Beccaria, Lúcia Marinilza; Doimo, Thays Marley Antonio; Polletti, Nádia Aparecida Antonia; Barbosa, Tais Pagliuco; Silva, Daniele Cristiny da; Werneck, Alexandre Lins

doi:10.1590/0034-7167-2016-0486

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RESEARCH • Rev. Bras. Enferm. 70 (6) • Nov-Dec 2017 • https://doi.org/10.1590/0034-7167-2016-0486 copiar

Mudança de pressão do balonete traqueal antes e depois da realização dos cuidados de enfermagem

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Verificar As mudanças de pressão do balonete traqueal antes e após higiene oral, elevação da cabeceira do leito a 0 º, 30 º e 60 º, mudança de decúbito, aspiração traqueal e banho no leito.

Método:

A população foi composta por 88 pacientes, totalizando 3696 verificações de julho a setembro de 2014.

Resultados:

Os valores de pressão foram analisados em sete procedimentos de cuidados de enfermagem realizados na parte da manhã. Seis apresentaram estavam alterações significativas antes e após a realização dos procedimentos de enfermagem. No período da tarde, cinco dos procedimentos de cuidados de enfermagem realizados apresentaram alterações, e à noite, apenas dois. A maioria dos valores de pressão estava abaixo dos valores recomendados.

Conclusão:

Houve diferenças antes e após a realização dos cuidados, demonstrando alteração da pressão do balonete. O banho no leito e a elevação da cabeceira do leito a 30 º apresentou valores de pressão mais alterados nos três turnos de trabalho. Portanto, é necessário medir a pressão do balonete pelo menos duas vezes por turno de trabalho, de preferência após o banho.

Descritores:
Intubação Endotraqueal; Pressão; Unidades de Terapia Intensiva; Enfermagem; 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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[1] CORRESPONDING AUTHOR Lúcia Marinilza Beccaria Email: lucia@famerp.br