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Avaliação da dispneia em doentes ventilados mecanicamente num Serviço de Medicina Intensiva
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| 3.27 MB | Adobe PDF |
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Abstract(s)
A dispneia é um sintoma multifatorial, e só pode ser descrito pela pessoa que o está a experienciar. Em doentes incapazes de verbalizar desconforto, seja por alteração do estado de consciência, seja por uso de ventilação mecânica invasiva, a avaliação correta da dispneia torna-se um desafio para os profissionais de saúde envolvidos. A utilização de escalas adaptadas à avaliação da dispneia torna-se fundamental para a prevenção de situações potencialmente traumáticas, tal como a sensação de “air hunger”- “fome de ar”.
Objetivos: Demonstrar a existência de dispneia em doentes mecanicamente ventilados nesta população do SMI; compreender a correlação entre a dispneia e fatores sociodemográficos e clínicos; demonstrar a importância do uso de ferramentas para a avaliação da dispneia com o intuito principal de promover conforto e segurança ao doente no SMI.
Métodos: Estudo quantitativo descritivo onde foi utilizada a RDOS (Respiratory Distress Observation Scale) para avaliação da dispneia. Foi também criada uma grelha de registo de dados clínicos e sociodemográficos.
Resultados: Com a aplicação da RDOS, observou-se que os valores obtidos variaram entre um mínimo de 0 e 8 pontos, obtendo uma média de 3,1 pontos com um desvio padrão de 2,4 pontos. Concluiu-se que 44,4% dos doentes incluídos no estudo não apresentou dispneia, 16,7% dispneia ligeira, 27,8% dispneia moderada e 11,1% dispneia
severa, correspondendo a uma taxa de doentes com dispneia de 55,6%.
Conclusão: Com este projeto de investigação, podemos concluir que os doentes com dispneia severa são doentes com um perfil idoso e com antecedentes cardiovasculares prévios. Os doentes com categoria de admissão cirúrgica de urgência, os doentes com maior sedação, e com RASS (Richmond Agitation and Sedation Scale) compreendido entre -2 e -1 apresentam valores de dispneia moderada. Os doentes com dispneia ligeira são sobretudo admitidos ao Serviço de Medicina Intensiva com categoria diagnóstica médica. Por fim, os doentes sem dispneia têm idade inferior a 71 anos, sem antecedentes cardiovasculares, sem sedação e com RASS 0.
Dyspnea is a multifactorial symptom, and it can only be described by the person who is experiencing it. In regards of patients who are unable to communicate discomfort, either because of alterations in consciousness level or the use of mechanical ventilation, an accurate dyspnea evaluation becomes a challenge for health care providers who are involved. It becomes essential to use scales that are adapted to correctly evaluate dyspnea to prevent potentially traumatizing sensations, such as air hunger. Aim: Demonstrate the existence of dyspnea in mechanically ventilated patients in a critical care setting; understand the association between the dyspnea and sociodemografic and clinical factors; demonstrate the importance of using validated scales to evaluate patient’s dyspnea in order to promote comfort and safety to the patients in a critical care setting. Methods: Quantitative descriptive study where the RDOS (Respiratory Distress Observations Scale) was used in order to evaluate the dyspnea. An observational tool was created and used to collect all the sociodemographic and clinical data. Results: Using the RDOS, we observe that our patients had a score between 0 and 8, with a mean value of 3,1 (± 2,4). 44,4% of all the patients in the study did not presente dyspnea, 16,7% presented mild dyspnea, 27,8% presented moderate dyspnea and 11,1% severe dyspnea, with a total of 55,6% of mechanically ventilated patients with dyspnea. Conclusion: With this investigation project, we can affirm that the elderly patients, with cardiovascular past medical history are the ones that presented severe dyspnea. The patients who were admitted under the surgical emergency cathegory, the patients receiving more sedation and the patients with RASS score between -2 a -1 presented with moderate dyspnea. The patients admited under the medical cathegory presented with mild dyspnea. Lastly, the patients with ages less than 71 years, with no cardiovascular past medical history and RASS score of 0 had no dyspnea.
Dyspnea is a multifactorial symptom, and it can only be described by the person who is experiencing it. In regards of patients who are unable to communicate discomfort, either because of alterations in consciousness level or the use of mechanical ventilation, an accurate dyspnea evaluation becomes a challenge for health care providers who are involved. It becomes essential to use scales that are adapted to correctly evaluate dyspnea to prevent potentially traumatizing sensations, such as air hunger. Aim: Demonstrate the existence of dyspnea in mechanically ventilated patients in a critical care setting; understand the association between the dyspnea and sociodemografic and clinical factors; demonstrate the importance of using validated scales to evaluate patient’s dyspnea in order to promote comfort and safety to the patients in a critical care setting. Methods: Quantitative descriptive study where the RDOS (Respiratory Distress Observations Scale) was used in order to evaluate the dyspnea. An observational tool was created and used to collect all the sociodemographic and clinical data. Results: Using the RDOS, we observe that our patients had a score between 0 and 8, with a mean value of 3,1 (± 2,4). 44,4% of all the patients in the study did not presente dyspnea, 16,7% presented mild dyspnea, 27,8% presented moderate dyspnea and 11,1% severe dyspnea, with a total of 55,6% of mechanically ventilated patients with dyspnea. Conclusion: With this investigation project, we can affirm that the elderly patients, with cardiovascular past medical history are the ones that presented severe dyspnea. The patients who were admitted under the surgical emergency cathegory, the patients receiving more sedation and the patients with RASS score between -2 a -1 presented with moderate dyspnea. The patients admited under the medical cathegory presented with mild dyspnea. Lastly, the patients with ages less than 71 years, with no cardiovascular past medical history and RASS score of 0 had no dyspnea.
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Keywords
Dispneia Cuidados críticos Ventilação mecânica