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A intervenção do enfermeiro especialista em enfermagem de reabilitação no descanulação eficiente do utente crítico: scoping review
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Authors
Abstract(s)
Enquadramento: A traqueostomia representa um marco no desmame ventilatório.
A remoção da mesma (descanulação), descreve-se como fundamental na reabilitação do
doente crítico, onde os enfermeiros desempenham um papel elementar. No sentido de
descrever qual a intervenção do enfermeiro no processo de descanulação foi elaborada uma
Scoping Review, que se apresenta nesta dissertação.
Objetivos: O objetivo desta revisão é mapear e analisar as evidências disponíveis
sobre a intervenção de reabilitação na descanulação do doente crítico. O desenvolvimento
deste estudo visa a criação de um protocolo que suporte a intervenção de reabilitação na
descanulação.
Métodos: Foi implementada a estratégia PCC e as recomendações PRISMA® do
Joanna Briggs Institute®. Pretendemos responder à questão: “Qual a intervenção do
enfermeiro especialista em enfermagem de reabilitação para uma descanulação eficiente
nos doentes traqueostomizados em cuidados intensivos?”. A pesquisa realizou-se no mês
de novembro de 2022, com recurso às plataformas MEDLINE, CINAHL® Complete,
Cochrane Database of Systematic Reviews, MedicLatina, Nursing & Allied Health
Collection, Scopus®, Web of Science, ProQuest, RCAPP, OpenGrey, MedNar e Google
Scholar.
Resultados: Identificou-se a necessidade de avaliação do doente, previamente à
descanulação, tendo em consideração os seguintes parâmetros: nível de consciência,
dependência de ventilação mecânica, capacidade de tossir, necessidade de aspiração de
secreções brônquicas, capacidade de deglutir, permeabilidade das vias aéreas e estabilidade
hemodinâmica e clínica. As intervenções sugeridas foram: redução do calibre da
traqueostomia, desinsuflação do cuff e implementação de programas de reabilitação
individual. Sugere-se a associação da ventilação mecânica não invasiva e da oxigenoterapia
humidificada de alto fluxo nas descanulações mais difíceis.
Conclusão: Este estudo permitiu identificar a necessidade de se realizar uma
avaliação objetiva do doente previamente à descanulação, como fator preponderante para
o seu sucesso. Concluiu-se que a implementação de programas de reabilitação individuais,
por equipas interdisciplinares, é fundamental para descanulações bem-sucedidas.
Background: Tracheostomy represents a milestone in ventilatory weaning. Its removal (decannulation) is described as fundamental in rehabilitation of critically ill patients, where nurses play an elementary role. To describe nurse's intervention in decannulation, a Scoping. Review was conducted, which is presented in this dissertation. Objectives: The purpose of this review is to map and analyze the available evidence on the rehabilitation intervention in decannulation of critically ill patients. The development of this study aims to create a protocol that supports rehabilitation intervention in decannulation. Methods: The PCC strategy and the PRISMA® recommendations by Joanna Briggs Institute® were implemented. We intend to answer the question: “What is the intervention of the specialist nurse in rehabilitation nursing for efficient decannulation in tracheostomized patients in intensive care?”. The research was carried out in November 2022, on MEDLINE, CINAHL® Complete, Cochrane Database Platforms of Systematic Reviews, MedicLatina, Nursing & Allied Health Collection, Scopus®, Web of Science, ProQuest, RCAPP, OpenGrey, MedNar and Google Scholar. Results: The need for evaluation of the patient, prior to decannulation, was identified, considering the following parameters: level of consciousness, dependence on mechanical ventilation, ability to cough, need for aspiration of bronchial secretions, swallowing ability, airway patency airways and hemodynamic and clinical stability. The suggested interventions were: reduction of tracheostomy caliber, cuff deflation and implementation of individual rehabilitation programs. It is suggested the association of non-invasive mechanical ventilation and high flow humidified oxygen therapy in the most difficult decannulation. Conclusion: This study identified the need for an objective assessment of the patient prior to decannulation, as a preponderant factor for its success. It was also concluded that the implementation of individual rehabilitation programs, by interdisciplinary teams, is fundamental for a successful decannulation.
Background: Tracheostomy represents a milestone in ventilatory weaning. Its removal (decannulation) is described as fundamental in rehabilitation of critically ill patients, where nurses play an elementary role. To describe nurse's intervention in decannulation, a Scoping. Review was conducted, which is presented in this dissertation. Objectives: The purpose of this review is to map and analyze the available evidence on the rehabilitation intervention in decannulation of critically ill patients. The development of this study aims to create a protocol that supports rehabilitation intervention in decannulation. Methods: The PCC strategy and the PRISMA® recommendations by Joanna Briggs Institute® were implemented. We intend to answer the question: “What is the intervention of the specialist nurse in rehabilitation nursing for efficient decannulation in tracheostomized patients in intensive care?”. The research was carried out in November 2022, on MEDLINE, CINAHL® Complete, Cochrane Database Platforms of Systematic Reviews, MedicLatina, Nursing & Allied Health Collection, Scopus®, Web of Science, ProQuest, RCAPP, OpenGrey, MedNar and Google Scholar. Results: The need for evaluation of the patient, prior to decannulation, was identified, considering the following parameters: level of consciousness, dependence on mechanical ventilation, ability to cough, need for aspiration of bronchial secretions, swallowing ability, airway patency airways and hemodynamic and clinical stability. The suggested interventions were: reduction of tracheostomy caliber, cuff deflation and implementation of individual rehabilitation programs. It is suggested the association of non-invasive mechanical ventilation and high flow humidified oxygen therapy in the most difficult decannulation. Conclusion: This study identified the need for an objective assessment of the patient prior to decannulation, as a preponderant factor for its success. It was also concluded that the implementation of individual rehabilitation programs, by interdisciplinary teams, is fundamental for a successful decannulation.
Description
Curso de Mestrado ministrado em parceria com Escola Superior de Enfermagem S. José de Cluny e Escola Superior de Enfermagem Dr. José Timóteo Montalvão Machado
Keywords
Enfermagem de Reabilitação Traqueostomia UCI