1
|
Gaspar L, Reis N, Sousa P, Silva APE, Cardoso A, Brito A, Bastos F, Campos J, Parente P, Pereira F, Machado N. Nursing Process Related to the Nursing Focus "Airway Clearance": A Scoping Review. NURSING REPORTS 2024; 14:1871-1896. [PMID: 39189270 PMCID: PMC11348224 DOI: 10.3390/nursrep14030140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Airway clearance impairment has a significant impact on self-care and quality of life. Identifying clinical data, nursing diagnoses, and nursing interventions is essential to clinical reasoning and enhancing nursing care. This study aims to map the existing evidence on clinical data, nursing diagnoses, and nursing interventions addressing the nursing focus on "airway clearance". METHODS Research was conducted based on Joanna Briggs's Scoping Review Methodology. We searched four databases for published studies until December 2023. RESULTS From the initial 1854 studies identified, 123 were included in the review. The findings highlighted two areas of nursing attention: one related to signs and symptom management, and the other related to education and coping strategies. The data that led to nursing diagnoses were divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretion retention, excessive mucus production, and airway obstruction. The most commonly identified nursing interventions were educational interventions assembled into predesigned education programs rather than patient-tailored programs. CONCLUSIONS Findings can add substantial value for systematizing the nursing process related to "airway clearance", improving nursing decision-making and care quality. This study was prospectively registered with the Open Science Framework (OSF) on 02 December 2022, with the registration number wx5ze.
Collapse
Affiliation(s)
- Luís Gaspar
- Faculty of Health Sciences and Nursing, Universidade Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Neuza Reis
- Faculty of Health Sciences and Nursing, Universidade Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Paula Sousa
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Abel Paiva e Silva
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Alexandrina Cardoso
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Alice Brito
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Fernanda Bastos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Joana Campos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Paulo Parente
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Filipe Pereira
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Natália Machado
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| |
Collapse
|
2
|
Effects of ventilator hyperinflation on pulmonary function and secretion clearance in adults receiving mechanical ventilation: A systematic review with meta-analysis. Heart Lung 2022; 56:8-23. [PMID: 35649308 DOI: 10.1016/j.hrtlng.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION It is important to clarify the effect of ventilator hyperinflation(VHI) on pulmonary function and secretion clearance in adults receiving mechanical ventilation(MV). There is no published meta-analysis on the effects VHI on pulmonary function and secretion clearance in adults receiving MV. Objective Analyze the published randomized clinical trials(RCTs) that investigated the effects of VHI on pulmonary function and secretion clearance in adults receiving MV, comparing VHI with isolated aspiration, VHI with manual hyperinflation(MHI), VHI +vibrocompression(VB) versus VB and VHI+VB versus isolated aspiration. METHODS The following databases PubMed, LILACS, EMBASE, SciELO, PEDro database and Cochrane Central Register of Controlled Trials (CENTRAL) were consulted up to December 2021. Secretion clearance, static and dynamic compliance of the respiratory system(Cstat and Cdyn), airway resistance(Raw) and oxygenation outcomes were evaluated. RESULTS Thirteen studies met the study criteria, but only 12 studies were included on meta-analysis. There was no difference between VHI versus isolated aspiration for amount of secretions removed(0.41 SMD; 95% CI: -0.08 to 0.89; n=270), VHI versus MHI(0.51 grams; 95% CI: -0.08 to 1.11; n=256), VHI+VB versus VB(0.31 grams; 95% CI: -0.42 to 1.05; n=130) and VHI+VB versus isolated aspiration(0.54 grams; 95% CI: -0.06 to 1.14; n=132). There was difference for VHI versus isolated aspiration to Cstat (4.77 ml/cm H2O; 95% CI: 2.41 to 7.14; n= 136). CONCLUSION No evidence was found that VHI was effective in increasing the amount of secretions removed, Cdyn and oxygenation, but VHI seems to show a slight improvement in Cstat when compared to isolated aspiration.
Collapse
|
3
|
Rodrigues-Gomes RM, Martí JD, Rolán RM, Gelabert-González M. Rapid chest compression effects on intracranial pressure in patients with acute cerebral injury. Trials 2022; 23:312. [PMID: 35428364 PMCID: PMC9012060 DOI: 10.1186/s13063-022-06189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with acute brain injury often require invasive mechanical ventilation, increasing the risk of developing complications such as respiratory secretions retention. Rapid chest compression is a manual chest physiotherapy technique that aims to improve clearance of secretions in these patients. However, the rapid chest compression technique has been suggested to be associated with increased intracranial pressure in patients with acute brain injury. The aim of this work is to elucidate the effects of the technique on intracranial pressure in mechanically ventilated patients with acute brain injury. Furthermore, the effects of the technique in different volumes and flows recorded by the ventilator and the relationship between the pressure applied in the intervention group and the different variables will also be studied. METHODS Randomized clinical trial, double-blinded. Patients with acute brain injury on invasive mechanical ventilation > 48 h will be included and randomized in two groups. In the control group, a technique of passive hallux mobilization will be applied, and in the intervention group, it will be performed using the rapid chest compression technique. Intracranial pressure (main variable) will be collected with an intracranial pressure monitoring system placed at the lateral ventricles (Integra Camino). DISCUSSION The safety of chest physiotherapy techniques in patients at risk of intracranial hyperpressure is still uncertain. The aim of this study is to identify if the rapid manual chest compression technique is safe in ventilated patients with acute brain injury. TRIAL REGISTRATION NCT03609866 . Registered on 08/01/2018.
Collapse
|
4
|
van der Lee L, Hill AM, Jacques A, Patman S. Efficacy of Respiratory Physiotherapy Interventions for Intubated and Mechanically Ventilated Adults with Pneumonia: A Systematic Review and Meta-Analysis. Physiother Can 2021; 73:6-18. [PMID: 35106019 PMCID: PMC8774958 DOI: 10.3138/ptc-2019-0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of stay, duration of ventilation, oxygenation, secretion clearance, and pulmonary mechanics for invasively ventilated adults with pneumonia. Method: Five databases were searched for randomized trials published between January 1995 and November 2018. Study quality was assessed using a standardized Joanna Briggs Institute critical appraisal tool, and Review Manager software was used to pool the studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the level of certainty of the evidence. Results: A total of 14 studies of moderate quality included 251 subjects with pneumonia. Eight studies were pooled for meta-analysis. Interventions that increased inspiratory volume appeared to benefit secretion clearance by nearly 2 grams (mean difference [MD] 1.97; 95% CI: 0.80, 3.14; very low GRADE evidence) and increase static lung compliance immediately after treatment by more than 5 millilitres/centimetre H20 (MD 5.40 mL/cm H2O; 95% CI: 2.37, 8.43; very low GRADE evidence) or by more than 6 millilitres/centimetre H2O after a 20- to 30-minute delay (MD 6.86 mL/cm H2O; 95% CI: 2.86, 10.86; very low GRADE evidence). No adverse events were found. Conclusions: Respiratory physiotherapy that increases tidal volume may benefit secretion clearance and lung compliance in invasively ventilated adults with pneumonia, but its impact on other outcomes, including mortality, length of stay, and other patient-centred outcomes, is unclear, and further research is required.
Collapse
Affiliation(s)
- Lisa van der Lee
- School of Physiotherapy
- Physiotherapy Department, Fiona Stanley Hospital, Murdoch
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, W.A., Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame, Fremantle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, W.A., Australia
| | - Shane Patman
- Physiotherapy Department, Fiona Stanley Hospital, Murdoch
| |
Collapse
|
5
|
van der Lee L, Hill AM, Patman S. Expert consensus for respiratory physiotherapy management of mechanically ventilated adults with community-acquired pneumonia: A Delphi study. J Eval Clin Pract 2019; 25:230-243. [PMID: 30565374 DOI: 10.1111/jep.13077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 01/04/2023]
Abstract
RATIONALE AND AIMS Patients with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit. Physiotherapy may be provided to optimize respiratory function; however, there is significant variability in clinical practice and limited research directing best practice for this cohort. This study aimed to determine expert consensus for best physiotherapy practice for invasively ventilated adults with CAP. METHOD A modified Delphi technique involved an international expert panel completing three rounds of an online questionnaire. The initial 35-statement questionnaire, based on a systematic literature review and survey of current clinical practice, covered physiotherapy assessment and treatment of intubated patients with CAP. Quantitative data using Likert scales determined level of agreement, with qualitative data collected through open-ended responses. Consensus threshold was set a priori at 70%. Items not achieving consensus were modified and new items added based on themes from qualitative data. Quantitative data were analysed descriptively, with thematic analysis used on qualitative data. RESULTS The panel comprised 29 international clinical and academic experts in critical care physiotherapy. Response rate was more than 95% for each round. Outcome achieved was 38 consensus statements covering assessment and treatment, with 28 statements (74%) providing consensus on recommended clinical practice, two consensus disagreement statements (7%) for what practice is not recommended, and eight statements (21%) indicating which treatments may be beneficial. CONCLUSION Expert consensus regarding physiotherapy for intubated adults with CAP patients provides an evidence-based approach to guide clinical practice. The consensus statements can also be used to guide research evaluating physiotherapy interventions for patients with CAP.
Collapse
Affiliation(s)
- Lisa van der Lee
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia.,Intensive Care Unit, Fiona Stanley Hospital Perth, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| |
Collapse
|
6
|
Naue WDS, Herve BB, Vieira FN, Deponti GN, Martins LDF, Dias AS, Vieira SRR. Comparison of bronchial hygiene techniques in mechanically ventilated patients: a randomized clinical trial. Rev Bras Ter Intensiva 2019; 31:39-46. [PMID: 30892477 PMCID: PMC6443316 DOI: 10.5935/0103-507x.20190005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 11/27/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To compare the effects of vibrocompression and hyperinflation with mechanical ventilator techniques alone and in combination (hyperinflation with mechanical ventilator + vibrocompression) on the amount of aspirated secretion and the change in hemodynamic and pulmonary parameters. METHODS A randomized clinical trial with critically ill patients on mechanical ventilation conducted in the intensive care unit of a university hospital. The patients were randomly allocated to receive one of the bronchial hygiene techniques for 10 minutes (vibrocompression or hyperinflation with mechanical ventilator or hyperinflation with mechanical ventilator + vibrocompression). Afterwards, the patients were again randomly allocated to receive either the previous randomly allocated technique or only tracheal aspiration. The weight of aspirated secretions (in grams), ventilatory mechanics and cardiopulmonary data before and after the application of the techniques were analyzed. The tracheal reintubation frequency and time and mortality on mechanical ventilation were also evaluated. RESULTS A total of 93 patients (29 vibrocompression, 32 hyperinflation with mechanical ventilator and 32 hyperinflation with mechanical ventilator + vibrocompression) on mechanical ventilation for more than 24 hours were included. The hyperinflation with mechanical ventilator + vibrocompression group was the only one that presented a significant increase in aspirated secretions compared to tracheal aspiration alone [0.7g (0.1 - 2.5g) versus 0.2g (0.0 - 0.6g), p value = 0.006]. CONCLUSION Compared to tracheal aspiration alone, the combination of hyperinflation with mechanical ventilator + vibrocompression techniques was most efficient for increasing the amount of aspirated secretions.
Collapse
Affiliation(s)
- Wagner da Silva Naue
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Bruno Barcelos Herve
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Fernando Nataniel Vieira
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Gracieli Nadalon Deponti
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Luciane de Fraga Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Alexandre Simões Dias
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Silvia Regina Rios Vieira
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| |
Collapse
|
7
|
Yousefnia-Darzi F, Hasavari F, Khaleghdoost T, Kazemnezhad-Leyli E, Khalili M. Effects of thoracic squeezing on airway secretion removal in mechanically ventilated patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:337-42. [PMID: 27186214 PMCID: PMC4857671 DOI: 10.4103/1735-9066.180374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Accumulation of secretions in the airways of patients with an endotracheal tube and mechanical ventilation will have serious consequences. One of the most common methods of airway clearance is endotracheal suctioning. In order to facilitate discharge of airway secretion resulting in promotion of gas exchange, chest physiotherapy techniques can be used at the time of expiration before suction. Materials and Methods: In this clinical trial with a cross-over design, 50 mechanically ventilated patients admitted to intensive care units (ICUs) were randomly divided into two groups of thoracic squeezing. In each patient, two interventions of endotracheal suctioning were conducted, one with and the other without thoracic squeezing during exhalation, with a 3 h gap between the two interventions and an elapse of three respiratory cycles between the number of compressions. Sputum secreted was collected in a container connected to a suction catheter and weighed. Data were recorded in data gathering forms and analyzed using descriptive and inferential statistics (Wilcoxon and independent t-test, Chi-square) in SPSS version 16. Results: Findings showed that the mean weight of the suction secretions removed from airway without thoracic squeezing was 1.35 g and that of suction secretions removed by thoracic squeezing was 1.94 g. Wilcoxon test showed a significant difference regarding the rate of secretion between the two techniques (P = 0.003). Conclusions: According to the study findings, endotracheal suction with thoracic squeezing on expiration helps airway secretion discharge more than suction alone in patients on mechanical ventilators and can be used as an effective method.
Collapse
Affiliation(s)
- Farkhondeh Yousefnia-Darzi
- Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Farideh Hasavari
- Department of Medical-Surgical Nursing, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Khaleghdoost
- Department of Medical-Surgical Nursing, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad-Leyli
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
8
|
de Alcântara J, Manzano R, Gonçalves M, dos Santos R, Albino D, Apostólico N, Fonseca N, Urbano J, Daibem C, Donner CF, Gimenes C, Ambrozin A, de Oliveira L. A new tuning fork with different vibration frequencies as an aid to bronchopulmonary hygiene physiotherapy. Multidiscip Respir Med 2014. [DOI: 10.1186/2049-6958-9-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|