La humidificación en oxigenoterapia convencional de bajo flujo se ha utilizado para prevenir sequedad de mucosas y mejorar la tolerancia, sin embargo, su beneficio sobre el confort y la seguridad del proceso continúan siendo debatidos. El objetivo de esta revisión de alcance fue mapear descriptivamente la evidencia sobre humidificación en oxigenoterapia convencional de bajo flujo en adultos, considerando confort, seguridad del paciente e implicancias potenciales para la práctica enfermera. Se realizaron búsquedas en PubMed/MEDLINE, Scopus, CINAHL y Web of Science, además de búsqueda manual, entre 2015 y 2025, en inglés, español o portugués. Se incluyeron estudios primarios y secundarios en adultos (≥18 años) con oxigenoterapia de bajo flujo mediante cánula nasal o mascarilla, y se efectuó extracción estandarizada orientada a la extracción de datos (charting) descriptivo de variables, desenlaces y medidas reportadas. Se incluyeron 12 estudios con diseños heterogéneos. Los estudios incluidos reportaron resultados no consistentes sobre beneficios de la humidificación rutinaria en confort global, los desenlaces se concentraron principalmente en síntomas nasales u orofaríngeos y tolerancia al dispositivo. En seguridad, se mapearon hallazgos de contaminación o colonización, especialmente en dispositivos reutilizables, con evidencia limitada sobre desenlaces clínicos atribuibles. La práctica enfermera apareció vinculada a valoración clínica, educación y estandarización del proceso cuando estos elementos fueron descritos por los estudios. En conjunto, esta revisión identifica una evidencia heterogénea que no permite sostener una recomendación general de humidificación rutinaria en bajo flujo, más bien, orienta a considerar decisiones contextualizadas y reevaluables, junto con estudios que incorporen medición estandarizada del confort y resultados clínicos y organizacionales.
Introduction Postoperative hemorrhagic shock is a time-critical complication associated with high morbidity and mortality, particularly in older surgical patients, requiring rapid, coordinated management in the intensive care unit (ICU). This case report describes specialized nursing management guided by the International Classification for Nursing Practice (ICNP®/CIPE®) and Benner's Clinical Wisdom Theory. Case presentation An 89-year-old woman underwent emergency gastrojejunostomy for intestinal obstruction and subsequently developed hemorrhagic shock with profound anemia (hemoglobin nadir 5.8g/dL), severe hyperlactatemia (12mmol/L), hypothermia (33.6̊C), peripheral hypoperfusion, and hypotension (mean arterial pressure<65mmHg). She required orotracheal intubation, invasive mechanical ventilation, and deep sedation. Diagnostic reassessment included serial hemoglobin and arterial blood gas analyses, lactate trending, invasive hemodynamic monitoring, and surgical re-exploration with intraoperative upper endoscopy, which suggested an upper gastrointestinal source (suspected Mallory–Weiss type lesion) treated endoscopically. Nursing priorities, structured using ICNP®, focused on perfusion restoration and correction of the lethal triad (hypothermia, acidosis, coagulopathy), multimodal analgesia, continuous monitoring, prevention bundles (infection and pressure injury prevention), and structured family communication. Discussion The patient progressively stabilized, with hemoglobin increasing to 9.6g/dL, lactate decreasing to <1mmol/L, normothermia recovery, discontinuation of vasopressors, and no documented ICU-acquired complications during the ICU stay. This case highlights how standardized nursing language (ICNP®/CIPE®), combined with advanced clinical reasoning and evidence-based ICU bundles, can improve the structure, traceability, and continuity of nursing care in postoperative hemorrhagic shock.
Introduction Vancomycin treats severe infections by resistant bacteria, but its acidity and local toxicity demand careful intravenous administration. Central venous catheters reduce these risks but pose complications. Midline catheters offer a less invasive alternative, though evidence remains limited. Objectives To map and describe the available clinical evidence on the safety and vascular complications associated with peripheral intravenous administration of vancomycin, compared with other vascular access devices, focusing on the type of complications reported, their diagnostic methods, and the methodological characteristics of the studies. Method A scoping review was conducted following the PRISMA-ScR guidelines. A comprehensive literature search was performed in Medline (via PubMed), Web of Science, Cochrane Library, CINAHL, and CUIDEN databases to identify studies reporting on intravenous vancomycin administration, catheter type and associated complications. Results Four studies met the inclusion criteria—two clinical trials and two cohort studies—with sample sizes ranging from 14 to 1087 participants. All studies reported complications attributed to vancomycin, regardless of catheter type. Two studies reported low rates of certain complications in patients receiving vancomycin through midline catheters, while other studies described complications associated with peripheral administration or recommended central access based on clinical considerations. Conclusion The available studies report heterogeneous findings regarding vascular complications associated with different vascular access devices for vancomycin administration. The evidence is limited and methodologically diverse, highlighting important gaps in the literature regarding outcome definitions, diagnostic approaches, and comparative evaluation across catheter types.
INTRODUCTION:Aerosol therapy during invasive mechanical ventilation is a common practice in intensive care units, however, its effectiveness is highly dependent on technical factors. Variability in device positioning and nursing technique produces substantial differences between the nominal dose and the fraction of drug that reaches the lungs, underscoring the need for standardized placement to enhance both safety and therapeutic efficiency. OBJECTIVE:To examine recent scientific evidence to determine the optimal positioning of aerosol delivery devices within the ventilator circuit, thereby guiding nursing practice toward standardized, evidence-informed procedures. METHODOLOGY:Systematized review (2018-2025) conducted in PubMed, BVSalud, and complementary academic search engines. MeSH, DeCS, and free-text terms related to aerosol therapy and mechanical ventilation were used. The PIO framework was applied following PRISMA guidelines and GRADE assessment. From 165 initial records, eight original studies were included. RESULTS:Vibrating mesh nebulizers demonstrated greater efficiency when positioned on the inspiratory limb, either near the Y-piece (10-15 cm) or at the humidifier inlet. Jet nebulizers showed optimal placement varying according to the device type (continuous, breath-actuated, or synchronized), although their overall performance was inferior to that of vibrating mesh nebulizers. Metered-dose inhalers were most effective when positioned on the inspiratory limb before the Y-piece, particularly when used with a spacer. CONCLUSIONS:The available evidence suggests that device positioning influences the efficiency of aerosol therapy during invasive mechanical ventilation. Vibrating mesh nebulizers and properly positioned inhalers may improve pulmonary drug delivery; however, the overall certainty of the evidence remains low.
