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Profilaxia antibiótica sistémica na prevenção da pneumonia associada à ventilação na pessoa com lesão cerebral aguda : Uma revisão sistemática
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Introdução: As constantes transformações no domínio científico e tecnológico, bem como a crescente complexidade dos cuidados de saúde, exigem profissionais altamente qualificados, cuja prática clínica se fundamente em evidência cientifica. A pneumonia associada à ventilação representa uma das infeções mais frequentes nas unidades de cuidados intensivos, sobretudo em pessoas com lesão cerebral aguda, estando associada a um pior prognóstico, maior tempo de internamento e agravamento do estado neurológico. Embora controversa e não incluída nas bundles de prevenção, a profilaxia antibiótica sistémica demonstra potencial para melhorar alguns outcomes.
Objetivos: Descrever o processo de desenvolvimento de competências comuns e a aquisição de competências específicas em Enfermagem Médico – Cirúrgica na área de Enfermagem em Pessoa em Situação Crítica, assim como identificar a efetividade da profilaxia antibiótica sistémica na prevenção da pneumonia associada à ventilação na pessoa com lesão cerebral aguda.
Metodologia: Este relatório foi dividido em duas partes. A primeira parte refere-se à componente clínica, na qual se reflete sobre o processo de desenvolvimento de competências, com base no modelo de aquisição de competências desenvolvido por Patrícia Benner, aplicado em dois contextos de estágio distintos. A segunda parte corresponde à componente de investigação, intitulada “Profilaxia Antibiótica Sistémica na Prevenção da Pneumonia Associada à Ventilação na Pessoa com Lesão Cerebral Aguda: uma revisão sistemática”, apresentada sob a forma de uma revisão sistemática da literatura e estruturada em formato de artigo.
Resultados: A realização dos estágios permitiu o desenvolvimento de competências através da aplicação da teoria na prática, da reflexão sobre a ação, da vivência de experiências desafiantes e da oportunidade de desenvolver projetos nas áreas da qualidade e segurança dos cuidados, desenvolvimento profissional e apoio à família. A componente de investigação reforçou a importância do papel do enfermeiro especialista na produção e divulgação do conhecimento científico. Os resultados indicam que a profilaxia antibiótica sistémica reduz a incidência de pneumonia associada à ventilação de início precoce, sem impacto significativo na pneumonia associada à ventilação de início tardio. No entanto, os seus efeitos na mortalidade, duração da ventilação mecânica e tempo de internamento foram heterogéneos.
Conclusão: Com a realização dos estágios, considera-se que as competências comuns foram desenvolvidas e que as competências específicas foram adquiridas. A investigação realizada permitiu concluir que a profilaxia antibiótica sistémica reduz a incidência de pneumonia associada à ventilação precoce em doentes com lesão cerebral aguda. No entanto, não se verificou um impacto significativo noutros outcomes, tornando a evidência insuficiente para sustentar a sua implementação generalizada. Recomenda-se que estudos futuros adotem metodologias mais homogéneas, de forma a fortalecer a evidência e permitir a atualização desta revisão.
Palavras – chave: enfermagem médico-cirúrgica; enfermeiro especialista; urgência; cuidados intensivos; pneumonia associada à ventilação; profilaxia antibiótica
Abstract Introduction: The constant changes in science and technology, as well as the growing complexity of healthcare, require highly qualified professionals whose clinical practice is based on scientific evidence. Ventilator-associated pneumonia is one of the most common infections in intensive care units, especially in patients with acute brain injury, and is associated with a worse prognosis, longer hospitalisation and worsening neurological status. Although controversial and not included in prevention bundles, systemic antibiotic prophylaxis shows potential for improving some outcomes. Objectives: To describe the process of developing common competences and acquiring specific competences in Medical-Surgical Nursing in the area of Critical Care Nursing, as well as to identify the effectiveness of systemic antibiotic prophylaxis in preventing ventilator-associated pneumonia in patients with acute brain injury. Methodology: This report is divided into two parts. The first part refers to the clinical component, which reflects on the process of competences development, based on the competences acquisition model developed by Patrícia Benner, applied in two different internship contexts. The second part corresponds to the research component, entitled “Systemic Antibiotic Prophylaxis in the Prevention of Ventilator-Associated Pneumonia in Patients with Acute Brain Injury: a systematic review”, presented in the form of a systematic literature review and structured in article format. Results: The internships allowed for the development of competences through the application of theory in practice, reflection on action, challenging experiences and the opportunity to develop projects in the areas of quality and safety of care, professional development and family support. The research component reinforced the importance of the role of specialised nurses in producing and disseminating scientific knowledge. The results indicate that systemic antibiotic prophylaxis reduces the incidence of early-onset ventilator-associated pneumonia, with no significant impact on late-onset ventilator-associated pneumonia. However, its effects on mortality, duration of mechanical ventilation and length of stay were heterogeneous. Conclusion: With the completion of the internships, it is considered that the common competences have been developed and the specific competences have been acquired. The research carried out led to the conclusion that systemic antibiotic prophylaxis reduces the incidence of early-onset ventilator-associated pneumonia in patients with acute brain injury. However, there was no significant impact on other outcomes, making the evidence insufficient to support its widespread implementation. It is recommended that future studies adopt more homogeneous methodologies in order to strengthen the evidence and allow this review to be updated. Keywords: medical-surgical nursing; nurse specialist; emergency; intensive care; ventilator-associated pneumonia; antibiotic prophylaxis
Abstract Introduction: The constant changes in science and technology, as well as the growing complexity of healthcare, require highly qualified professionals whose clinical practice is based on scientific evidence. Ventilator-associated pneumonia is one of the most common infections in intensive care units, especially in patients with acute brain injury, and is associated with a worse prognosis, longer hospitalisation and worsening neurological status. Although controversial and not included in prevention bundles, systemic antibiotic prophylaxis shows potential for improving some outcomes. Objectives: To describe the process of developing common competences and acquiring specific competences in Medical-Surgical Nursing in the area of Critical Care Nursing, as well as to identify the effectiveness of systemic antibiotic prophylaxis in preventing ventilator-associated pneumonia in patients with acute brain injury. Methodology: This report is divided into two parts. The first part refers to the clinical component, which reflects on the process of competences development, based on the competences acquisition model developed by Patrícia Benner, applied in two different internship contexts. The second part corresponds to the research component, entitled “Systemic Antibiotic Prophylaxis in the Prevention of Ventilator-Associated Pneumonia in Patients with Acute Brain Injury: a systematic review”, presented in the form of a systematic literature review and structured in article format. Results: The internships allowed for the development of competences through the application of theory in practice, reflection on action, challenging experiences and the opportunity to develop projects in the areas of quality and safety of care, professional development and family support. The research component reinforced the importance of the role of specialised nurses in producing and disseminating scientific knowledge. The results indicate that systemic antibiotic prophylaxis reduces the incidence of early-onset ventilator-associated pneumonia, with no significant impact on late-onset ventilator-associated pneumonia. However, its effects on mortality, duration of mechanical ventilation and length of stay were heterogeneous. Conclusion: With the completion of the internships, it is considered that the common competences have been developed and the specific competences have been acquired. The research carried out led to the conclusion that systemic antibiotic prophylaxis reduces the incidence of early-onset ventilator-associated pneumonia in patients with acute brain injury. However, there was no significant impact on other outcomes, making the evidence insufficient to support its widespread implementation. It is recommended that future studies adopt more homogeneous methodologies in order to strengthen the evidence and allow this review to be updated. Keywords: medical-surgical nursing; nurse specialist; emergency; intensive care; ventilator-associated pneumonia; antibiotic prophylaxis
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Competência profissional Enfermagem médico cirúrgica Lesões encefálicas Pneumonia associada à ventilação mecânica Pneumonia associada à ventilação mecânica - prevenção e controle Profilaxia antibiótica Revisão sistemática Serviço de urgência hospitalar Unidades de cuidados intensivos Antibiotic prophylaxis Brain injuries Emergency service hospital Intensive care units Medical surgical nursing Pneumonia ventilator associated Professional competence Systematic review
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