Protocolo de identificação e correção de assincronia paciente-ventilador pelo método de inspeção visual para unidade de terapia intensiva pediátrica
Invasive mechanical ventilation constitutes one of the main treatment supports for children who have acute or acute chronic respiratory failure in a pediatric intensive care unit. However, its prolonged use induces inflammatory processes, in addition to the occurrence of patientventilator asynchro...
Na minha lista:
| Autor principal: | |
|---|---|
| Outros Autores: | |
| Formato: | Dissertação |
| Idioma: | pt_BR |
| Publicado em: |
Universidade Federal do Rio Grande do Norte
|
| Assuntos: | |
| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/51927 |
| Tags: |
Adicionar Tag
Sem tags, seja o primeiro a adicionar uma tag!
|
| Resumo: | Invasive mechanical ventilation constitutes one of the main treatment supports for children who
have acute or acute chronic respiratory failure in a pediatric intensive care unit. However, its
prolonged use induces inflammatory processes, in addition to the occurrence of patientventilator asynchrony, defined as the incompatibility between the ventilatory demands of the
patient about what is offered by the mechanical ventilator. This event produces adverse clinical
outcomes and an increased risk of mortality. Faced with this problem, the objective of this study
was to build and validate a protocol for identifying and correcting patient-ventilator asynchrony
using the visual inspection method for children hospitalized in a pediatric intensive care unit.
This is a methodological development research, with a quantitative approach, based on
Pasquali's model of Psychometry, according to the following axes: theoretical pole, empirical
pole, and analytical pole. In the theoretical pole, a scoping review was carried out for the
construction of domains, items and protocol sub-items. At the empirical pole, there was a
theoretical analysis of the items, carried out in two stages: content and appearance analysis by
eight judges who were specialists in invasive ventilatory support, who evaluated the domains,
items and sub-items about the comprehensiveness, clarity, and representativeness; and semantic
analysis of the items, using the Brainstorming technique, which consisted of checking the
understanding of the domains, items and sub-items by three groups of two residents, two doctors
in one group, a physiotherapist and a nurse in another group, and a doctor and a nurse in the
third group, in the second year of residency, in the pediatrics area, at a University Hospital.
Finally, the analytical pole consisted of analyzing the data using the Content Validity Index
(CVI) and the kappa Coefficient of agreement (k). The research followed all the ethical and
legal aspects of research in human beings, obtaining the opinion of the Research Ethics
Committee under nº 5,388,822. Initially, the protocol was built from ten studies obtained
through the scoping review, consisting of 24 domains, 13 items, and 24 sub-items. Afterward,
this first version was sent for analysis by the judges who evaluated the title, the instrument, and
the appearance (layout). All these items were judged adequate, obtaining maximum agreement
rates (CVI=1.00, k=1.00). In the analysis of the 24 domains, 15 obtained maximum agreement
rates (CVI=1.00, k=1.00), and nine showed substantial agreement (CVI=0.88 and k=0.75) in
terms of clarity and representativeness. Of the 13 items analyzed, only items 7.1 and 7.2 of
domain 7 showed substantial agreement (CVI=0.88 and k=0.75); the remaining items obtained
maximum agreement rates (CVI=1.00; k=1.00). All sub-items were considered adequate and
obtained maximum agreement rates (CVI=1.00; k=1.00). In the semantic analysis step, all
domains, items and sub-items obtained maximum agreement rates (CVI=1.00; k=1.00). The
final version of the protocol was composed of 20 domains, 15 items and 24 sub-items. It is
expected that the technological product (protocol) constructed and validated will direct the
professionals working in the pediatric intensive care unit, so that they can identify and correct
patient-ventilator asynchronies, with the aim of improving the quality-of-care practice in the
care of mechanically ventilated children, minimizing the time of invasive ventilatory support
and complications, as well as supporting the implementation of safe-conducts. |
|---|