Introduzione: Extra Corporeal Membrane Oxygenation (ECMO) consists of a procedure used to ensure the support of vital functions in subjects with heart or respiratory failure refractory to conventional therapy. There are two main types of ECMO (Veno-Venous Ecmo and Artero-Venous Ecmo). This study focuses on Artero-Venous ECMO, which emerged as the first-choice treatment in patients with refractory or post cardiotomy cardiogenic shock with or without respiratory failure, evaluating the main risks and benefits in order to identify the most suitable guidelines and tools to lead the clinical practice of the nursing process in the assistance to the patient who is subjected, in order to be able, finally, to carry out a correct care planning and define the best clinical practice. Obiettivo: The aim is to know what is the most up-to-date evidence on the effectiveness of nursing interventions in improving care in patients undergoing VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION. Materiali e Metodi: It was carried out a review of primary and secondary literature in the Medline, Cochrane Database of Systematic Reviews, Cinhal, and Google Scholar databases. The International ELSO Guidelines for the management of out-of-body support were reviewed. The bibliographic research has focused on the critical reading of the studies of the last ten years. Eighteen articles were selected that matched the selection criteria. Risultati: For the development of the thesis were found eighteen studies were found including nine Systematic Literature Reviews, of which three also included Meta-Analyses, three Retrospective Cohort studies, one Prospective Cohort study, two Non-Randomized Controlled Clinical Trials, one Cross-Sectional study, and two Narrative Literature reviews. Discussione: The results found record a statistically significant improvement in mortality and quality of life outcomes. However, the complications remain relevant. In this regard, the assisted person in ECMO A-V requires careful, specific and rigorous management by the nursing staff. Conclusioni: In the last ten years, the use of ECMO A-V has resulted in a significant reduction in mortality in patients with cardiogenic shock or refractory post-cardiotomy myocardial infarction. Nursing has contributed significantly to the determination of improvements in terms of recovery and reduction of hospitalization time. Further evaluation studies are needed related to quality of life and mortality outcomes. Parole chiave: Venoarterial extracorporeal membrane oxygenation, cardiogenic shock, management, nursing, mortality, outcomes, risks.
Introduzione: L’Extra Corporeal Membrane Oxygenation (ECMO) consiste in una procedura alla quale si ricorre per garantire il supporto delle funzioni vitali nei soggetti con insufficienza cardiaca o respiratoria refrattaria alla terapia convenzionale. Esistono due principali tipi di ECMO: Veno-Venoso e Artero-Venoso. Questo studio si focalizza principalmente sull’analisi del paziente sottoposto ad ECMO Artero-Venoso, emerso come trattamento di prima scelta nei pazienti con shock cardiogeno refrattario o infarto del miocardio acuto post cardiotomico, con o senza insufficienza respiratoria e sulla valutazione dei principali rischi e benefici correlati ad esso. Successivamente è stata effettuata l’analisi delle Linee Guida, identificando le procedure infermieristiche nell’assistenza al paziente in ECMO, per poter definire la best clinical practice. Obiettivo: Conoscere quali sono le evidenze più aggiornate sull’efficacia degli interventi infermieristici nel migliorare l’assistenza in pazienti sottoposti a VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION. Materiali e Metodi: è stata effettuata una revisione della letteratura primaria e secondaria nelle banche dati Medline, Cochrane Database of Systematic Reviews, Cinhal e Google Scholar. Sono state esaminate le Linee Guida ELSO Internazionali per la gestione del supporto extracorporeo. La ricerca bibliografica si è concentrata sulla lettura critica degli studi degli ultimi dieci anni. Sono stati selezionati diciotto articoli che corrispondevano ai criteri di selezione. Risultati: Sono stati reperiti diciotto studi di cui nove Revisioni Sistematiche della letteratura, delle quali tre comprendevano anche Meta-Analisi, tre studi Osservazionali Retrospettivi, uno studio Osservazionale Prospettico, due Trial Clinici non Randomizzati, uno studio Trasversale e due Revisioni Narrative della letteratura. Discussione: I risultati conseguiti hanno analizzato un miglioramento statisticamente significativo per gli esiti di mortalità e qualità della vita successivamente al supporto ECMO ma le complicanze rimangono comunque rilevanti. A tal proposito l’assistito in ECMO A-V necessita di un’attenta e rigorosa gestione da parte del personale infermieristico sulla base di speci Conclusioni: Negli ultimi dieci anni l’utilizzo di ECMO A-V ha determinato una rilveante riduzione della mortalità nei pazienti con shock cardiogeno o infarto del miocardio post cardiotomico refrattario. L’assistenza infermieristica ha contribuito notevolmente nella determinazione di miglioramenti in termini di ripresa e diminuzione del tempo di degenza. Sono necessari ulteriori studi di valutazione rispetto agli outcome relativi alla qualità della vita e alla mortalità Parole chiave: Venoarterial extracorporeal membrane oxygenation, cardiogenic shock, management, nursing, mortality, outcomes, risks.
NURSING PROCESS DEL PAZIENTE SOTTOPOSTO A VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION: UNA REVISIONE DELLA LETTERATURA
BELVEDERESI, LETIZIA
2020/2021
Abstract
Introduzione: Extra Corporeal Membrane Oxygenation (ECMO) consists of a procedure used to ensure the support of vital functions in subjects with heart or respiratory failure refractory to conventional therapy. There are two main types of ECMO (Veno-Venous Ecmo and Artero-Venous Ecmo). This study focuses on Artero-Venous ECMO, which emerged as the first-choice treatment in patients with refractory or post cardiotomy cardiogenic shock with or without respiratory failure, evaluating the main risks and benefits in order to identify the most suitable guidelines and tools to lead the clinical practice of the nursing process in the assistance to the patient who is subjected, in order to be able, finally, to carry out a correct care planning and define the best clinical practice. Obiettivo: The aim is to know what is the most up-to-date evidence on the effectiveness of nursing interventions in improving care in patients undergoing VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION. Materiali e Metodi: It was carried out a review of primary and secondary literature in the Medline, Cochrane Database of Systematic Reviews, Cinhal, and Google Scholar databases. The International ELSO Guidelines for the management of out-of-body support were reviewed. The bibliographic research has focused on the critical reading of the studies of the last ten years. Eighteen articles were selected that matched the selection criteria. Risultati: For the development of the thesis were found eighteen studies were found including nine Systematic Literature Reviews, of which three also included Meta-Analyses, three Retrospective Cohort studies, one Prospective Cohort study, two Non-Randomized Controlled Clinical Trials, one Cross-Sectional study, and two Narrative Literature reviews. Discussione: The results found record a statistically significant improvement in mortality and quality of life outcomes. However, the complications remain relevant. In this regard, the assisted person in ECMO A-V requires careful, specific and rigorous management by the nursing staff. Conclusioni: In the last ten years, the use of ECMO A-V has resulted in a significant reduction in mortality in patients with cardiogenic shock or refractory post-cardiotomy myocardial infarction. Nursing has contributed significantly to the determination of improvements in terms of recovery and reduction of hospitalization time. Further evaluation studies are needed related to quality of life and mortality outcomes. Parole chiave: Venoarterial extracorporeal membrane oxygenation, cardiogenic shock, management, nursing, mortality, outcomes, risks.File | Dimensione | Formato | |
---|---|---|---|
TESI DI LAUREA.pdf
accesso aperto
Descrizione: tesi di laurea.
Dimensione
3 MB
Formato
Adobe PDF
|
3 MB | Adobe PDF | Visualizza/Apri |
I documenti in UNITESI sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/20.500.12075/8663