Related factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit

Prado, Patricia Rezende do; Bettencourt, Ana Rita de Cássia; Lopes, Juliana de Lima

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Brasil

Revista Latino-Americana de Enfermagem

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Brasil

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Sumário

Original Article • Rev Lat Am Enfermagem 27 • 2019 • https://doi.org/10.1590/1518-8345.2902.3153 copy

Related factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit^* * Paper extracted from doctoral dissertation “Predictive factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit”, presented to Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

to identify the predicting factors and sensitivity, specificity, positive and negative related value of nursing diagnosis Ineffective Breathing Pattern among patients of an intensive care unit.

Method

cross-sectional study. A logistic regression was fitted to assess the simultaneous effects of related factors.

Results

among the 120 patients, 67.5% presented Ineffective Breathing Pattern. In the univariate analysis, the related factors were: group of diseases, fatigue, obesity and presence of bronchial secretion, and the defining characteristics were: changes in respiratory depth, auscultation with adventitious sounds, dyspnea, reduced vesicular murmurs, tachypnea, cough and use of the accessory musculature to breathe. The mean age of patients with was higher than those without this diagnosis. The defining characteristics reduced murmurs had high sensitivity (92.6%), specificity (97.4%), negative related value (86.4%) and positive related value (98.7%). The related factors of Ineffective Breathing Pattern were the related factors fatigue, age and group of diseases.

Conclusion

fatigue, age and patients with a group of diseases were related factors of Ineffective Breathing Pattern in this study. Reduced vesicular murmurs, auscultation with adventitious sounds and cough may be defining characteristics to be added in the international classification, as well as the related factors bronchial secretion and group of diseases.

Risk Factors; Signs and Symptoms; Nursing Diagnosis, Respiratory System; Classification; Nursing

	Ineffective Breathing Pattern				Total		ODDS RATIO	p-value*

	Absent		Present

	n	%	n	%	n	%
Changes in respiratory depth	39	32.5%	81	67.5%	120	100.0%		<0.001*
Absent	39	44.8%	48	55.2%	87	100.0%	1.00
Present	0	0.0%	33	100.0%	33	100.0%	(1)^†
Auscultation with adventitious sounds	39	32.5%	81	67.5%	120	100.0%		<0.001*
Absent	39	62.9%	23	37.1%	62	100.0%	1.00
Present	0	0.0%	58	100.0%	58	100.0%	(1)^†
Nose wing beats	39	32.5%	81	67.5%	120	100.0%		0.172^‡
Absent	39	33.9%	76	66.1%	115	100.0%	1.00
Present	0	0.0%	5	100.0%	5	100.0%	(1)^†
Bradypnea	39	32.5%	81	67.5%	120	100.0%		-
Absent	39	32.5%	81	67.5%	120	100.0%	-
Increased anteroposterior chest diameter	39	32.5%	81	67.5%	120	100.0%		0.172^‡
Absent	39	33.9%	76	66.1%	115	100.0%	1.00
Present	0	0.0%	5	100.0%	5	100.0%	(1)^†
Dyspnea	39	32.5%	81	67.5%	120	100.0%		<0.001*
Absent	39	41.9%	54	58.1%	93	100.0%	1.00
Present	0	0.0%	27	100.0%	27	100.0%	(1)^†
Altered chest excursion	39	32.5%	81	67.5%	120	100.0%		0.052^‡
Absent	39	34.8%	73	65.2%	112	100.0%	1.00
Present	0	0.0%	8	100.0%	8	100.0%	(1)^†
Abnormal breathing pattern	39	32.5%	81	67.5%	120	100.0%		0.328^‡
Absent	3	60.0%	2	40.0%	5	100.0%	1.00
Present	36	31.3%	79	68.7%	115	100.0%	3.29
Prolonged expiratory phase	39	32.5%	81	67.5%	120	100.0%		1.000^‡
Absent	39	32.8%	80	67.2%	119	100.0%	1.00
Present	0	0.0%	1	100.0%	1	100.0%	(1)^†
Pursed-lip breathing	39	32.5%	81	67.5%	120	100.0%		1.000^‡
Absent	39	33.1%	79	66.9%	118	100.0%	1.00
Present	0	0.0%	2	100.0%	2	100.0%	(1)^†
Reduced vesicular murmurs	39	32.5%	81	67.5%	120	100.0%		<0.001*
Absent	38	86.4%	6	13.6%	44	100.0%	1.00
Present	1	1.3%	75	98.7%	76	100.0%	475.00
Orthopnea	39	32.5%	81	67.5%	120	100.0%		1.000^‡
Absent	39	32.8%	80	67.2%	119	100.0%	1.00
Present	0	0.0%	1	100.0%	1	100.0%	(1)^†
Decreased expiratory pressure	39	32.5%	81	67.5%	120	100.0%		-
Present	39	32.5%	81	67.5%	120	100.0%	-
Decreased inspiratory pressure	39	32.5%	81	67.5%	120	100.0%		0.325^‡
Absent	1	100.0%	0	0.0%	1	100.0%	(2)^§
Present	38	31.9%	81	68.1%	119	100.0%
Assumption of a three-point position	39	32.5%	81	67.5%	120	100.0%		0.172^‡
Absent	39	33.9%	76	66.1%	115	100.0%	1.00
Present	0	0.0%	5	100.0%	5	100.0%	(1)^†
Tachypnea	39	32.5%	81	67.5%	120	100.0%		<0.001*
Absent	39	40.2%	58	59.8%	97	100.0%	1.00
Present	0	0.0%	23	100.0%	23	100.0%	(1)^†
Cough	39	32.5%	81	67.5%	120	100.0%		0.001*
Absent	39	40.6%	57	59.4%	96	100.0%	1.00
Present	0	0.0%	24	100.0%	24	100.0%	(1)^†
Use of accessory muscles to breathe	39	32.5%	81	67.5%	120	100.0%		<0.001*
Absent	39	39.0%	61	61.0%	100	100.0%	1.00
Present	0	0.0%	20	100.0%	20	100.0%	(1)^†
Decreased minute ventilation	39	32.5%	81	67.5%	120	100.0%		1.000^‡
Absent	39	33.1%	79	66.9%	118	100.0%	1.00
Present	0	0.0%	2	100.0%	2	100.0%	(1)^†

Defining characteristics	Sensitivity (%)	Specificity (%)	Related value (%)

			Positive	Negative
Reduced vesicular murmurs	92.6 (84.6 - 97.2)	97.4 (86.5 - 99.9)	98.7 (92.9-100.0)	86.4 (72.6 - 94.8)
Auscultation with adventitious sounds	71.6 (60.5 - 81.1)	100.0 (91.0 - 100.0)	100 (93.8-100.0)	62.9 (49.7 - 74.8)
Abnormal breathing pattern	97.5 (91.4 - 99.7)	7.7 (1.6 - 20.9)	68.7 (59.4-77.0)	60.0 (14.7 - 94.7)
Decreased inspiratory pressure	100.0 (95.5- 100)	2.6 (0.1 - 13.5)	68.1 (58.9-76.3)	100.0 (2.5-100.0)
Decreased expiratory pressure	100.0 (-)*	0.0 (-)*	67.5 (-)	-
Changes in respiratory depth	40.7 (29.9 - 52.2)	100.0 (91.0 - 100.0)	100 (89.4 -100.0)	44.8 (34.1 - 55.9)
Dyspnea	33.3 (23.2 - 44.7)	100.0 (91.0 - 100.0)	100.0 (87.2-100.0)	41.9 (31.8 - 52.6)
Cough	29.6 (20.0 - 40.8)	100.0 (91.0 - 100.0)	100 (85.8 - 100.0)	40.6 (30.7 - 51.1)
Tachypnea	28.4 (18.9 - 39.5)	100.0 (91.0 - 100.0)	100.0 (85.2-100.0)	40.2 (30.4 - 50.7)
Use of accessory muscles to breathe	24.7 (15.8 - 35.5)	100.0 (91.0 - 100.0)	100.0 (83.2-100.0)	39.0 (29.4 - 49.3)
Altered chest excursion	9.9 (4.4 - 18.5)	100.0 (91.0 - 100.0)	100.0 (63.1-100.0)	34.8 (26.1 - 44.4)
Increased anteroposterior chest diameter	6.2 (2.0 - 13.8)	100.0 (91.0 - 100.0)	100.0 (47.8-100.0)	33.9 (25.3 - 43.3)
Nose wing beats	6.2 (2.0 - 13.8)	100.0 (91.0 - 100.0)	100.0 (47.8-100.0)	33.9 (25.3 - 43.3)
Assumption of a three-point position	6.2 (2.0 - 13.8)	100.0 (91.0 - 100.0)	100.0 (47.8-100.0)	33.9 (25.3 - 43.3)
Decreased minute ventilation	2.5 (0.3 - 8.6)	100.0 (91.0 - 100.0)	100.0 (15.8-100.0)	33.1 (24.7 - 42.3)
Pursed-lip breathing	2.5 (0.3 - 8.6)	100.0 (91.0 - 100.0)	100.0 (15.8-100.0)	33.1 (24.7 - 42.3)
Orthopnea	1.2 (0.0 - 6.7)	100.0 (91.0 - 100.0)	100.0 (2.5 - 100.0)	32.8 (24.4 - 42.0)
Prolonged expiratory phase	1.2 (0.0 - 6.7)	100.0 (91.0 - 100.0)	100.0 (2.5 - 100.0)	32.8 (24.4 - 42.0)
Bradypnea	0.0 (-)*	100.0 (-)*	-	32.5 (-)*

	Ineffective Breathing Pattern				Total		ODDS RATIO	p-value

	Absent		Present

	n	%	n	%	N	%
Anxiety	39	32.5%	81	67.5%	120	100.0%		0.272*
Absent	38	33.9%	74	66.1%	112	100.0%	1.00
Present	1	12.5%	7	87.5%	8	100.0%	3.59
Group of diseases	39	32.5%	81	67.5%	120	100.0%		0.008^†
Trauma	6	16.7%	30	83.3%	36	100.0%	1.00
Cardiocirculatory	13	37.1%	22	62.9%	35	100.0%	0.34
Respiratory	5	22.7%	17	77.3%	22	100.0%	0.68
Others	15	55.6%	12	44.4%	27	100.0%	0.16
Pain	39	32.5%	81	67.5%	120	100.0%		0.058*
Absent	38	35.5%	69	64.5%	107	100.0%	1.00
Present	1	7.7%	12	92.3%	13	100.0%	6.61
Fatigue	39	32.5%	81	67.5%	120	100.0%		<0.001^†
Absent	38	48.7%	40	51.3%	78	100.0%	1.00
Present	1	2.4%	41	97.6%	42	100.0%	38.95
Respiratory muscle fatigue	39	32.5%	81	67.5%	120	100.0%		1.000*
Absent	39	33.1%	79	66.9%	118	100.0%	1.00
Present	0	0.0%	2	100.0%	2	100.0%	(1)^†
Hyperventilation	39	32.5%	81	67.5%	120	100.0%		0.172*
Absent	39	33.9%	76	66.1%	115	100.0%	1.00
Present	0	0.0%	5	100.0%	5	100.0%	(1)^†
Obesity	39	32.5%	81	67.5%	120	100.0%		0.019*
Absent	35	38.0%	57	62.0%	92	100.0%	1.00
Present	4	14.3%	24	85.7%	28	100.0%	3.68
Position of the body that prevents lung expansion	39	32.5%	81	67.5%	120	100.0%		0.550*
Absent	39	33.3%	78	66.7%	117	100.0%	1.00
Present	0	0.0%	3	100.0%	3	100.0%	(1)^†
Bronchial secretion	39	32.5%	81	67.5%	120	100.0%		0.016*
Absent	39	35.8%	70	64.2%	109	100.0%	1.00
Present	0	0.0%	11	100.0%	11	100.0%	(1)^†
Smoking	39	32.5%	81	67.5%	120	100.0%		0.155*
No	27	38.0%	44	62.0%	71	100.0%	1.00
Yes	8	32.0%	17	68.0%	25	100.0%	1.30
Ex-smoker	4	16.7%	20	83.3%	24	100.0%	3.07

	Univariate model		Final multivariate model

	Gross Odds Ratio (95%)	p-value*	Adjusted Odds Ratio (95%)	p-value*
Anxiety	3.59 (0.43- 30.29)	0.239	-	-
Chest wall deformity	(1)^†	0.999	-	-
Bone deformity	(2)^‡	-	-	-
Pain	6.61 (0.83- 52.8)	0.075	-	-
Fatigue	38.95 (5.10- 297.4)	<0.001	61.96 (6.88- 557.74)	<0.001
Respiratory muscle fatigue	(1)^†	0.999	-	-
Hyperventilation	(1)^†	0.999	-	-
Obesity	3.68 (1.18- 11.51)	0.025	2.76 (0.64- 11.84)	0.171
Position of the body that prevents lung expansion	(1)^†	0.999	-	-
Musculoskeletal damage	3.04 (0.35- 26.17)	0.311	-	-
Hypoventilation syndrome	(1)^†	1.000	-	-
Bronchial secretion	(1)^†	0.999	-	-
Age (years)	1.03 (1.01- 1.05)	0.009	1.06 (1.02- 1.09)	0.001
Smoking (ref. = no)		0.172
Yes	1.30 (0.5- 3.43)	0.591
Ex-smoker	3.07 (0.95- 9.94)	0.062
Medical diagnosis (ref. = trauma)		0.011		0.013
Cardiocirculatory	0.34 (0.11- 1.03)	0.056	0.07 (0.01- 0.38)	0.002
Respiratory	0.68 (0.18- 2.56)	0.569	0.23 (0.04- 1.30)	0.096
Others	0.16 (0.05- 0.51)	0.002	0.15 (0.04- 0.62)	0.009

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[1] Corresponding author: Patricia Rezende do Prado E-mail: patyrezendeprado@gmail.com https://orcid.org/0000-0002-3563-6602