Aspiração endotraqueal em paciente crítico: elaboração e validação de um checklist

Abstract

Introduction: Critically ill patients require immediate care, requiring hemodynamic monitoring and continuous care from a multidisciplinary team. Among the most complex care provided, there is assistance to the patient maintained under mechanical ventilation. The endotracheal tube makes it impossible for the patient to voluntarily mobilize and expel bronchial secretions, so the only way to remove them is through endotracheal suction. This procedure must be done carefully and judiciously, based on recommendations/guidelines so that it does not cause harm to patients. Despite its complexity, it is a procedure routinely performed, most of the time, by professionals from the nursing team and also from physiotherapy, however, many times there is no adoption of protocols for carrying out these procedures. Objective: To develop and validate a checklist-type instrument to identify adherence to the recommendations in the endotracheal aspiration procedure in critically ill patients under mechanical ventilation, according to the Clinical Practice Guidelines of the American Association for Respiratory Care. Method: This is a methodological, cross-sectional study with a quantitative approach. A checklist was developed for endotracheal aspiration procedures, in critically ill patients under mechanical ventilation, and then it was submitted to the process of apparent and content validation. Applied pre-test, interobserver reliability analysis and for data analysis, descriptive statistics, Kappa tests, Intraclass Coefficient and proportion of agreement were used. Results: In the face and content validation phase, five judges evaluated the instrument, and all suggestions were analyzed and incorporated into it. In the pre-test, the checklist application time varied between 10 and 15 minutes. The need for adequacy of the items was not identified, thus remaining the second version as the final version of the instrument, with 35 items, divided into two parts. Part I consisted of data on the characterization of participants/vital and ventilatory parameters, and part II, of the aspiration technique (criteria evaluated before, during and after performing the endotracheal aspiration procedure). An interobserver reliability analysis was performed, with a sample of 116 endotracheal aspiration procedures in critically ill patients, aged 18 years or older, conscious or unconscious, of both sexes, with endotracheal intubation and hospitalized in the intensive care units of a hospital largescale teaching. In the reliability analysis, it was observed that most items showed almost perfect agreement strength, above 81%, minimum of 70.68% and maximum of 100%. Kappa coefficient values ranged from regular to perfect (0.338 to 0.982; p<0.001), and reliability was considered excellent (ICC= 0.918). Conclusion: the face and content validation of the checklist for the endotracheal aspiration procedure in critically ill patients on mechanical ventilation was considered satisfactory. The checklist is considered reliable and allows researchers and health professionals to evaluate the care provided, in addition to subsidizing interventions that guarantee safer, quality and harm-free care.