Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke

Objective: to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration. Method: cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration. Results: risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration. Conclusion: dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration.

Knowledge of intensive care unit nurses about the procedure of endotracheal suctioning/Conhecimento do enfermeiro de unidade de terapia intensiva sobre o procedimento de aspiração endotraqueal/Conocimiento del enfermero de unidad de cuidados intensivos so

ABSTRACT Objective: to evaluate nurses' knowledge about the procedure of endotracheal suctioning performed in the Intensive Care Unit (ICU). Method: descriptive exploratory study with a quantitative approach, carried out in the Intensive Care Unit of a public hospital in Fortaleza-CE, with 39 nurses. Data collected from April to May 2012, from a questionnaire and organized into an Excel and subjected to statistical analysis. Study approved by the Ethics Committee of Hospital with number 090207/11. Results: regarding the procedure of endotracheal suction, draws attention not to perform the lung auscultation for 69.23%. Other points that deserve attention include the non-suspension of enteral feeding (51.29%) and non-use of Personal Protective Equipment (51.28%) during the procedure; 94.27% said to use saline solution at 0.9% to thin the secretions. Conclusion: it´s need to intensify the educational activities regarding the importance of care during the procedure, in order to minimize risks to patients. Keywords: Respiratory aspiration. Intensive care unit. Nursing care. RESUMO Objetivo: verificar o conhecimento dos enfermeiros acerca do procedimento de aspiração endotraqueal realizado na unidade de terapia intensiva (UTI). Metodologia: estudo exploratório descritivo, com abordagem quantitativa, realizado nas Unidades de Terapia Intensiva de um hospital público, em Fortaleza-CE, com uma amostra de 39 enfermeiros. Dados coletados de abril a maio de 2012, com um questionário, organizados no Excel e submetidos à análise estatística. Estudo aprovado pelo Comitê de Ética da instituição com parecer no. 090207/11. Resultados: quanto ao procedimento de aspiração endotraqueal, chama a atenção a não realização da ausculta pulmonar por 69,23%. Outros pontos merecem destaque como a não suspensão da dieta enteral (51,29%) e a não utilização dos Equipamentos de Proteção Individual (51,28%) durante o procedimento; 94,27% utilizam soro fisiológico 0,9% para fluidificar as secreções. Conclusão: há necessidade de intensificar as atividades educativas quanto à importância dos cuidados durante o procedimento, na tentativa de minimizar os riscos para os pacientes. Palavras-chave: Aspiração respiratória. Unidade de terapia intensiva. Cuidados de enfermagem. RESUMEN Objetivo: evaluar el conocimiento de los enfermeros sobre el procedimiento de aspiración endotraqueal realizado en la Unidad de Cuidados Intensivos (UCI). Método: estudio exploratorio descriptivo, con abordaje cuantitativo, realizado en las Unidades de Cuidados Intensivos de un hospital público, en Fortaleza-CE, con 39 enfermeros. Datos recolectados en el periodo de abril a mayo de 2012, con un cuestionario y organizados en el Excel, siendo sometidos a análisis estadístico. Estudio aprobado por el comité de ética, con el parecer no. 090207/11. Resultados: en cuanto al procedimiento de aspiración endotraqueal, llama la atención la no realización de la ausculta pulmonar por 69,23% de los participantes. Otros puntos merecen destacarse como la no suspensión de la dieta enteral (51,29%) y la no utilización de los Equipos de Protección Individual (51,28%) durante el procedimiento; 94,27% utiliza suero fisiológico 0,9% para fluidificar las secreciones. Conclusión: hay necesidad de intensificar las actividades educativas en relación a la importancia de los cuidados durante el procedimiento, intentando minimizar los riesgos para los pacientes. Palabras clave: Aspiración respiratoria. Unidad de cuidados intensivos. Atención de enfermería.

Clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced a cerebrovascular accident

OBJECTIVE: the study's objective was the clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced cerebrovascular accidents (CVA). METHOD: a prospective cohort study was conducted with 24 patients hospitalized due to a CVA. The instrument used to collect the data addressed the risk factors for respiratory aspiration, validated by concept analysis and by experts. RESULTS: the most frequent risk factors for respiratory aspiration were: dysphagia (54.2%) and impaired physical mobility (41.7%). The prevalence of the nursing diagnosis Risk for Aspiration was 58.3% and the prevalence of respiratory aspiration over the span of 48 hours (monitoring period) was 37.5%. Risk factors for dysphagia and impaired physical mobility were significantly associated with respiratory aspiration. CONCLUSION: the risk factors dysphagia and impaired physical mobility are good predictors of the nursing diagnosis Risk for Aspiration. This study contributed to improving the NANDA-I Taxonomy and the systematization of the nursing process.

Laryngeal survey in glyphosate intoxication: a pathophysiological investigation

Respiratory aspiration is a serious potential complication of glyphosate-surfactant herbicide intoxication. From October 1, 1992 to June 30, 1996, we performed laryngeal evaluations in 53 cases to investigate the possible pathophysiological mechanism of glyphosate intoxica tion. There were 36 cases with significant laryngeal injury. The blood WBC count were significantly higher and the hospital stays were significantly longer in patients with laryngeal injury, when compared with patients with no laryngeal injury (Student t-test, P < 0.005). Laryngeal injury was strongly correlated with aspiration pneumoni tis (X2 =4.449, P<0.05). We concluded that laryngeal injury may be the major cause of aspiration that leads to some degree of morbidity and mortality, following concentrated glyphosate-surfactant herbicide intoxica tion. Laryngeal survey may be indicated in cases of glyphosate-surfactant intoxication, to evaluate the sever ity of mucosal injury, and to apply adequate supportive management as early as possible to prevent from aspiration complications and even mortality.