Aspiração endotraqueal de adultos intubados: evidências para boas práticas
DOI:
https://doi.org/10.33233/fb.v18i6.742Abstract
Introdução: A aspiração endotraqueal é o procedimento invasivo mais realizado em indivíduos intubados em unidades de terapia intensiva. Contudo, existem poucos estudos nacionais de boa qualidade metodológica sobre o assunto, não havendo no Brasil consenso da literatura e/ou padronização da técnica. Objetivos: Estabelecer recomendações baseadas em evidências científicas sobre a aspiração endotraqueal em adultos intubados. Métodos: Revisão sistemática de estudos secundários: diretrizes, guidelines e revisões sistemáticas em inglês e português, pesquisada nas bases de dados PubMed, Cochrane, Cochrane Review, Cochrane Library, Scielo Org, Scielo Brasil, PEDro, Clinical Evidence e Evidence Based Medicine. Resultados: Foram incluídos cinco artigos com classificação entre C e D pelo R-Amstar. Conclusão: A aspiração endotraqueal deve ser realizada em adultos intubados por pessoal qualificado, assepticamente, sempre que necessária. Não deve exceder 15 segundos por aspiração e nem ser realizada rotineiramente, e sim, na presença de secreções – grau de recomendação A. A sonda de aspiração deve ter um diâmetro menor que 50% do tubo endotraqueal e a hiperoxigenação com fração inspirada de oxigênio a 100% no ventilador deve ser utilizada – grau de recomendação A. A pressão de sucção não deve exceder 150 mmHg negativos – grau de recomendação B. É recomendada a aspiração subglótica, especialmente naqueles indivíduos com mais de 72 horas de ventilação mecânica invasiva – grau de recomendação A.
Palavras-chave: sucção, aspiração mecânica, drenagem por sucção.
References
Çelik SS, Elbas NO. The standard of suction for patients undergoing endotracheal intubation. Intensive Crit Care Nurs 2000;16(3):191-8.
Rosa FK, Roese CA, Savi A, Dias AS, Monteiro MB. Comportamento da mecânica pulmonar após a aplicação de protocolo de fisioterapia respiratória e aspiração traqueal em pacientes com ventilação mecânica invasiva. Rev Bras Ter Intensiva 2007;19(2):170-5.
Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard JC et al. Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care 2013;58(10):1588-97.
Flume PA, Robinson KA, O'Sullivan BP, Finder JD, Vender RL, Willey-Courand DB, et al. Clinical Practice Guidelines for Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: airway clearance therapies. Respir Care 2009;54(4):522-37.
ERNBG Guideline - Suction February 2006 Review due: February 2006 Eastern Regional Neonatal Benchmarking Group Suctioning Guideline. [citado 2013 Nov 27]. Available http://documents.mx/documents/neonatal-suctioning-guidelinespdf.html/.
American Association for Respiratory Care. AARC Clinical Practice Guidelines. Nasotracheal Suctioning - 2004 Revision & Update. Respir Care 1992;37(8):1176-9.
Odell A, Allder A, Bayne R, Everett C, Scott S, Still B, et al. Endotracheal suction for adult, non-head- injured, patients. A review of the literature. Intensive Crit Care Nurs 1993;9(4):274-8.
Wood CJ. Endotracheal suctioning: a literature review. Intensive Crit Care Nurs 1998;14(3):124-36.
Czarnik RE, Stone KS, Everhart CC Jr, Preusser BA. Differential effects of continuous versus intermittent suction on tracheal tissue. Heart Lung 1991;20(2):144-51.
Lookinland S, Appel PL. Haemodynamic and oxygen transport changes following endotracheal suctioning in trauma patients. Nurs Res 1991;40(3):133-9.
Diniz GCLM, Souza AO, Oliveira HMD, Arrais RCS, Pessoa BP, Figueiredo PHS. A utilização de FiO2 inferior a 100% para hiperoxigenação de pacientes estáveis submetidos à aspiração endotraqueal. ASSOBRAFIR Ciência. 2012;3(1):45-56.
Carroll P. Safe suctioning prn. RN. 1994;57(5):32-6.
Dean B. Evidence-based suction management in accident and emergency: a vital component of airway care. Accid Emerg Nurs 1997;5(2):92-8.
Gonçalves RL, Tsuzuki LM, Carvalho MGS. Aspiração endotraqueal em recém-nascidos intubados: uma revisão integrativa da literatura. Rev Bras Ter Intensiva 2015;27(3):284-92.
Ridling DA, Martin LD, Bratton SL. Endotracheal Suctioning With or Without Instillation of Isotonic Sodium Chloride Solution in Critically Ill Children. Am J Crit Care 2003;12(3):212-9.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Loannidis JPA, et al. The PRISMA statement for systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Ann Intern Med 2009;18;151(4):W65-94.
Kung J, Chiappelli F, Cajulis OO, Avezova R, Kossan G, Chew L, et al. From systematic reviews to clinical recommendations for evidence-bases health care: validation of revised assessment of multiple systematic reviews (R-AMSTAR) for grading of clinical relevance. Open Dent J 2010;16(4):84-91.
United States Preventive Services Task Force. Process for Recommendation Statements [Internet]. [place unknow]: Process for Recommendation Statements [cited 2015 August]. Available from: http://www.uspreventiveservicestaskforce.org/Page/Name/process-for-recommendation-statements/.
Pedersen CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient - What is the evidence? Intensive Crit Care Nurs 2009;25(1):21-30.
Restrepo RD, Brown JM, Hughes JM. American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care 2010;55(6):758-64.
Overend TJ, Anderson CM, Brooks D, Cicutto L, Keim M, McAuslan D et al. Updating the evidence base for suctioning adult patients: A systematic review. Can Respir J 2009;16(3):e6-e17.
Brooks D, Anderson CM, Carter MA, Downes LA, Keenan SP, Kelsey CJ, et al. Clinical practice guidelines for suctioning the airway of the intubated and nonintubated patient. Can Respir J 2001;8(3):163-81.
Favretto DO, Silveira RC, Canini SR, Garbin LM, Martins FT, Dalri MC. Endotracheal suction in intubated critically ill adult patients undergoing mechanical ventilation: a systematic review. Rev Lat Am Enfermagem 2012;20(5):997-1007.
Lopes FM. Lopez MF. Impact of the open and closed tracheal suctioning system on the incidence of mechanical ventilation associated pneumonia: literature review. Rev Bras Ter Intensiva 2009;21(1):80-8.
Niel-Weise BS, Snoeren RLMM, Van den Broek PJ. Policies for endotracheal Suctioning of Patients receiving Mechanical Ventilation: A systematic Review of Randomized Controlled Trials. Infection Control and Hospital Epidemiology. Infect Control Hosp Epidemiol 2007;28(5):531-6.
Day T, Farnell S, Wilson-Barnett J. Suctioning: a review of current research recommendations. Intensive Crit Care Nurs 2002;18(2):79-89.
Thompson L. Suctioning adults with an artificial airway: a systematic review. The Joanna Briggs Institute. 2000 May: 1-5.
The Joanna Briggs Institute For Evidence Based Nursing And Midwifery. Evidence based practice information sheets for health professionals. Tracheal suctioning of adults with an artificial airway. Best Practice 2000;4(4):1329-1874.
Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control 2007;(35):65-164.
Russian CJ, Gonzales JF, Henry NR. Suction catheter size: an assessment and comparison of 3 different calculation methods. Respir Care 2014;59(1):32-8.
Gray JE, MacIntyre NR, Kronenberger WG. The effects of bolus normal-saline instillation in conjunction with endotracheal suctioning. Respir Care 1990;35(8):785-90.
Ji YR. kim HS. Park JH. Instillation of normal saline before suctioning in patients with pneumonia. Yonsei Med J 2002;43(5):607-12.
Branson RD. Secretion management in the mechanically ventilated patient. Respir Care 2007;52(10):1328-47.
Demir F, Dramali A. Requirement for 100% oxygen before and after closed suction. J Adv Nurs 2005;51:245-51.
Paratz JD, Stockton KA. Efficacy and safety of normal saline instillation: A systematic review. Physiotherapy 2009;95:241-50.
Oh H, Seo W. A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia. J Clin Nurs 2003;12(6):912-24.
Published
Issue
Section
License
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.