Cambio de la presión del manguito traqueal antes y después de la realización de los cuidados de enfermeira

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: verificar los câmbios de presión del manguito traqueal antes y después de la higiene oral, elevación de la cabecera del lecho a 0º, 30º y 60º, cambio de decúbito, aspiración traqueal y baño en el lecho.

Método: La población fue compuesta por 88 pacientes, totalizando 3696 verificaciones de julio a septiembre de 2014.

Resultados: Los valores de presión fueron analisados em siete procedimentos de atención de enfermeira realizados em la parte de la mañana. Seis apresentaron alteraciones significativas antes y después de la realización de los procedimentos de enfermería. En el periodo de la tarde, cinco de los procedimentos de atención de enfermería realizados apresentaron alteraciones, y por la noche, sólo dos.

Conclusión: Hubo diferencias antes y después de la realización de la atención de enfermería, demostrando alteración de la presión del manguito. El baño em el lecho y la elevación de la cabecera del lecho a 30º presentó valores de presíonmásalterados em los tres turnos de trabajo, preferentemente después del baño.

Descriptores:
Intubación Endotraqueal; Presión; Unidades de Terapia Intensiva; Enfermería; Paciente

Nursing care	Mean	SD	Median	p value
Before bathing	29.32	19.06	20	*<0.0001^ * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.**
After bathing	19.37	4.16	20
Before oral hygiene	20.05	7.64	20	0.0482^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After oral hygiene	20.42	4.19	20
Before aspiration of endotracheal tube	20.35	3.93	20	0.0075^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After aspiration of endotracheal tube	19.32	3.61	9
Before head-of-bed elevation at 0°	20.53	8.14	19	0.0489^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 0°	18.72	3.40	18.5
Before head-of-bed elevation at 30°	19.00	3.58	19	0.0039^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 30°	18.19	3.62	18
Before head-of-bed elevation at 60°	18.02	3.68	18	0.9906^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 60°	19.29	4.33	17
Before change of decubitus	18.31	34.37	17	0.0005^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After change of decubitus	16.53	3.96	16

Nursing care	Mean	SD	Median	p value
Before bathing	24.89	13.83	20	0.0005^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After bathing	19.77	6.21	20
Before oral hygiene	19.79	6.05	20	0.145
After oral hygiene	19.92	3.64	20	0.145
Before aspiration of endotracheal tube	25.91	17.28	21	0.0033^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After aspiration of endotracheal tube	20.19	4.32	20
Before head-of-bed elevation at 0°	26.21	18.25	20	0.0019^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 0°	21.20	6.50	20
Before head-of-bed elevation at 30°	21.22	6.57	20	*<0.0001^ 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.**
After head-of-bed elevation at 30°	18.96	4.63	18
Before head-of-bed elevation at 60°	19.01	4.65	18	0.2396
After head-of-bed elevation at 60°	18.48	4.45	19	0.2396
Before change of decubitus After	18.40	4.32	19	0.0013^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
change of decubitus	17.26	4.47	17

Nursing care	Mean	SD	Median	p value
Before bathing	30.63	22.07	23	*<0.0001 ^ * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.**
After bathing	18.50	3.61	18
Before oral hygiene	18.62	4.24	18	0.2214
After oral hygiene	19.07	4.08	20	0.2214
Before aspiration of endotracheal tube	19.20	4.06	20	0.0663
After aspiration of endotracheal tube	18.88	3.74	19	0.0663
Before head-of-bed elevation at 0°	18.82	3.83	19	0.1462
After head-of-bed elevation at 0°	18.27	3.71	18	0.1462
Before head-of-bed elevation at 30°	18.46	4.06	18	0.0309^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 30°	17.80	3.76	18
Before head-of-bed elevation at 60°	17.82	3.81	18	0.3404
After head-of-bed elevation at 60°	17.55	3.42	18	0.3404
Before change of decubitus	17.59	3.38	18	0.2189
After change of decubitus	17.02	3.37	17	0.2189

Nursing care	Cuff pressure < 25 cmH₂O: average summation
Nursing care	Morning (%)	Afternoon (%)	Night (%)
Before bathing	56.8	68.2	53.4
After bathing	89.8	86.4	96.6
Before oral hygiene	88.6	87.5	96.6
After oral hygiene	75.0	84.1	87.5
Before aspiration of endotracheal tube	73.9	73.9	85.2
After aspiration of endotracheal tube	84.1	80.7	90.9
Before head-of-bed elevation at 0°	84.1	68.2	90.9
After head-of-bed elevation at 0°	96.6	75.0	95.5
Before head-of-bed elevation at 30°	93.2	73.9	92.0
After head-of-bed elevation at 30°	95.5	89.8	96.6
Before head-of-bed elevation at 60°	95.5	88.6	95.5
After head-of-bed elevation at 60°	90.9	90.9	97.7
Before change of decubitus	89.8	92.0	98.9
After change of decubitus	95.5	93.2	100.0
Nursing care	Cuff pressure 25-30 cmH₂O: average summation
Nursing care	Morning (%)	Afternoon (%)	Night (%)
Before bathing	21.6	17.0	22.7
After bathing	9.1	12.5	1.1
Before oral hygiene	9.1	11.4	2,3
After oral hygiene	23.9	15.9	0.0
Before aspiration of endotracheal tube	26.1	18.2	0.0
After aspiration of endotracheal tube	15.9	17.0	0.0
Before head-of-bed elevation at 0°	12.5	15.9	0.0
After head-of-bed elevation at 0°	3.4	17.0	0.0
Before head-of-bed elevation at 30°	6.8	18.2	0.0
After head-of-bed elevation at 30°	4.5	8.0	1.1
Before head-of-bed elevation at 60°	4.5	9.1	1.1
After head-of-bed elevation at 60°	9.1	9.1	0.0
Before change of decubitus	10.2	8.0	0.0
After change of decubitus	4.5	5.7	0.0
Nursing care	Cuff pressure > 30 cmH₂O: average summation
Nursing care	Morning (%)	Afternoon (%)	Night (%)
Before bathing	21.6	1.1	22.7
After bathing	1.1	1.1	1.1
Before oral hygiene	2.3	1.1	2.3
After oral hygiene	1.1	0.0	0.0
Before aspiration of endotracheal tube	0.0	8.0	0.0
After aspiration of endotracheal tube	0.0	2.3	0.0
Before head-of-bed elevation at 0°	3.4	15.9	0.0
After head-of-bed elevation at 0°	0.0	8.0	0.0
Before head-of-bed elevation at 30°	0.0	8.0	0.0
After head-of-bed elevation at 30°	0.0	2.3	1.1
Before head-of-bed elevation at 60°	0.0	2.3	1.1
After head-of-bed elevation at 60°	0.0	0.0	0.0
Before change of decubitus	0.0	0.0	0.0
After change of decubitus	0.0	1.1	0.0

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Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
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[TFN2] ^*
p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.