Respiratory Nursing Diagnoses: Presenting Evidence for Identification of the Defining Characteristics in Neonatal and Pediatric Populations.

PURPOSE: To identify and summarize clinical data supporting selection of nursing diagnoses related to the respiratory system for pediatric and neonatal populations. METHOD: A literature review conducted in indexed publications was used. FINDINGS: The final sample consisted of 13 studies conducted in children with cardiac disease, respiratory infection, and asthma with nursing diagnoses such as ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance. CONCLUSION: The higher frequency defining characteristics were dyspnea, abnormal breathing pattern, use of accessory muscle to breathe, change in frequency and respiratory rate, decreased SaO2 , and agitation. IMPLICATION FOR NURSING KNOWLEDGE: This literature review may provide a basis for consideration of important diagnostic criteria in the pediatric population; however, clinical validation in different stages of development is critical for ensuring diagnostic accuracy.

[Evaluation of oxygenation, ventilation and respiratory mechanics before and after endotracheal suction in mechanically ventilated children]. / Avaliação da mecânica respiratória e da oxigenação pré e pós-aspiração de secreção em crianças submetidas à ventilação pulmonar mecânica.

OBJECTIVES: The aim of this study was to know the effects of endotracheal suction in respiratory mechanics and oxigenation of patients with mechanical ventilation. METHODS: 13 children were studied in the pediatric intensive care unit of Hospital São Paulo, age between 47 days and 5 years old, male and female, surgical and clinic pathology, intubated by cuffed endotracheal tube, sedated and paralyzed few minutes before measurements, under previous established suction routine without preventive maneuvers, followed by a continuous monitoring of oxygenation, ventilation and respiratory mechanics under identical ventilatory sets. The parameters analyzed was Heart rate; SpO2; ph arterial; PaO2; PaCO2; SaO2; inspiratory and expiratory tidal volume; minute volume; dynamic compliance, respiratory resistance; mean airway pressure; PEEP and PEEPi., and the measurements were made immediately before suction, immediately after, ten and twenty minutes after suction RESULTS: The results showed that the technique increase the CO2 arterial pressures (PaCO2) even after 20 minutes; decrease the oxygen saturation (SpO2) immediately after the procedure with regular recuperation after 10 minutes and decrease the lung compliance (Cdin.) immediately after with lower recuperation after 10 minutes. CONCLUSION: We concluded that intratracheal suction in front of compromise of oxygenation, ventilation or respiratory mechanic, applied as minimal as possible under preventive maneuvers. We need more studies to establish the real need of intratracheal suction and a practice guideline of intervention to avoid deleterious effects of that in pediatric patients.

Avaliaçäo da mecânica respiratória e da oxigenaçäo pré e pós-aspiraçäo de secreçäo em crianças submetidas à ventilaçäo pulmonar mecânica / Evaluation of oxygenation, ventilation and respiratory mechanics before and after endotracheal suction in mechanically ventilated children

OBJETIVO: O objetivo deste estudo foi avaliar as alterações de oxigenaçäo, ventilaçäo e mecânica respiratória em crianças submetidas a ventilaçäo pulmonar mecânica, pré e pós-aspiraçäo de secreções intratraqueais e identificar através de parâmetros de mecânica respiratória e/ou oxigenaçäo o momento correto da aspiraçäo de secreções intratraqueais MÉTODOS: O estudo foi realizado na UCI Pediátrica do Hospital São Paulo-Unifesp, e participaram do estudo, 13 crianças com faixa etária de lactente até cinco anos, ambos os sexos, com patologias clínica e cirúrgica. Os parâmetros analisados foram: freqüência cardíaca (FC), saturaçäo de oxigênio por oximetria de pulso (Sp0(2)), pH arterial; pressäo arterial de oxigênio (Pa0(2)); pressäo arterial de gás carbônico (PaC0(2)); saturaçäo arterial de oxigênio (Sa0(2)), volume corrente inspirado (VC insp.) e expirado (VC exp.), volume minuto (V min), complacência pulmonar (C), resistência inspiratória das vias aéreas (R insp), pressäo média das vias aéreas (PmVA), pressäo expiratória final positiva (PEEP) e pressäo expiratória final positiva intrínseca (PEEPi); com parâmetros ventilatórios mantidos inalterados, crianças sedadas e curarizadas. Foram efetuadas quatro medidas de mecânica respiratória e duas de gases sangüíneos. RESULTADOS: A análise dos resultados demonstrou elevaçäo significante e prolongada no índice de CO2 arterial; declínio na saturaçäo de oxigênio imediatamente após o procedimento e diminuiçäo na complacência dinâmica torácica e pulmonar. CONCLUSÕES: A aspiraçäo de secreções intratraqueal é responsável por retençäo da PaCO2, queda SpO2 e diminuiçäo da complacência torácica e pulmonar. Por ser um procedimento de risco para o paciente deve ser aplicada após avaliaçäo e indicaçäo individual, tendo necessidade de padronizações em manobras para prevençäo de hipoxemia, hipoventilaçäo e de atelectasias