Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations.

Aim: This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV). Background: NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation. Methods: Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done. Review results: Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile. Conclusion: Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations. How to cite this article: Karim HMR, Sarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938-948.

Secretion management in patients with ineffective airway clearance with non-invasive mechanical ventilation use: Expert guidance for clinical practice.

Non-invasive ventilation (NIV) is a mainstay of management of chronic respiratory failure in many disorders which are known to cause abnormal airway secretion clearance. Currently, there is no guidance regarding either the secretion handling during NIV use or the role of NIV in secretion management in these patients. The aim of this document was to provide an overview of the various techniques available in the management of respiratory secretions and their use in conjunction with NIV. Literature search was performed using the keywords, "(secretion OR secretions) AND (noninvasive ventilation OR NIV)" on PubMed and EMBASE. The search yielded 1681 and 509 titles from PubMed and EMBASE, respectively. After screening, 19 articles were included in this review. Suggestions of the expert panel were formulated by mutual consensus after reviewing the relevant literature. The draft of the expert panel's suggestions was circulated among all authors via electronic mail for comments. Any conflicts were resolved by mutual discussion to achieve agreement. The final document was approved by all. This document by the International Network for Airway Secretions Management in NIV describes various airway secretion clearance techniques. It provides the expert panel's suggestions for the use of these techniques in conjunction with NIV for patients with muco-obstructive and neuromuscular disorders.

Inspiratory muscle training in neuromuscular patients: Assessing the benefits of a novel protocol.

BACKGROUND: Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE: To assess the benefits of adding inspiratory muscle training to neuromuscular patients' treatment and their compliance to the approach. METHODS: We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based on patients' baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS: There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n= 12, 57.3%) and amyotrophic lateral sclerosis (n= 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p= 0.002) and peak cough flow (p= 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS: This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term.

Is the 1-Minute Sit-To-Stand Test a Good Tool to Evaluate Exertional Oxygen Desaturation in Chronic Obstructive Pulmonary Disease?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is frequently associated with exertional oxygen desaturation, which may be evaluated using the 6-minute walking test (6MWT). However, it is a time-consuming test. The 1-minute sit-to-stand test (1STST) is a simpler test, already used to evaluate the functional status. The aim of this study was to compare the 1STST to the 6MWT in the evaluation of exertional desaturation. METHODS: This was a cross-sectional study including 30 stable COPD patients who performed the 6MWT and 1STST on the same day. Six-minute walking distance (6MWD), number of 1STST repetitions (1STSTr), and cardiorespiratory parameters were recorded. RESULTS: A significant correlation was found between the 6MWD and the number of 1STSTr (r = 0.54; p = 0.002). The minimum oxygen saturation (SpO2) in both tests showed a good agreement (intraclass correlation coefficient (ICC) 0.81) and correlated strongly (r = 0.84; p < 0.001). Regarding oxygen desaturation, the total agreement between the tests was 73.3% with a fair Cohen´s kappa (κ = 0.38; p = 0.018), and 93.33% of observations were within the limits of agreement for both tests in the Bland-Altman analysis. CONCLUSION: The 1STST seems to be a capable tool of detecting exercise-induced oxygen desaturation in COPD. Because it is a less time- and resources-consuming test, it may be applied during the outpatient clinic consultation to regularly evaluate the exercise capacity and exertional desaturation in COPD.

Follow-up loss in smoking cessation consultation: can we predict and prevent it?

BACKGROUND: Cigarette smoking has a considerable health and economic burden in modern society, with increased risk of morbidity and mortality. Therefore, smoking cessation policies and medical treatments are essential. However, cessation rates are low and the abandonment of the consultation is common. The identification of characteristics that may predict adherence will help defining the best treatment strategy. This study aimed to identify predictors of follow-up loss in smoking cessation consultation. METHODS: We made a retrospective observational study, including a cohort of patients who started smoking cessation consultation (April-December 2018). Clinical data from consultations was collected and analyzed with IBM SPSS Statistics (SPSS, RRID:SCR_002865). RESULTS: A total of 175 patients was selected (41.1% female), with a mean age of 53±12 years. Eighty-five patients (48.6%) were discharged for abandonment. They had a median pack-year unit 38±36 (P=0.011), Fagerström and Richmond scores of 5±2 and 7±2, respectively. There was an association between women (P<0.001), younger age (P<0.001), depression/anxiety (P=0.023), lower smoking load (P=0.019), starting the treatment in the first appointment (P=0.004) and the abandonment of the consultation. In binary logistic regression, younger age (less than 50 years) (OR =4.39; 95% CI: 1.99-9.70), starting the treatment in the first appointment (OR =3.04; 95% CI: 1.44-6.42) and depression/anxiety (OR =2.30; 95% CI: 1.08-4.88) remained independent predictors of loss in follow-up. CONCLUSIONS: Women, younger age, depression/anxiety, lower smoking load and starting treatment in the first appointment are predictors of follow-up loss, so, these patients may benefit from more frequent evaluations and intensive cognitive approach. This study also raises awareness about the adequate timing to start pharmacological support for smoking cessation.

The role of non-invasive ventilation in weaning and decannulating critically ill patients with tracheostomy: A narrative review of the literature.

INTRODUCTION: Invasive mechanical ventilation (IMV) is associated with several complications. Placement of a long-term airway (tracheostomy) is also associated with short and long-term risks for patients. Nevertheless, tracheostomies are placed to help reduce the duration of IMV, facilitate weaning and eventually undergo successful decannulation. METHODS: We performed a narrative review by searching PubMed, Embase and Medline databases to identify relevant citations using the search terms (with synonyms and closely related words) "non-invasive ventilation", "tracheostomy" and "weaning". We identified 13 publications comprising retrospective or prospective studies in which non-invasive ventilation (NIV) was one of the strategies used during weaning from IMV and/or tracheostomy decannulation. RESULTS: In some studies, patients with tracheostomies represented a subgroup of patients on IMV. Most of the studies involved patients with underlying cardiopulmonary comorbidities and conditions, and primarily involved specialized weaning centres. Not all studies provided data on decannulation, although those which did, report high success rates for weaning and decannulation when using NIV as an adjunct to weaning patient off ventilatory support. However, a significant percentage of patients still needed home NIV after discharge. CONCLUSIONS: The review supports a potential role for NIV in weaning patients with a tracheostomy either off the ventilator and/or with its decannulation. Additional research is needed to develop weaning protocols and better characterize the role of NIV during weaning.

High-Flow Nasal Oxygen Therapy in Acute Hypoxemic Respiratory Failure: Concise Review on Technology and Initial Methodology.

High-flow nasal cannula oxygen therapy (HFNCOT) system consists of an air/oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 80 L/min. The system includes a blender, active humidifier, single heated tube, and nasal cannula. HFNCOT has many physiological advantages compared with other standard oxygen therapies, such as anatomical dead space washout, more constant fraction of inspired oxygen, positive end-expiratory (PEEP) effect, supplement of adequate humidification and maintenance of muco-ciliary function. HFNCOT is mostly used for hypoxemic acute respiratory failure, although it also has other indications. HFNCOT is a common choice of physicians as its technology makes it more silent and comfortable. Though HFNCOT is used in many clinical settings, there is a lack of publications addressing devices and initial settings. We present a review on HFNCOT, with focus on device and application methodology.

Pulmonary nocardiosis: A Single Center Study.

OBJECTIVES: Nocardiosis is a rare infection caused by Nocardia spp., a gram-positive bacteria non-commensal of the human flora. Nocardiosis usually presents with lung infection but may disseminate to other organs, most frequently the brain. The major risk factor is immunosuppression, but lung diseases also increase the risk of infection. Treatment with antibiotics is usually prolonged. In this study, we made a retrospective analysis of pulmonary nocardiosis cases and a review of the available literature. METHODS: We made a retrospective analysis of all pulmonary nocardiosis cases from 13 years (January 2005 to December 2017) in our institution, selecting patients from pulmonology and infectious diseases consultation. RESULTS: We found four patients diagnosed with pulmonary nocardiosis, three males (patients 1, 2 and 3) and one female (patient 4). Median age was 71 ± 15 years old. Different specimens were identified (N. cyriacigeorgica, Nocardia spp., N. nova, and N. wallacei/transvalensis). Bronchofibroscopy with bronchoalveolar lavage culture was the most frequent diagnostic procedure (patients 1 and 4). Only patient 2 presented an unfavorable response to treatment and died from septic shock. CONCLUSIONS: Pulmonary nocardiosis has a good prognosis if diagnosed early and treated adequately. It should always be considered in the differential diagnosis of pulmonary infections concomitant with brain or other soft tissue lesion, especially in immunocompromised patients.

Non-invasive ventilation in patients with an altered level of consciousness. A clinical review and practical insights.

Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respira-tory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preserva-tion of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation. Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed.

Rapid sequence induction: a survey of practices in three French prehospital mobile emergency units.

OBJECTIVES: This prospective study was conducted in three mobile emergency and intensive care units. METHODS: The patients were over 15 years of age and were not in cardiac arrest. The study was to compare practices in the three units with the guidelines drawn up by the Commission of Experts so as to define the main parameters for quality assurance. All of the patients involved were considered to have full stomachs and required rapid sequence induction. RESULTS: This procedure comply the guidelines only in 45% of cases; in the other cases succinylcholine should have been administered (mobile emergency and intensive care unit A) and the Sellick manoeuvre should have been used (mobile emergency and intensive care unit A and B). Notwithstanding, these two centres treated more traumatized patients than mobile emergency and intensive care unit C, and use of the Sellick manoeuvre in such circumstances is questionable. CONCLUSIONS: More training and greater diffusion of the protocols are required, especially with regard to doctors who intervene intermittently.

Beneficial effects of direct call to emergency medical services in acute myocardial infarction.

OBJECTIVES: We investigated the impact of an emergency medical services call on the management of acute myocardial infarction, considering time intervals for intervention and revascularization procedures. METHODS: Data were prospectively collected from January 2001 to October 2002 from 531 patients hospitalized for myocardial infarction with ST segment elevation and a pre-hospital delay of less than 24 h. RESULTS: Only 26% of patients called the emergency medical services at the onset of symptoms (n=140). Other patients (n=391, 74%) called another medical contact. Baseline characteristics and cardiovascular history were similar in the two groups, except for the percutaneous coronary intervention history (10% in the emergency medical services group versus 4% in the other medical contact group, P<0.05). Time intervals from the onset of symptoms of myocardial infarction to call or to medical intervention, as well as the time interval from medical intervention to hospital admission were significantly shorter in the emergency medical services group. The early reperfusion rate was also significantly greater in the emergency medical services group (77%) compared with the other medical contact group (64%), mainly because of a greater incidence of primary percutaneous coronary intervention (36 versus 26%, P<0.03, respectively). Multivariate analysis adjusted for sex and age showed that less than three medical care providers [odds ratio (OR) 5.042, P<0.001], percutaneous coronary intervention history (OR 2.462, P<0.05), as well as rhythmic disorders (OR 2.105, P<0.05) and complete atrioventricular block (OR 2.757, P<0.05) were independent predictors of emergency medical services care. CONCLUSION: This study demonstrated that a call to the emergency medical services is underutilized by patients with symptoms of myocardial infarction, and documented the beneficial effects of an emergency medical services call by reducing pre-hospital delays and increasing early revascularization therapies.

Atuação do enfermeiro na consulta pré-natal: limites e potencialidades / Actuación del enfermero en la consulta prenatal: límites y potencialidades / Nurse’s performance in prenatal consultation: limits and capabilities

identifying the limits and the capabilities of the nurse’s performance in the prenatal consultation. Method: a narrative review of literature. The choice of articles was conducted between 2005 and 2009, carried out at VHL with the following descriptors: prenatal care, prenatal assistance, nursing care and nurse assistance. The subject matters dealt in two sections: those which reported to the limits and those related to nurse’s the capabilities of the nurse in prenatal appointment. Discussion: 26 productions: 21 scientific and 5 institutional. Regarding the limits of nurse’s performance in prenatal care, there are: the attention focused on the biomedical model; the precariousness of resources and the ignorance of the nurse’s work were identified as nurse’s limits of performance. Capabilities: acceptance, bond and interaction, education practice of education in health and the professional commitment of the nurse’s commitment. Conclusion: the positive impact of their actions on prenatal consultation is obvious, particularly when regarding the recognition of women’s needs and effort to the integrality of health actions...

identificar os limites e as potencialidades da atuação do enfermeiro na consulta pré-natal. Método: revisão narrativa da literatura. A seleção dos artigos de 2005 a 2009 foi realizada na BVS com os descritores: cuidado pré-natal, assistência pré-natal, cuidados de enfermagem, assistência de enfermagem. As temáticas foram agrupadas em dois eixos: aquelas que se reportavam aos limites e aquelas voltadas às potencialidades da atuação do enfermeiro na consulta pré-natal. Discussão: 26 produções: 21 científicas e 5 institucionais. Como limites foram destacados: atuação do enfermeiro no pré-natal; atenção baseada no modelo biomédico; precariedade de recursos e o desconhecimento do trabalho do enfermeiro. Como potencialidades: acolhimento, vínculo e interação, prática de educação em saúde e o comprometimento profissional do enfermeiro. Conclusão: o impacto positivo de suas ações na consulta pré-natal é evidente, particularmente no que se refere ao reconhecimento das necessidades das mulheres e no esforço à integralidade das ações em saúde...

Analizar y listar factores y técnicas de monitoreo relacionados a adhesión al tratamiento antiretroviral. Método: estudio de revisión integradora de la literatura a partir de las bases electrônicas LILACS y MEDLINE, realizado en el mes de abril y mayo de 2013, Resultados: factores como escolaridad, complejidad del tratamiento, agravantes psicológicos y la relación entre profesional de salud y usuario, tuvieron destaque relevante en la adhesión a TARV. En ese contexto, monitorear y medir la adhesión a la terapia antiretroviral con el uso de técnicas adecuadas puede contribuir para un aumento significativo de esos valores. Conclusión: es cierto que no existe um padrón oro que garantize la adhesión ideal, com todo, el uso de técnicas de monitoreo correctas y combinadas, pueden disminuir significativamente el impacto de diversos factores que predisponen la adhesión ineficaz al tratamiento del SIDA...

A busca do cuidado pela gestante de alto risco e a relação integralidade em saúde / The search for care by high risk pregnant in relation to integrality in health

O objetivo deste estudo foi compreender o itinerário terapêutico da gestante de alto risco do município de Niterói no acompanhamento do seu pré-natal, sob a ótica da Integralidade da atenção à saúde. Trata-se de estudo descritivo, com abordagem qualitativa. Procura-se oferecer um olhar reflexivo para a busca e a produção de cuidado nas condições das gestantes durante o alto risco, atendidas na unidade de saúde de referência da cidade devido à hipertensão arterial na gestação. A partir de uma leitura atenciosa e da discussão dos dados obtidos, e após a construção do Itinerário Terapêutico, organizou-se a análise dos dados em função de duas categorias: o acesso à saúde diante do primeiro sinal ou sintoma e a repercussão da assistência à gestante; e a integralidade da assistência no caminho percorrido. A avaliação dos dados teve como referencial teórico a análise de conteúdo de Bardin. Esta pesquisa envolveu 5 gestantes de alto risco, atendidas na Policlínica de Especialidades da Mulher Malu Sampaio. O acesso ao serviço de referência revelou-se, de acordo com as gestantes, rápido, porém, a continuidade da atenção pela unidade de origem do pré-natal ainda se mostrou frágil perante a abordagem integral e participativa na vida das usuárias.

The aim of this study was to understand the therapeutic itinerary of pregnant women at high risk in prenatal care from the perspective of Integrality in health care. A descriptive study, qualitative approach, which seeks to offer a reflective look for the search and production of care in condition of the high-risk pregnant women, attended at health unity due to hypertension in gestation. From the attentive reading and discussion of the data and, after the construction of therapeutic itinerary organized the analysis of data from two categories -Access to health care at the first sign or symptom and the impact of prenatal care; Comprehensive care in the walked way. The data analysis was based on the theoretical content analysis of Bardin. This research involved five high-risk pregnants attended at Women's Specialties Polyclinic Malu Sampaio. The access to the service proved, according to pregnant women, quickly; however, the continuity of care for the unity of origin still proved fragile before the integral and participatory approach in the lives of users.

O normal e o patológico na perspectiva do envelhecimento: uma revisão integrativa / The normal and the pathological in the outlook of aging: an integrative review

O presente estudo pretende discutir o normal e o patológico na bibliografia sobre envelhecimento, sob a perspectiva de Canguilhem. Para isso, foi realizada uma revisão integrativa através da busca de textos na Biblioteca Virtual em Saúde, de 2002 a 2012, que contemplassem as obras sobre o normal e o patológico na perspectiva do envelhecimento. A amostra final resultou em seis textos relacionados às noções de Canguilhem, que emergiram nas seguintes categorias: a perspectiva normativa no processo do envelhecimento; e o normal e o patológico e a medicina anatomopatológica. Evidenciou-se, portanto, o crescimento da cirurgia plástica em relação às mudanças de imagem corporal, que a sociedade incorpora como verdade e que retarda o envelhecimento, conformando-se ao discurso de Canguilhem, que reflete sobre as modificações corporais, assim como as terapêuticas relacionadas ao envelhecimento a fim de retardar esse processo.

The present study aims to discuss the normal and the pathological into the literature about aging, from the perspective of Canguilhem. To that end, an integrative review was performed by means of text searching in the Virtual Library of Health, from 2002 to 2012, whose works about the normal and the pathological, in the outlook of aging, were envisaged. The final sample has resulted in six texts related to Canguilhem's notions, that have emerged in the following categories: the normative perspective on the aging process; the normal and the pathological, and the anatomopathological medicine. It was evident, therefore, the growth of plastic surgery in relation to the changes of body image that society embodies as true, and that slows aging, conforming to Canguilhem's speech, wich reflects about the bodily changes, as well as the aging related therapies, in order to delay this process.

The production of care in risky prenatal situations: a descriptive study

Aim: To describe the health services offered with regard to high risk pregnancies by the care network; to map the route of the path of pregnant women care. Method: This is a descriptive, qualitative research which has as a scenario, the Malu Sampaio Woman Specialties Polyclinic and, as subjects, pregnant women at potential pregnancy risk who are not hospitalized. In order to collect data we will use semi-structured interviews, participant observation and bibliographic and documentary material. The collection period is from August to September 2013. The processing of data will be performed using Bardin analysis, which will allow the construction of the therapeutic path...

Vivências de gestantes soropositivas em relação à assistência de enfermagem: estudo descritivo / Experiences of hiv-positive pregnant women in relation to nursing care: a descriptive study / Experiencias de gestantes seropositivas en relación a la atención de enfermería: estudio descriptivo

O objetivo do estudo consistiu em descrever a vivência das gestantes portadoras do vírus da imunodeficiência humana (HIV) e a assistência de enfermagem recebida no pré-natal sob a ótica da gestante. Estudo do tipo descritivo-exploratório, de abordagem qualitativa, cujos sujeitos foram oito gestantes portadoras do HIV, atendidas no Hospital Universitário Antônio Pedro em 2008. A coleta de dados ocorreu através de entrevista semiestruturada, na análise dos dados utilizou-se a análise de conteúdo de Bardin da qual emergiram duas categorias "descortinar é preciso" e "personagem da desgraça do (des) cuidado". Os resultados mostraram que o papel do (a) enfermeiro (a), pela visão das mulheres, não ficou evidenciado durante o pré-natal, porém, no puerpério este papel se confundia com a ação dos demais profissionais da enfermagem e, por vezes, as mulheres se ressentiram de não receber assistência de enfermagem mais especializada. Sugere-se que haja parceria entre o aparelho formador e a instituição de ensino do cenário hospitalar a fim de que se estabeleça protocolo específico para atendimento da gestante soropositiva pela enfermagem.

The aim of the study was to describe the experience of pregnant women with human immunodeficiency virus (HIV) and nursing care received in prenatal under the perspective of the mother. A study of descriptive and exploratory type, of qualitative approach, whose participants were eight HIV infected pregnant women treated at the University Hospital Antonio Pedro in 2008. The data were collected through a semi-structured interview; data analysis used the content analysis of Bardin from which emerged two categories "unveil it takes" and "Doom character (lack of) care." The results showed that the role of the nurse, through the view of women, not evidenced during the prenatal period, however, in the puerperium this role was confused with the action of other nursing professionals and sometimes women resented of not receiving a more specialized nursing care. It is suggested that should be a partnership between the educational institution of the hospital scenario in order to establish specific protocol for care of HIV positive pregnant women in nursing.

El objetivo del estudio fue describir la experiencia de las gestantes portadoras del virus de la inmunodeficiencia humana (VIH) y la atención de enfermería recibida en el prenatal bajo la óptica de la gestante. Estudio del tipo descriptivo-exploratorio, de abordaje cualitativo, cuyos participantes fueron ocho gestantes portadoras del VIH, atendidas en el Hospital Universitario Antônio Pedro en 2008. La recolección de los datos ocurrió a través de entrevista semiestructurada, en el análisis de los datos se utilizó el análisis de contenido de Bardin del cual emergieron dos categorías "desvelar es necesario" y "personaje de la desgracia del (des) cuidado". Los resultados mostraron que el papel del (la) enfermero (a), por la perspectiva de las mujeres, no quedó evidente durante el período prenatal, sin embargo, en el puerperio este papel se confundía con la acción de los demás profesionales de la enfermería y, a veces, las mujeres se resintieron por no haber recibido cuidados de enfermería más especializados. Se sugiere que haya una sociedad entre el aparato formador y la institución educativa del escenario hospitalario con el fin de que se establezca un protocolo específico para la atención de la gestante seropositiva por la enfermería.

Breastfeeding as an evaluative practice in know-how: a descriptive study / Amamantamiento como práctica valorativa en el saber hacer: estudio descriptivo / Amamentação como prática valorativa no saber fazer: estudo descritivo

Aim: To analyze the axiological dimensions of nurses regarding breastfeeding and their reflections along with the nursing mothers, in the process of knowledge transmission. Method: A descriptive and qualitative study of 11 nurses from the Friendly Breastfeeding Primary Care Initiative of Rio de Janeiro. The data were collected by means of semi-structured interviews between January/March 2010, generating categories articulated with Max Scheler's Theory of Values. Result: The following categories emerged: the affective bond as a value for successful breastfeeding; and breastfeeding and nutritional value and protection for the child. Discussion: To analyze the evaluative link of the act of breastfeeding between mother and child and the link related to the value of food safety also means thinking about the love and affection that, in the conception of Scheler, are absolutely unique. Conclusion: the valuation of women as individuals is seen through a totally new perspective concerning breastfeeding, as recommended by public policies regarding women's care.

Objetivo: analizar la dimensión axiológica de los enfermeros acerca del amamantamiento y sus reflejos junto a las mujeres que amamantan, en el proceso de transmisión de conocimiento. Método: estudio descriptivo, cualitativo, del que participaron once enfermeros de la Iniciativa Unidad Básica Amiga del Amamantamiento de Rio de Janeiro. Los datos fueron recolectados por medio de entrevista semiestruturada, entre enero/marzo de 2010, generando categorías articuladas con la Teoría de los Valores de Max Scheler. Resultado: Emergieron las categorías: el vínculo afectivo como valor para el suceso del amamantamiento; el amamantamiento como valor nutricional y de protección para el niño. Discusión: Pensar en el vínculo valorativo del acto de amamantar y en el vínculo con valor de seguridad alimentaria es también pensar en el amor y en el afecto que, en la concepción Scheleriana, es absolutamente original. Conclusión: La valoración de la mujer como sujeto es extremamente rescatada en relación al amamantamiento, como preconizan las políticas públicas en la línea de cuidado ofrecido a la mujer.

Objetivo: analisar a dimensão axiológica dos enfermeiros acerca da amamentação e seus reflexos junto às nutrizes, no processo de transmissão de conhecimento. Método: estudo descritivo, qualitativo, do qual participaram onze enfermeiros da Iniciativa Unidade Básica Amiga da Amamentação do Rio de Janeiro. Dados coletados por entrevista semiestruturada, entre janeiro/março de 2010, gerando categorias articuladas com a Teoria dos Valores de Max Scheler. Resultado: Emergiram as categorias: o vínculo afetivo como valor para o sucesso da amamentação; a amamentação como valor nutricional e de proteção para a criança. Discussão: Pensar no vínculo valorativo do ato de amamentar e o vínculo com valor de segurança alimentar é também pensar no amor e afeto que, na concepção Scheleriana, é absolutamente original. Conclusão: a valoração da mulher como sujeito é extremamente resgatada em relação à amamentação, como preconizam as políticas públicas na linha de cuidado à mulher.

A ausência do companheiro nas consultas de pré-natal: desafios e conquistas / La ausencia de la pareja en las consultas para la atención prenatal: logros y desafios / The absence of the partner in prenatal care: challenges and achievements

Analisar a inserção e visão do companheiro acerca da assistência pré-natal, identificar e analisar os motivos que levam a uma parcela desses companheiros a não acompanharem suas mulheres gestantes nas consultas de pré-natal. Métodos: Descritiva com abordagem qualitativa, com coleta de dados através de entrevista semi-estruturada com perguntas abertas e posterior análise do conteúdo. Resultados: Foram realizadas 20 entrevistas, sendo 15 na Maternidade Municipal Alzira Reis Vieira Ferreira e 05 na maternidade do Hospital Universitário Antônio Pedro. Conclusão: É perceptível, a pouca ou nenhuma participação dos homens relatada pelas mulheres no processo de planejamento familiar. Já está provado que o companheiro é receptivo ao nosso chamado, que o estímulo do profissional mobiliza o homem, mesmo tendo uma visão restrita acerca da assistência pré-natal, acreditando que todo aquele esforço do sistema de saúde é apenas para acompanhar o desenvolvimento do bebê.

Analizar la inserción y visión de la compañía sobre el cuidado prenatal, identificar y analizar las razones que llevan a um número de estos indivíduos no acompañar a sus mujeres embarazadas en las consultas. Métodos: Enfoque cualitativo descriptivo, recopilación de datos a través de entrevista semiestructurada y un análisis más detallado. Resultados: Incluyeron 20 entrevistas, 15 de la Maternidad Municipal de Alzira Vieira Ferreira Reis y 05 en el Hospital Universitário Antônio Pedro. Conclusion: La participación de poco o nada de los hombres denunciados porlas mujeres em el proceso de planificación de la familia. El sócio sea receptivo a nuestra llamada, que el estímulo moviliza el hombreprofesional, incluso con uma visión restringida sobre el cuidado prenatal, la creencia de que todo ese esfuerzo del sistema de salud es sólo para vigilar el desarrollo del bebé.

Objective: To analyze the insertion and the vision of the partner about prenatal care, identify and analyze the reasons that lead to a number of these partners do not accompany their pregnant women in prenatal care. Methods: Descriptive qualitative approach, with data collection through semi-structured interview with open questions and further analysis of the content. Results: We conducted 20 interviews, 15 of the Municipal Maternity Alzira Vieira Ferreira Reis and 05 at the Hospital University Antonio Pedro. Conclusion: It is noticeable, with little or no participation of men reported by women in the process of family planning. It has been demonstrated that the partner is receptive to our call, that the stimulus mobilizes the professional man, even with a restricted view about prenatal care, believing that all that effort of the health system is only to monitor the baby's development.

Consulta puerperal: demandas de las mujeres bajo la perspectiva de la enfermera - estudio exploratorio / Consulta puerperal: demandas das mulheres sob a perspectiva da enfermeira - estudo exploratório / Puerperium consulting: needs of women from the nursing perspective - exploratory study

Objectives: The research aimed to understand the health needs of postpartum women in the nurse's perspective, considering the integration of actions. Method: The research was conducted as a Exploratory type. 15 nurses who participated in puerperium consultations in nine health units of the Sanitary District Cajuru the Municipal Health Secretariat from Curitiba / Paraná, Brazil. For the data collection we used an instrument with objective questions, applied in the period from February to March 2007. Data were analyzed based on descriptive statistics. Result: It was found that the set of requirements for good living conditions has been appointed as 41.2%, and least cited: needs guaranteed access to technologies, and 4% bond with the host and the professional / health team, 2%. Discussion: It may wonder about the notion of completeness is being incorporated into puerperal consultations. Conclusion: There are still important gaps in meeting the needs of mothers.

Objetivos: La pesquisa tuvo como objetivo conocer las necesidades de salud de la puérpera en la perspectiva de la enfermera, considerando la integralidad de las acciones. Método: Fue realizada una pesquisa de tipo Exploratoria. Participaron 15 enfermeras que realizaban consultas de puerperio, en nueve unidades de salud del Distrito Sanitario Cajuru de la Secretaría Municipal de Salud de Curitiba/Paraná, Brasil. Para la colecta de datos se utilizó un instrumento con cuestiones objetivas, aplicado en el período de febrero a marzo de 2007. Los datos fueron analizados con base en la estadística descriptiva. Resultado: Se verificó que el conjunto de las necesidades para buenas condiciones de vida fue el más nombrado 41,2 %, y los menos citados: necesidades de garantía de acceso a las tecnologías, 4% y de recepción y vínculo con el profesional/equipo de salud, 2%. Discusión: se puede indagar cómo la noción de integralidad está siendo incorporada en las consultas puerperales. Conclusión: Todavía persisten espacios importantes en el atendimiento a las necesidades de las puérperas.

Objetivos: A pesquisa teve como objetivo conhecer as necessidades de saúde da puérpera na perspectiva da enfermeira, considerando a integralidade das ações. Método: Foi realizada uma pesquisa do tipo Exploratório. Participaram 15 enfermeiras que realizavam consultas de puerpério, em nove unidades de saúde do Distrito Sanitário Cajuru da Secretaria Municipal da Saúde de Curitiba/Paraná, Brasil. Para coleta de dados utilizou-se um instrumento com questões objetivas, aplicado no período de fevereiro a março de 2007. Os dados foram analisados com base em estatística descritiva. Resultado: Verificou-se que o conjunto de necessidades de boas condições de vida foi o mais apontado 41,2 %, e os menos citados: necessidades de garantia de acesso à tecnologias, 4% e de acolhimento e vínculo com o profissional/equipe de saúde, 2%. Discussão: Pode-se indagar sobre como a noção de integralidade está sendo incorporada nas consultas puerperais. Conclusão: Ainda persistem lacunas importantes no atendimento às necessidades das puérperas.

A rede de cuidado e o itinerário terapêutico de gestantes de alto risco no município de Niterói / The network of care and the therapeutic itinerary of pregnant women of high risk in the city of Niterói

Este trabalho tem por objetivos descrever os serviços de saúde oferecidos pela rede de atenção à gestante que desenvolve a gravidez de alto risco no município de Niterói; Conhecer o itinerário terapêutico à gestante que desenvolve a gravidez de alto risco nas Unidades de saúde do município de Niterói. Metodologia: pesquisa do tipo exploratória, abordagem qualitativa. utilizado como campo de pesquisa a Policlínica de Especialidades da Mulher Malu Sampaio, no município de Niterói, Rio de Janeiro, por ser unidade de referência para o tratamento das complicações oriundas da gestação. Os sujeitos deste estudo constituíram-se de um grupo de 6 gestantes, número que se definiu pela saturação da narrativa dos dados recolhidos. Como critérios de inclusão: gestantes maior de 18 anos classificada pela equipe de saúde em situação de risco. O estudo teve como embasamento teórico os territórios existenciais. Como técnica de coleta de dados, utilizou-se as fontes de levantamentos bibliográficos, a entrevista semiestruturada. A análise dos dados teve como referencial teórico a análise de conteúdo na perspectiva de Bardin. Esta pesquisa tem aprovação do Comitê de Ética e Pesquisa do Hospital Universitário Antônio Pedro, através do protocolo número: CAAE 11707413.0.0000.5243. Resultados: Após a transcrição das entrevistas e análise do conteúdo, construímos as seguintes categorias temáticas: 1) O acesso à saúde diante do primeiro sinal ou sintoma; 2) Universalidade e equidade no caminho percorrido. Discussão: O acompanhamento pré-natal de alto risco não se configura apenas como um controle dependente da gestante, e sim, um controle totalmente dependente do saber médico e da equipe de saúde cuidadora e dos recursos materiais e terapêuticos envolvidos. Iniciar ou continuar o pré-natal sem a devida confiança na equipe de saúde apresenta-se como um fator relevante na experiência das mulheres. O encaminhamento para um serviço especializado, em outro espaço de saúde, longe da sua moradia e as idas e vindas das mulheres representam o grau de preocupação e atenção à própria saúde e/ou do bebê. Nas falas, se observa que as unidades correspondem à disposição das vagas para atendimento, mas não destaca o trabalho de uma equipe no cuidado da gestante. as gestantes, em muitos casos, frequentam a unidade de origem apenas para o registro da pressão arterial, e que não realizam a consulta do pré-natal propriamente dita, considerada como fundamental na criação de vínculo e otimização da qualidade da assistência que corresponda à expectativa. Conclusão: podemos considerar que a qualidade e rapidez da assistência prestada expressam, efetivamente, a disposição da mulher em buscar outras formas de cuidar fora das instituições públicas de saúde. Por outro lado, observa-se o anonimato de alguns profissionais da equipe em integrar o cuidado à essa mulher. Assim, o itinerário terapêutico das mulheres estudadas, durante o tratamento das complicações da gravidez, é atravessado por tensões, ansiedades, adequações para novos hábitos, mudança nos papéis sociais e saberes que não estão descritos em algum nível de complexidade da assistência, incluindo grandes aparatos tecnológicos que vá proporcionar e satisfazer o seu cuidado

This study aims to describe the health services offered by the network of care for pregnant women who develop pregnancy between low and high risk in Niterói; Meet the therapeutic itinerary the pregnant woman develops pregnancy between low and high risk Units health of Niterói. Methodology: An exploratory study, qualitative approach. used as a research field the Polyclinic specialties Woman Malu Sampaio, in Niterói, Rio de Janeiro, being unit for the treatment of complications arising from pregnancy. The subjects of this study consisted of a group of six pregnant women, that number is set by the saturation of the narrative data collected. Inclusion criteria: pregnant women over 18 classified by the health staff at risk. The theoretical study was the existential territories. As a technique for data collection, we used the bibliographical sources, semi-structured interview. Data analysis was as theoretical content analysis from the perspective of Bardin. This research has been approved by the Ethics and Research of the University Hospital Antonio Pedro, through the protocol number: CAAE 11707413.0.0000.5243. Results: After transcribing the interviews and content analysis, we construct the following thematic categories: 1) Access to health care at the first sign or symptom; 2) Universality and equity in the path traveled. Discussion : The prenatal high risk not only sets as a control -dependent pregnant women , and yes, totally dependent control of medical knowledge and health staff caring and therapeutic materials and resources involved . Start or continue the prenatal without proper confidence in the health team presents itself as a relevant factor in the experience of women . The referral to a specialist service in other health space , away from your house and the comings and goings of women represent the degree of concern and attention to their health and / or baby . In the speech , noted that the units correspond to the arrangement of vacancies for service , but it highlights the work of a team in the care of pregnant women . pregnant women , in many cases , attending the source drive just for recording blood pressure , and does not perform the query prenatal itself , considered fundamental in creating links and optimizing the quality of care that meets the expectations . Conclusion: we can consider that the quality and speed of care express effectively the willingness of women to seek other forms of care outside the public health institutions. On the other hand, there is the anonymity of some professional team to integrate care for this woman. Thus, the therapeutic women studied for the treatment of complications of pregnancy, is traversed by tensions, anxieties, adaptations to new habits, change in social roles and knowledge that are not described in any level of complexity of care, including large apparatus technologies that provide go and meet your care