Protocolo de identificação e correção de assincronia paciente-ventilador pelo método de inspeção visual para unidade de terapia intensiva pediátrica

Abstract

Invasive mechanical ventilation constitutes one of the main treatment supports for children who have acute or acute chronic respiratory failure in a pediatric intensive care unit. However, its prolonged use induces inflammatory processes, in addition to the occurrence of patientventilator asynchrony, defined as the incompatibility between the ventilatory demands of the patient about what is offered by the mechanical ventilator. This event produces adverse clinical outcomes and an increased risk of mortality. Faced with this problem, the objective of this study was to build and validate a protocol for identifying and correcting patient-ventilator asynchrony using the visual inspection method for children hospitalized in a pediatric intensive care unit. This is a methodological development research, with a quantitative approach, based on Pasquali's model of Psychometry, according to the following axes: theoretical pole, empirical pole, and analytical pole. In the theoretical pole, a scoping review was carried out for the construction of domains, items and protocol sub-items. At the empirical pole, there was a theoretical analysis of the items, carried out in two stages: content and appearance analysis by eight judges who were specialists in invasive ventilatory support, who evaluated the domains, items and sub-items about the comprehensiveness, clarity, and representativeness; and semantic analysis of the items, using the Brainstorming technique, which consisted of checking the understanding of the domains, items and sub-items by three groups of two residents, two doctors in one group, a physiotherapist and a nurse in another group, and a doctor and a nurse in the third group, in the second year of residency, in the pediatrics area, at a University Hospital. Finally, the analytical pole consisted of analyzing the data using the Content Validity Index (CVI) and the kappa Coefficient of agreement (k). The research followed all the ethical and legal aspects of research in human beings, obtaining the opinion of the Research Ethics Committee under nº 5,388,822. Initially, the protocol was built from ten studies obtained through the scoping review, consisting of 24 domains, 13 items, and 24 sub-items. Afterward, this first version was sent for analysis by the judges who evaluated the title, the instrument, and the appearance (layout). All these items were judged adequate, obtaining maximum agreement rates (CVI=1.00, k=1.00). In the analysis of the 24 domains, 15 obtained maximum agreement rates (CVI=1.00, k=1.00), and nine showed substantial agreement (CVI=0.88 and k=0.75) in terms of clarity and representativeness. Of the 13 items analyzed, only items 7.1 and 7.2 of domain 7 showed substantial agreement (CVI=0.88 and k=0.75); the remaining items obtained maximum agreement rates (CVI=1.00; k=1.00). All sub-items were considered adequate and obtained maximum agreement rates (CVI=1.00; k=1.00). In the semantic analysis step, all domains, items and sub-items obtained maximum agreement rates (CVI=1.00; k=1.00). The final version of the protocol was composed of 20 domains, 15 items and 24 sub-items. It is expected that the technological product (protocol) constructed and validated will direct the professionals working in the pediatric intensive care unit, so that they can identify and correct patient-ventilator asynchronies, with the aim of improving the quality-of-care practice in the care of mechanically ventilated children, minimizing the time of invasive ventilatory support and complications, as well as supporting the implementation of safe-conducts.