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Fatores que influenciam a eficácia da terapêutica inalatória na Ventilação Mecânica Invasiva: uma Scoping Review
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Orientador(es)
Resumo(s)
A terapêutica inalatória em doentes sob ventilação mecânicam invasiva constitui uma intervenção frequente em unidades de cuidados intensivos, sendo relevante no tratamento de alterações respiratórias e na otimização da mecânica ventilatória. Contudo, a sua eficácia depende de múltiplos fatores, nomeadamente técnicos, ventilatórios, humanos e organizacionais, que podem interferir na deposição pulmonar do fármaco e, consequentemente, nos resultados clínicos.
Objetivo: Mapear a extensão da evidência científica acerca dos fatores que influenciam a eficácia da terapêutica inalatória em doentes adultos sob Ventilação Mecânica Invasiva.
Métodos: Foi realizada uma scoping review segundo as orientações do Joanna Briggs Institute e estruturada de acordo com as recomendações PRISMA-ScR. A pesquisa foi realizada nas bases de dados PubMed, Scopus e B-on, em abril e maio de 2026. A seleção dos estudos foi efetuada com base em critérios de inclusão previamente definidos, dividida em duas etapas: leitura do título e resumo e, em seguida, leitura completa dos estudos aparentemente relevantes. As informações dos estudos incluídos foram organizadas em uma matriz de mapeamento elaborada pela autora, que abrange autor, objetivo, desenho do estudo, principais fatores identificados e a contribuição para a questão da revisão. Considerando que se trata de uma Scoping Review, não foi feita uma avaliação formal da qualidade metodológica dos estudos selecionados, uma vez que o objetivo principal foi mapear a evidência existente e identificar fatores, lacunas e implicações para a prática. A revisão foi realizada por um único revisor, no âmbito de uma dissertação de mestrado, o que representa uma limitação metodológica.
Resultados: Foram incluídos 15 estudos na síntese final. A evidência analisada permitiu identificar fatores associados à eficácia da terapêutica inalatória durante a ventilação mecânica invasiva, nomeadamente o tipo de dispositivo utilizado, a posição do nebulizador ou inalador no circuito ventilatório, a humidificação, os parâmetros ventilatórios, o tempo inspiratório, o fluxo inspiratório, a sincronização com a inspiração, a utilização de espaçador, as características do aerossol e a técnica de administração. Foram ainda identificados fatores humanos e organizacionais, como o conhecimento dos profissionais, a variabilidade da prática clínica, a ausência de protocolos padronizados e a necessidade de formação contínua. As principais limitações desta revisão relacionam-se com a heterogeneidade metodológica dos estudos incluídos, diversidade dos dispositivos e condições ventilatórias analisadas.
Conclusão: A eficácia da terapêutica inalatória em doentes sob ventilação mecânica invasiva resulta da interação entre fatores técnicos, ventilatórios, humanos e organizacionais. A otimização da técnica, a utilização adequada dos dispositivos, a adaptação dos parâmetros ventilatórios e a implementação de protocolos baseados na evidência podem contribuir para melhorar a deposição pulmonar do fármaco, reduzir perdas terapêuticas e promover cuidados mais seguros e eficazes. Recomenda-se o desenvolvimento de investigação clínica adicional e de programas formativos dirigidos aos profissionais de saúde, em
particular no contexto dos cuidados intensivos e da Enfermagem de Reabilitação.
Inhalation therapy in patients undergoing invasive mechanical ventilation is a frequent intervention in intensive care units, being relevant in the treatment of respiratory disorders and in the optimization of ventilatory mechanics. However, its effectiveness depends on multiple factors, namely technical, ventilatory, human and morganizational factors, which can interfere with pulmonary drug deposition and, consequently, with clinical outcomes. Objective: To map the extent of scientific evidence regarding the factors that influence the effectiveness of inhaled therapy in adult patients undergoing invasive mechanical ventilation. Methods: A scoping review was conducted according to the Joanna Briggs Institute guidelines and structured according to PRISMA-ScR recommendations. The search was performed in the PubMed, Scopus, and B-on databases in April and May 2026. The selection of studies was based on predefined inclusion criteria, divided into two stages: reading the title and abstract, and then reading the full text of apparently relevant studies. The information from the included studies was organized into a mapping matrix developed by the author, which includes author, objective, study design, main factos identified, and contribution to the review question. Considering that this is a scoping review, a formal assessment of the methodological quality of the selected studies was not performed, since the main objective was to map the existing evidence and identify factors, gaps, and implications for practice. The review was conducted by a single reviewer within the scope of a master's thesis, which represents a methodological limitation. Results: Fifteen studies were included in the final synthesis. The analyzed evidence allowed the identification of factors associated with the effectiveness of inhalation therapy during invasive mechanical ventilation, namely the type of device used, the position of the nebulizer or inhaler in the ventilatory circuit, humidification, ventilatory parameters, inspiratory time, inspiratory flow, synchronization with inspiration, use of a spacer, aerosol characteristics, and administration technique. Human and organizational factors were also identified, such as professional knowledge, variability in clinical practice, lack of standardized protocols, and the need for continuing education. The main limitations of this review are related to the methodological heterogeneity of the included studies, the diversity of devices, and the ventilatory conditions analyzed. Conclusion: The effectiveness of inhalation therapy in patients undergoing invasive mechanical ventilation results from the interaction between technical, ventilatory, human, and organizational factors. Optimization of technique, appropriate use of devices, adaptation of ventilatory parameters, and implementation of evidence-based protocols can contribute to improving pulmonary drug deposition, reducing therapeutic losses, and promoting safer and more effective care. Further clinical research and training programs aimed at healthcare professionals are recommended, particularly in the context of intensive care and rehabilitation nursing.
Inhalation therapy in patients undergoing invasive mechanical ventilation is a frequent intervention in intensive care units, being relevant in the treatment of respiratory disorders and in the optimization of ventilatory mechanics. However, its effectiveness depends on multiple factors, namely technical, ventilatory, human and morganizational factors, which can interfere with pulmonary drug deposition and, consequently, with clinical outcomes. Objective: To map the extent of scientific evidence regarding the factors that influence the effectiveness of inhaled therapy in adult patients undergoing invasive mechanical ventilation. Methods: A scoping review was conducted according to the Joanna Briggs Institute guidelines and structured according to PRISMA-ScR recommendations. The search was performed in the PubMed, Scopus, and B-on databases in April and May 2026. The selection of studies was based on predefined inclusion criteria, divided into two stages: reading the title and abstract, and then reading the full text of apparently relevant studies. The information from the included studies was organized into a mapping matrix developed by the author, which includes author, objective, study design, main factos identified, and contribution to the review question. Considering that this is a scoping review, a formal assessment of the methodological quality of the selected studies was not performed, since the main objective was to map the existing evidence and identify factors, gaps, and implications for practice. The review was conducted by a single reviewer within the scope of a master's thesis, which represents a methodological limitation. Results: Fifteen studies were included in the final synthesis. The analyzed evidence allowed the identification of factors associated with the effectiveness of inhalation therapy during invasive mechanical ventilation, namely the type of device used, the position of the nebulizer or inhaler in the ventilatory circuit, humidification, ventilatory parameters, inspiratory time, inspiratory flow, synchronization with inspiration, use of a spacer, aerosol characteristics, and administration technique. Human and organizational factors were also identified, such as professional knowledge, variability in clinical practice, lack of standardized protocols, and the need for continuing education. The main limitations of this review are related to the methodological heterogeneity of the included studies, the diversity of devices, and the ventilatory conditions analyzed. Conclusion: The effectiveness of inhalation therapy in patients undergoing invasive mechanical ventilation results from the interaction between technical, ventilatory, human, and organizational factors. Optimization of technique, appropriate use of devices, adaptation of ventilatory parameters, and implementation of evidence-based protocols can contribute to improving pulmonary drug deposition, reducing therapeutic losses, and promoting safer and more effective care. Further clinical research and training programs aimed at healthcare professionals are recommended, particularly in the context of intensive care and rehabilitation nursing.
Descrição
Palavras-chave
Terapia por inalação Ventilação mecânica Aerossóis Unidades de cuidados intensivos Enfermagem de reabilitação