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- Recommendations for the prevention of adverse events in endotracheal suctioning – integrative reviewPublication . Sousa, Ana Sabrina; Ferrito, Candida; Paiva, José ArturIntroduction: The use of endotracheal suctioning is a common procedure in intensive care units, which implies various risks, namely hypoxemia, atelectasis, arterial hypertension, microbial colonization, etc. Nevertheless, healthcare professionals can adopt certain strategies to prevent these adverse events. Aim: To describe good practice relating to endotracheal suctioning in patients undergoing invasive ventilation. Materials and Methods: Integrative literature review. The research occurred in December 2015, using the databases B-on, PUBMED and RCAAP and 534 documents were found. After inclusion/exclusion and quality criteria evaluation, four studies were accepted for inclusion in this review. Results: Recommendations encountered were: suction only when necessary, pre-oxygenate, use a suction catheter with half the diameter of the endotracheal tube, avoid saline instillation, employ a closed aspiration system when FiO2 or positive end-expiratory pressure is elevated, limit the procedural duration to under 15 seconds and monitor the patient. Conclusion: The review demonstrates that some conclusions are not consensual, which represents a limitation of this study, since more experimental studies are needed, which represents a limitation of this study, since more experimental studies are needed. However, the stimulation of open debate, reflection, as well as the adoption of preventative measures, can lead to safer practice.
- Application of a ventilator associated pneumonia prevention guideline and outcomes: a quasi-experimental studyPublication . Sousa, Ana Sabrina; Ferrito, Cândida; Paiva, José ArturObjective: Ventilator associated pneumonia is the most frequent health-care-associated infection in Intensive Care Units, causing increased antibiotic consumption and resistance, length of stay, plus multiple health and economic costs. The aim of the study was to assess whether a customised guideline implementation would improve ventilator-associated pneumonia incidence and associated intensive care outcomes. Design: This was a quasi-experimental, before-after study consisting of pre-intervention, intervention and post-intervention periods. Setting: Three intensive care units at a well-known Portuguese hospital centre. Intervention: A set of eight recommendations was implemented after a guideline adaptation process. Patients: Adult patients admitted to the intensive care units over the study periods, aged 18 years or older and under invasive ventilation through an endotracheal tube or tracheostomy cannula. Measurements and main results: Data related to patient characterisation, guideline compliance and health outcomes were analysed. From a population of 1970 patients, a study sample of 828 was studied. Compliance with the recommendations was high. We identified a significant reduction in the incidence of ventilator-associated pneumonia in two of the units (p = 0.020 and p = 0.001) and a reduction in duration of invasive ventilation, intensive care unit length of stay and mortality in all the three units. We found associations between some recommendations and the implementation of the set of recommendations and intensive care unit length of stay, duration of invasive ventilation and mortality. Conclusion: The implementation of an evidence-based, locally customised guideline may improve ventilator associated pneumonia incidence and several outcomes.
- A segurança do doente é influenciada pelo ambiente da prática de cuidados dos enfermeiros que trabalham em serviço de urgência? Uma revisão integrativaPublication . Azevedo, Luciana Ramos de; Sousa, Ana Sabrina; Coelho, Sílvia Patrícia FernandesIntrodução: A identificação de fatores que possam influenciar a segurança do doente possibilita a implementação de melhorias nos cuidados prestados reduzindo a ocorrência de possíveis danos para os doentes. A realização deste estudo prende-se com a necessidade de identificar os erros ocorridos na prestação de cuidados a doentes num serviço de urgência. Objetivo: Identificar os fatores que influenciam a segurança do doente em serviço de urgência. Materiais e Métodos: Revisão integrativa realizada na base de dados Ebsco no período de 2017 a 2019, descritores MeSH combinados por operador boleano AND: “medication errors or drug errors or medication administration errors or drug administration errors”, “emergency room or emergency department” e “nurse or nurses or nursing”. Como critérios de inclusão foram definidos os artigos que se adequavam ao objetivo deste estudo e foram excluídos todos os artigos duplicados, artigos referentes a unidades de cuidados intensivos e a pediatria e artigos que não se adequavam ao objetivo do estudo. Resultados: Os 17 artigos analisados revelaram que os fatores relacionados com a elevada afluência de doentes ao serviço de urgência, a sobrecarga de trabalho, a escassez de recursos humanos e as interrupções constantes levam a ocorrência de erros e consequente risco para a segurança do doente. Conclusão: Devem ser criadas condições físicas e humanas para a prática segura dos cuidados, reduzindo a ocorrência de erros e assegurando a segurança do doente em serviço de urgência.
- Intubation-associated pneumonia: an integrative reviewPublication . Sousa, Ana Sabrina; Ferrito, Cândida; Paiva, José ArturObjective: This article aims to characterise intubation-associated pneumonia regarding its diagnosis, causes, risk factors, consequences and incidence. Research methodology: Integrative literature review using database Pubmed and B-on and webpages of organisations dedicated to this area of study. Setting: The research took place between May and July 2015. After selection of the articles, according to established criteria, their quality was assessed and 17 documents were included. Results: Evidence has demonstrated that intubation associated pneumonia has a multifactorial aetiology and one of its main causes is micro-aspiration of gastric and oropharynx contents. Risk factors can be internal or external. The diagnostic criteria are based on clinical, radiological and microbiological data, established by several organisations, including the European Centres for Disease Control and Prevention, which are, however, still not accurate. In recent years, there has been a downward trend in the incidence in Europe. Nevertheless, it continues to have significant economic impact, as well as affecting health and human lives. Conclusions: Several European countries are committed to addressing this phenomenon through infection control and microbial resistance programmes; however there is a much to be done in order to minimise its effects. The lack of consensus in the literature regarding diagnosis criteria, risk factors and incidence rates is a limitation of this study.