not fit the face of the wearer. In particular, it was highlighted that one given respirator cannot fit all facial dimensions and that the best match between the respirator size and facial dimensions is difficult to predict because respirator sizes are not standardized. Moreover, although the total efficiency of a well-fitted respirator naturally decreases when increasing the breathing rate due to filtration mechanisms, the reduction is more significant if the respirator does not fit well. To consider both the mTE and the breathing resistance, a quality factor value was determined for each tested combination of head form, respirator, and breathing rate. The maximum manikin fit factor mFFmax measured for each combination of head form and respirator was compared to that measured on nine human subjects with similar facial dimensions, providing encouraging results concerning the use of head forms during respirator testing.

KNOWLEDGE OF NURSES ABOUT INVASIVE MECHANICAL VENTILATION

INTRODUCTION: Mechanical ventilation (MV), in recent years, has been considered the main alternative to replace, totally or partially, the respiratory function of patients in pathological conditions, especially in cases of acute respiratory failure (ARF). It consists, basically, in the use of a mechanical device that will artificially provide the body with the necessary ventilation and oxygenation to maintain life. Its main function is to send a volume of air (ventilate), with a determined concentration of oxygen (FiO2) per unit of time (minute) in order to perform gas exchange, and can be applied invasively or non-invasively with positive pressure in the airways. OBJECTIVE: Faced with the presented problem, the objective was, in the light of the scientific literature, to identify the knowledge of nurses about invasive mechanical ventilation. METHODOLOGY: This is an integrative literature review, whose bibliographic survey was carried out from December 2022 to January 2023, in the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS); Medical Literature Analyzes and Retrieval System Online (MEDLINE), Spanish Bibliographic Index of Health Sciences (IBECS) and the Nursing Database (BDENF) indexed in the Virtual Health Library (VHL) portal. In the aforementioned databases, the advanced search method was applied, categorizing the titles and abstracts, where the search was performed by crossing the following Health Sciences Descriptors (DeCS): “Nurses and Nurses”; “Artificial respiration”; “Mechanical ventilation” using the Boolean AND operator. Taking into account the following inclusion criteria: complete articles, available for download and reading in full; published in Portuguese, English and Spanish, in the last 05 years and excluding duplicate articles in the databases. The data obtained were extracted in full, and a descriptive-interpretive synthesis was elaborated, discussed in the light of the scientific literature pertinent to the study theme. RESULTS AND DISCUSSION: the results point to a limited knowledge of nursing professionals about invasive mechanical ventilation. Care practices such as: pain management, sedation control, mobilization, attention to clinical parameters, pressure injury prevention and applicability of Care Systematization are essential to direct quality care. Thus, the need for training emerges from the permanent education process. CONCLUSION: Through the results presented, it can be considered that the objective of this research was achieved, allowing to demonstrate the knowledge of the nursing professional regarding the patient under invasive mechanical ventilation. In view of this, it is evident that the deficiencies and lack of professional skills exist, however, there are strategies that can be devised to reverse this reality.