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Advisor(s)
Abstract(s)
A pneumonia associada à ventilação mecânica é uma infeção grave
adquirida no serviço de medicina intensiva em doentes submetidos a intubação e
ventilação mecânica por mais de 48 horas. É uma infeção passível de prevenção com o
cumprimento de medidas simples (bundle) e a sua prevenção, constitui um grande
desafio à prática de enfermagem.
Objetivos: Identificar os procedimentos de enfermagem em doentes submetidos a
ventilação mecânica invasiva e o desenvolvimento de pneumonia num serviço de
medicina intensiva.
Métodos: estudo transversal descritivo realizado no serviço de medicina intensiva da
Unidade Local de Saúde Nordeste, no período de novembro de 2017 a fevereiro de
2018. Participaram no estudo 20 enfermeiros do referido serviço aos quais foram
realizadas 102 observações aos procedimentos de cuidados de enfermagem aos 634
doentes/intubados/dia/mês. Como instrumento de recolha de dados foi utilizado um
questionário para a caracterização da amostra e uma grelha de observação direta para
registo dos procedimentos realizados aquando da prestação de cuidados ao doente
ventilado. Os dados foram introduzidos e analisados pelo número de codificação no
programa informático Microsoft Excel 2016. O estudo foi submetido a aprovação e
autorização pelo Conselho de Administração da referida unidade.
Resultados: A amostra foi constituída por 20 enfermeiros, maioritariamente do sexo
feminino 75%, a faixa etária entre os 30 e os 39 anos representa 50%, 30% possuem
apenas licenciatura, 40% especialidade, 15% especialidade em médico-cirúrgica e igual
proporção em reabilitação, com tempo de exercício em enfermagem há 20 ou mais anos
50% e exercício de funções no serviço de medicina intensiva 45% fazem-no há menos
de 5 anos e igual proporção há mais de 10 anos. Todos afirmam possuir conhecimentos
na área da prevenção da pneumonia associada à ventilação, classificando esses
conhecimentos como bons 85%, 73,7% refiram ter adquirido essa formação em
contexto de serviço e esta decorreu no último ano em 73,7%. Do total de 102
observações diretas aos procedimentos dos cuidados de enfermagem ao doente
ventilado verificamos que em 98% dos procedimentos foi feita a elevação da cabeceira,
a higiene oral e a higiene das mãos. Em 99% observamos a manutenção dos circuitos
ventilatórios, 89,2% a verificação da pressão do cuff, 90,2% aspiração de secreções em
sos com a cabeira elevada e 5,9% em decúbito dorsal puro, 95,1% uso de equipamento proteção individual e 88,2% utilizou luvas esterilizadas aquando da realização da
aspiração de secreções no tubo oro traqueal. A frequência de pneumonia associada à
ventilação no período do estudo foi de 2 novos casos.
Conclusão: A frequência de pneumonia nos doentes ventilados foi baixa, verificou-se
uma elevada taxa de adesão à blundle preconizada pela Direção Geral de Saúde. A
verificação da pressão do cuff e a aspiração de secreções foram os procedimentos que
registaram menor adesão. Sugerimos que sejam adquiridos novos cufometros, sejam
sensibilizados os profissionais de enfermagem para a necessidade do cumprimento
rigoroso da bundle, evitando à aspiração de secreções do doente em posição decúbito
dorsal puro e o uso de técnica assética para a aspiração de secreções no tubo
endotraqueal com sistema aberto. Sugerimos ainda a realização de outros estudos com
amostras e em períodos maiores de forma a poder fazer associações e inferências para a
população em geral.
Ventilator-associated pneumonia is a serious infection acquired in the intensive care unit in patients undergoing intubation and mechanical ventilation for more than 48 hours. It is a preventable infection with the accomplishment of simple measures (bundle) and its prevention constitutes a great challenge to the practice of nursing. Objectives: To identify nursing procedures in patients undergoing invasive mechanical ventilation and the development of pneumonia in an Intensive Care Unit. Methods: A descriptive cross-sectional study carried out at the Intensive Care Unit of the Local Health Unit of the Northeastern Region of Portugal, from November 2017 to February 2018. Twenty nurses from the service participated in the study, and 102 observations were made on the nursing care procedures of 634 patients / intubated / day / month. As data collection instruments, a questionnaire was used to characterize the sample and a direct observation grid was used to record the procedures performed when care was given to the ventilated patient. The data was entered and analyzed by the coding number in the Microsoft Excel 2016 software. The study was submitted for approval and authorization by the Board of Directors of that unit. Results: The sample consisted of 20 nurses, 75% were female, the age group between 30 and 39 years represented 50%, as for literacy 30% have a degree and 20% have a postgraduate degree, 15% medical-surgical specialization and 15% have a rehabilitation specialization, as far as the years of nursing practice 50% have been working for 20 or more years,50% regarding work at intensive care medicine, 45% have been doing it for less than 5 years, 45% for at least 10 years. 100% claim to have knowledge in the area of prevention of ventilator-associated pneumonia, 85% classified this knowledge as good, regarding the provenance of this training 73.7% said it was in-service, answered it was during the last year 73.7%. Of the total 102 direct observations of the nursing care procedures to the ventilated patients, we verified that in 98% of the procedures, the head was elevated, and care was provided to oral and hand hygiene. In 99%, we observed maintenance of ventilatory circuits, 89.2% cuff pressure verification, 90.2% aspiration of secretions in sos with raised head and 5.9% in pure dorsal decubitus. 95.1% use personal protection equipment and 88.2% used sterilized gloves when performing aspiration of secretions in the orotracheal tube. 2 new cases of pneumonia in the ventilated patients developed during the course of this study. Conclusion: The frequency of pneumonia in the ventilated patients was low, with a high rate of adhesion to the recommended blundle of the Direçao Geral de Saúde. Cuff pressure verification and aspiration of secretions were the procedures that the nurses adhere to least. We suggest that new cuff manometers be acquired, nursing professionals be sensitized to the need for strict compliance to the bundle, avoiding aspiration of patient's secretions in a pure dorsal position and the use of aseptic technique for the aspiration of secretions in the endotracheal tube with an open system . We also suggest other studies with different samples and longer periods are conducted so as to be able to make associations and inferences for the general population.
Ventilator-associated pneumonia is a serious infection acquired in the intensive care unit in patients undergoing intubation and mechanical ventilation for more than 48 hours. It is a preventable infection with the accomplishment of simple measures (bundle) and its prevention constitutes a great challenge to the practice of nursing. Objectives: To identify nursing procedures in patients undergoing invasive mechanical ventilation and the development of pneumonia in an Intensive Care Unit. Methods: A descriptive cross-sectional study carried out at the Intensive Care Unit of the Local Health Unit of the Northeastern Region of Portugal, from November 2017 to February 2018. Twenty nurses from the service participated in the study, and 102 observations were made on the nursing care procedures of 634 patients / intubated / day / month. As data collection instruments, a questionnaire was used to characterize the sample and a direct observation grid was used to record the procedures performed when care was given to the ventilated patient. The data was entered and analyzed by the coding number in the Microsoft Excel 2016 software. The study was submitted for approval and authorization by the Board of Directors of that unit. Results: The sample consisted of 20 nurses, 75% were female, the age group between 30 and 39 years represented 50%, as for literacy 30% have a degree and 20% have a postgraduate degree, 15% medical-surgical specialization and 15% have a rehabilitation specialization, as far as the years of nursing practice 50% have been working for 20 or more years,50% regarding work at intensive care medicine, 45% have been doing it for less than 5 years, 45% for at least 10 years. 100% claim to have knowledge in the area of prevention of ventilator-associated pneumonia, 85% classified this knowledge as good, regarding the provenance of this training 73.7% said it was in-service, answered it was during the last year 73.7%. Of the total 102 direct observations of the nursing care procedures to the ventilated patients, we verified that in 98% of the procedures, the head was elevated, and care was provided to oral and hand hygiene. In 99%, we observed maintenance of ventilatory circuits, 89.2% cuff pressure verification, 90.2% aspiration of secretions in sos with raised head and 5.9% in pure dorsal decubitus. 95.1% use personal protection equipment and 88.2% used sterilized gloves when performing aspiration of secretions in the orotracheal tube. 2 new cases of pneumonia in the ventilated patients developed during the course of this study. Conclusion: The frequency of pneumonia in the ventilated patients was low, with a high rate of adhesion to the recommended blundle of the Direçao Geral de Saúde. Cuff pressure verification and aspiration of secretions were the procedures that the nurses adhere to least. We suggest that new cuff manometers be acquired, nursing professionals be sensitized to the need for strict compliance to the bundle, avoiding aspiration of patient's secretions in a pure dorsal position and the use of aseptic technique for the aspiration of secretions in the endotracheal tube with an open system . We also suggest other studies with different samples and longer periods are conducted so as to be able to make associations and inferences for the general population.
Description
Keywords
Pneumonia associada à ventilação mecânica Cuidados críticos