[Nursing interventions for the prevention of accidental extubation]

Brazilian recommendations of mechanical ventilation 2013. Part 2

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devices

AbstractOBJECTIVETo analyze the care implemented by the nursing team to promote the safety of adult patients and prevention of skin and mucosal lesions associated with the presence of lower airways invasive devices.METHODStudy with qualitative and quantitative approach, descriptive and exploratory type, whose investigative scenarios were adult inpatient units of a hospital in the West Frontier of Rio Grande do Sul. The study subjects consisted of nurses, nursing technicians and nursing assistants.RESULTSA total of 118 professionals were interviewed. We highlight the observed specific care with endotracheal tube and tracheostomy, management and assessment of the cuff and the criteria used to secretion aspiration.CONCLUSIONThere is a superficial nursing work in the patient direct care and a differentiation in relation to the perception of nurse technicians, especially those working in the intensive care unit, who presented major property and view of the patient's clinical status.

Brazilian recommendations of mechanical ventilation 2013. Part 2

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Práticas assistenciais para segurança do paciente em unidade de terapia intensiva

Objetivo Verificar as boas práticas assistenciais de enfermagem para segurança do paciente em unidade de terapia intensiva.Métodos Pesquisa descritiva, utilizando um checklist com 19 itens sobre higiene/conforto, identificação do paciente/queda e infecção hospitalar. Foram analisadas 450 verificações por meio do Teste G de independência com a correção de Williams.Resultados Em conjunto, as boas práticas estão sendo realizadas com índice acima de 90%, com exceção da mudança de decúbito, restrições de membros limpas e circuito do ventilador.Conclusão As boas práticas assistenciais de enfermagem para a segurança do paciente foram realizadas, com diversidade conforme o turno de trabalho.

[Quality of nursing care in intensive therapy: evaluation through operational auditing]

This study aimed to evaluate the quality of nursing care of an Adult Intensive Care Unit. Data from fifty in-hospital patients, who stayed in ICU for more than three days, were collected through observation, physical examination and patients' medical-information records analysis, using an Operational Auditing Plan. Care considered of quality were those that obtained positive answer percentage ≥ 70%, as those related to Physical Safety (71%) and Equipment Use (72%). Physical Activity (28%) and Oxygenation/Ventilation (29%) reached the lowest scores. We concluded that is urgent to implement continuing education actions in the service studied, since most care items and sub-items did not present the quality needed.

Influência do dimensionamento da equipe de enfermagem na qualidade do cuidado ao paciente crítico

Estudo na modalidade Revisão Integrativa, com objetivo de analisar a influência do dimensionamento do pessoal de enfermagem intensivista na qualidade do cuidado ao paciente crítico adulto. Foram incluídas apenas publicações científicas, das principais bases eletrônicas, veiculadas em periódicos de acesso livre e eletrônico, referentes à última década (janeiro de 2000 a janeiro de 2010), nos idiomas inglês, português e espanhol. Obteve-se um total de 10 publicações, dentre as quais três avaliaram a incidência de mortalidade e extubação acidental no pós-operatório; três avaliaram os reflexos no cuidado resultantes da redução no número de enfermeiros; dois avaliaram o desenvolvimento de infecções; e um, respectivamente, avaliou a incidência de quedas e de pneumonia associada à ventilação mecânica. Os estudos indicam relação entre o subdimensionamento de trabalhadores da enfermagem e o aumento nas taxas de infecções, mortalidade, quedas, pneumonia associada à ventilação mecânica e extubação acidental.