Banca de DEFESA: Ludmylla Cristina de Faria Pontes

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : Ludmylla Cristina de Faria Pontes
DATE: 22/03/2023
TIME: 09:30
LOCAL: Plataforma Teams
TITLE:

UNPLANNED EXTUBATION IN A NEONATAL INTENSIVE CARE UNIT: SYSTEMATIC REVIEW OF IMPROVEMENT CYCLES

KEY WORDS:

Unplanned Extubation; Neonatal Intensive Care Units; Improvement Cycles; Patient Safety; Quality Management.

PAGES: 100
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Newborns in neonatal intensive care often require long periods of hospitalization and are subjected to several invasive therapeutic procedures, making them exposed to a number of adverse events. Quality improvement cycles have proven to be an important ally in preventing these events. Unplanned extubation (UE), understood as the accidental loss of the endotracheal tube (ETT) during mechanical ventilation or its exchange due to suspicion of obstruction or inadequate diameter, is considered the fourth most common adverse event in neonatal intensive care units (NICUs) in North America. Evidence on factors related to UE in neonatal intensive care and measures to prevent it are not well described in the literature. Thus, this study aimed to analyze the main intervention measures used in order to reduce UE in Neonatal Intensive Care Units. Thus, a systematic review of the literature was conducted. Original articles of randomized or nonrandomized clinical trial, quasi-experimental with control group, before-and-after without control group and interrupted time series types, which presented measures targeted at unplanned extubation prevention and whose outcomes were measured before-andafter intervention were searched in the following databases/journal portals: United States National Library of Medicine and National Institutes of Health (PubMed), Excerpta Medica (EMBASE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scientific Electronic Library Online (Scielo), Latin American Literature in Health Sciences (LILACS). Four reviewers, in a paired and independent manner, selected and evaluated the papers, and in case of disagreements, a fifth reviewer was consulted. The adopted search strategy retrieved 8,616 papers, of which 17 met the predetermined inclusion criteria. All included studies were before-and-after studies with no control group and interrupted time series. The main interventions directed at reducing UE were: presence of two or more clinical professionals while performing care or procedures on intubated patients; standardization and routine evaluation of ETT positioning; standardization of the ETT fixation model and routine evaluation of its integrity; documentation and review of all UE; signaling to increase team engagement or serve as a warning to intensify surveillance. The risk of bias of the selected studies was independently assessed by three reviewers using the NHI Assessment Tool for Before and After Studies, who pointed out a low methodological quality of the studies, mainly related to a lack of clarity regarding the eligibility criteria of participants, sample size, and statistical methods used. A positive relationship was identified between the adoption of intervention strategies and the reduction of UE, but more robust studies with more robust methodological quality are still needed to better determine the causal relationship of the outcomes with the interventions adopted.

BANKING MEMBERS:
Externa à Instituição - CINTIA JOHNSTON - USP
Externa à Instituição - ANA HELONEIDA DE ARAÚJO MORAIS - UFRN
Externo ao Programa - 186.580.591-20 - FRANCISCO DE ASSIS ROCHA NEVES - UNIFESP
Presidente - 1055549 - HELAINE CARNEIRO CAPUCHO