Hyperinflammation in COVID-19 Obese Patients Treated With Tocilizumab: A Successful Case Series.

The cytokine storm syndrome has been suggested as a mechanism in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; COVID-19 [coronavirus disease 2019]) infection. Drugs such as tocilizumab, an interleukin-6 antagonist, have shown good results in other scenarios of hyperinflammatory state and might also be effective in COVID-19 disease. However, the best dosing regimen and the timing of infusion is currently unknown, specifically in obese patients. We report the first cases of tocilizumab administration in obese patients during the first days of COVID-19 worsening hypoxemia. This infusion was not adjusted by weight, following the manufacturer maximal dose limit. We kept a strict monitoring for possible infections, prior and during the treatment. All patients showed good improvements on chest-computed tomography images and oxygenation and were discharged from hospital shortly after, without complications or intubation. This case series highlights that tocilizumab seems to be effective to treat hyperinflammation of critical COVID-19 obese patients, even when the infusion of the ideal dose is not feasible to be administered. It also shows the importance of early timing in the decision to treat and the relevance of infections exclusion prior to the induction of immunosuppression by tocilizumab.

Content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects.

OBJECTIVE: To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. METHOD: Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. RESULTS: The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. CONCLUSION: The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

Content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects / Validez de contenido del diagnóstico de enfermería Estándar Respiratoria Ineficaz en niños con cardiopatías congénitas / Validade de conteúdo do diagnóstico de enfermagem Padrão Respiratório Ineficaz em crianças com cardiopatias congênitas

ABSTRACT Objective: To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. Method: Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. Results: The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. Conclusion: The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

RESUMEN Objetivo: Estimar validez de contenido del diagnóstico de enfermería Estándar Respiratoria Ineficaz en niños con cardiopatías congénitas. Métodos: Estudio metodológico realizado en dos etapas: 1) revisión integrativa de literatura; 2) validez del contenido, con 23 enfermeros. Utilizó instrumento conteniendo 10 factores relacionados y 21 características definidoras para recogida de datos. Jueces realizaron el análisis con base en criterio de relevancia. Utilizado Índice de Validez de Contenido diagnóstico, considerado válido si superior a 0,9 y si test de Wilcoxon mayor que 0,05. Resultados: Propuesta final incorpora nueve de los diez factores causales. De ellos, cinco no pertenecen a la lista de la NANDA-I. Cuanto a características definidoras, todas han consideradas relevantes, y cinco no pertenecen al rol de señales y síntomas de la taxonomía NANDA-I. Conclusión: Los hallados de esto estudio incluyen elementos específicos de población pediátrica con cardiopatía congénita que no están presentes en la estructura del diagnóstico en estudio.

RESUMO Objetivo: Estimar a validade de conteúdo do diagnóstico de enfermagem Padrão Respiratório Ineficaz em crianças com cardiopatias congênitas. Métodos: Estudo metodológico realizado em duas etapas: 1) revisão integrativa da literatura; 2) validade do conteúdo, com 23 enfermeiros. Utilizou-se instrumento contendo 10 fatores relacionados e 21 características definidoras para coleta de dados. Os juízes realizaram a análise com base no critério de relevância. Foi utilizado o Índice de Validade de Conteúdo diagnóstico, considerado válido se superior a 0,9 e se teste de Wilcoxon maior que 0,05. Resultados: A proposta final incorpora nove dos dez fatores causais. Deles, cinco não pertencem à lista da NANDA-I. Quanto às características definidoras, todas foram consideradas relevantes, e cinco não pertencem ao rol de sinais e sintomas da taxonomia NANDA-I. Conclusão: Os achados deste estudo incluem elementos específicos da população pediátrica com cardiopatia congênita que não estão presentes na estrutura do diagnóstico em estudo.

Prognostic indicators of short-term survival of ineffective airway clearance in children with acute respiratory infection: a longitudinal study.

Background: Studies that establish the indicators of clinical status deterioration of Ineffective airway clearance remain scarce. Prognostic studies provide data for nurses identify clinical indicators that suggest a higher chance of early development of a nursing diagnosis. Objective: To identify the prognostic indicators of short-term survival of ineffective airway clearance (IAC) in children with acute respiratory infection (ARI). Design: A prospective open cohort study. Methods: This study was with a group of 136 children with acute respiratory infection who were followed for a minimum of six and a maximum of ten consecutive days. Children who had not completed six days of monitoring or who were carriers of diseases that would alter the specific symptoms of respiratory infection were excluded. The survival rate of ineffective airway clearance was calculated using Nelson-Aalen's method. A Cox regression model was used to analyze the influence of clinical indicators on survival time of this diagnosis. Results: The diagnosis survival rate was extremely low (only 0.4% on the 5th day of follow-up). The greatest reduction in survival rate was observed in the first 48 h (survival rate = 2.5%). Four defining characteristics associated with a worse prognosis of IAC among children with ARI: ineffective cough (RR = 5.86; 95% CI: 3.53-9.72), absence of cough (RR = 2.92; 95% CI: 1.68-5.08), adventitious breath sounds (RR = 2.47; 95% CI: 2.01-3.03), and diminished breath sounds (RR = 1.23; 95% CI: 1.05-1.45). Conclusion: Four clinical indicators showed a strong relationship with an increased risk of worsening clinical status associated with this nursing diagnosis. Impact statement: Clinical deterioration related to ineffective airway clearance among children with acute respiratory infection is fast and requires particular attention from nurses.

Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review.

PURPOSE: Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem. METHODS: A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed. RESULTS: Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low. CONCLUSIONS: Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.

Impaired Gas Exchange: Prognostic Clinical Indicators of Short-Term Survival in Children with Acute Respiratory Infection.

PURPOSE: To establish prognostic indicators of survival for impaired gas exchange (IGE) (00030). METHODS: Secondary analysis of data from an open prospective cohort developed with a group of 136 children with acute respiratory infection (ARI). FINDINGS: On Day 1, IGE (00030) was present in 42.6% of the sample. New cases arose until the last day of evaluation. With regards to defining characteristics, only hypoxemia and abnormal skin color were associated with a higher risk of developing diagnosis. CONCLUSIONS: Children with ARI who exhibit hypoxemia and abnormal skin color had a worse prognosis for IGE (00030). IMPLICATIONS FOR NURSE PRACTICE: Nurses can use the research findings as a predictive marker of the evolution of the patient's health status.

Classification tree to screen for the nursing diagnosis Ineffective airway clearance.

OBJECTIVE: to identify the defining characteristics of Ineffective airway clearance with better predictive power using classification trees. METHOD: the predictive power of the defining characteristics of Ineffective airway clearance was evaluated based on classification trees generated from the data of 249 children with acute respiratory infection. RESULTS: Ineffective cough and adventitious breath sounds were identified as the main defining characteristics when screening for Ineffective airway clearance in accordance with trees based on three different computational algorithms. CONCLUSION: Ineffective coughing and adventitious breath sounds had better predictive capacity for Ineffective airway clearance in the sample.

Classification tree to screen for the nursing diagnosis Ineffective airway clearance / Árvore de classificação para detecção do diagnóstico de enfermagem Desobstrução ineficaz de vias aéreas / Árbol de clasificación para la detección del diagnóstico enfermero Limpieza ineficaz de las vías aéreas

ABSTRACT Objective: to identify the defining characteristics of Ineffective airway clearance with better predictive power using classification trees. Method: the predictive power of the defining characteristics of Ineffective airway clearance was evaluated based on classification trees generated from the data of 249 children with acute respiratory infection. Results: Ineffective cough and adventitious breath sounds were identified as the main defining characteristics when screening for Ineffective airway clearance in accordance with trees based on three different computational algorithms. Conclusion: Ineffective coughing and adventitious breath sounds had better predictive capacity for Ineffective airway clearance in the sample.

RESUMO Objetivo: identificar as características definidoras de Desobstrução ineficaz de vias aéreas com melhor poder preditivo usando árvores de classificação Método: o poder preditivo das características definidoras da Desobstrução ineficaz de vias aéreas foi avaliado com base em árvores de classificação geradas a partir dos dados de 249 crianças com infecção respiratória aguda. Resultados: tosse ineficaz e ruídos adventícios respiratórios foram identificados como as principais características definidoras na detecção de Desobstrução ineficaz de vias aéreas de acordo com as árvores, com base em três diferentes algoritmos computacionais. Conclusão: Tosse ineficaz e ruídos adventícios respiratórios tiveram melhor capacidade preditiva para Desobstrução ineficaz de vias aéreas na amostra.

RESUMEN Objetivo: identificar las características definitorias de la Limpieza ineficaz de las vías aéreas con un mejor poder predictivo utilizando árboles de clasificación. Método: el poder predictivo de las características definitorias de Limpieza ineficaz de las vías aéreas se evaluó basado en los árboles de clasificación generados a partir de los datos de 249 niños con infección respiratoria aguda. Resultados: La tos ineficaz y los sonidos respiratorios anormales se identificaron como las principales características definitorias cuando se realizaba una Limpieza ineficaz de las vías aéreas de acuerdo con los árboles en función de tres algoritmos computacionales diferentes. Conclusión: La tos ineficaz y los sonidos respiratorios anormales tienen una mejor capacidad predictiva para la Limpieza ineficaz de las vías aéreas en la muestra.

Árvore de classificação para identificação de Padrão respiratório ineficaz em crianças com infecção respiratória aguda / Classification tree for identifying ineffective breathing pattern in children with acute respiratory infection

O estudo teve como objetivo verificar as características definidoras com melhor poder de predição para auxiliar na classificação de Padrão respiratório ineficaz, utilizando árvores de classificação, em crianças com infecção respiratória aguda. Estudo transversal, realizado em dois hospitais pediátricos juntamente a 249 crianças com infecção respiratória aguda. Para a coleta, foi utilizado um instrumento específico desenvolvido para o estudo. Empregaram-se três algoritmos de indução para a geração das árvores, CHi-square Automatic Interaction Detection, Classification and Regression Treese Quick, Unbiased, Efficient Statistical Tree. Construíram-se três árvores para auxiliar na identificação de Padrão Respiratório ineficaz. As árvores de classificação geradas apresentam probabilidades condicionais à ocorrência do diagnóstico associada a dispneia e alterações na profundidade respiratória. Padrão respiratório ineficaz esteve presente 65,5% da amostra. Assim, a probabilidade da ocorrência do referido diagnóstico nas crianças com infecção respiratória aguda foi de 100% com a presença de dispneia e de alterações na profundidade respiratória.

The objective of the study was to verify defining characteristics with greater predictive power to aid in the classification of ineffective breathing pattern using classification trees in children with acute respiratory infections. A cross-sectional study was carried out in two pediatric hospitals with 249 children with acute respiratory infection. For data collection, a specific instrument developed for the study was used. Three induction algorithms were used to generate the trees: Chi-square Automatic Interaction Detection, Classification and Regression Trees, and Quick, Unbiased, Efficient Statistical Tree. Three trees were constructed to aid in the identification of ineffective breathing pattern. The classification trees generated present probabilities conditionalto the occurrence of the diagnosis associated with dyspnea and changes in respiratory depth. Ineffective breathing pattern was present in 65.5% of the sample. Thus, the probability of occurrence of this diagnosis in children with acute respiratory infection was 100% with the presence of dyspnea and changes in respiratory depth.

Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy.

OBJECTIVE: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of "ventilation" in adult patients hospitalized in an intensive care unit with use of oxygen therapy. METHOD: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. RESULTS: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses). Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode) presented better fit and structure of the component defining characteristics. CONCLUSION: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct.

Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy / Análise do padrão respiratório ineficaz e ventilação espontânea prejudicada de adultos com oxigenoterapia / Análisis del patrón respiratorio ineficaz y de ventilación espontánea perjudicada de adultos con oxigenoterapia

ABSTRACT Objective: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of "ventilation" in adult patients hospitalized in an intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses). Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode) presented better fit and structure of the component defining characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct.

RESUMO Objetivo: analisar como se manifestam as características definidoras dos diagnósticos de enfermagem padrão respiratório ineficaz e ventilação espontânea prejudicada, da NANDA Internacional, e as características definidoras identificadas na literatura para o conceito "ventilação", em pacientes adultos hospitalizados em unidade de terapia intensiva com uso de oxigenoterapia. Método: estudo de validação clínica diagnóstica, realizado com 626 pacientes em terapia intensiva em uso de oxigenoterapia, em três modalidades distintas. A análise de correspondências múltiplas foi utilizada para verificação da capacidade discriminativa das características definidoras e a análise de classe latente para determinação da acurácia diagnóstica das mesmas, com base no nível de gravidade definido a partir do modo ventilatório empregado. Resultados: na análise de correspondências múltiplas, demonstrou-se que a maioria das características definidoras apresentou baixa capacidade discriminativa e baixo percentual de variância explicada para duas dimensões (diagnósticos). Modelos de classe latente, ajustados para os dois diagnósticos, separadamente, apresentaram pior ajuste com compartilhamento de algumas características definidoras. Modelos ajustados por nível de gravidade (modo de ventilação) apresentaram melhor ajuste e estrutura das características definidoras componentes. Conclusão: evidências clínicas obtidas no presente estudo parecem demonstrar que o conjunto de características definidoras dos dois diagnósticos de enfermagem estudados melhor se ajustam em um único constructo.

RESUMEN Objetivo: analizar cómo se manifiestan las características definidoras de los diagnósticos de enfermería "patrón respiratorio ineficaz" y "ventilación espontánea perjudicada", de la NANDA Internacional; y también las características definidoras identificadas en la literatura para el concepto "ventilación", en pacientes adultos hospitalizados en unidad de terapia intensiva con uso de oxigenoterapia. Método: estudio de validación clínica diagnóstica, realizado con 626 pacientes en terapia intensiva en uso de oxigenoterapia, en tres modalidades distintas. El análisis de correspondencias múltiples fue utilizado para verificación de la capacidad discriminadora de las características definidoras y el análisis de clase latente para determinación de la precisión diagnóstica de las mismas, con base en el nivel de gravedad, definido a partir del modo de ventilación empleado. Resultados: en el análisis de correspondencia múltiple, se demostró que la mayoría de las características definidoras presentó baja capacidad discriminadora y bajo porcentaje de variancia explicada para dos dimensiones (diagnósticos). Los modelos de clase latente, ajustados para los dos diagnósticos, separadamente, presentaron peor ajuste en el caso de compartir algunas características definidoras. Modelos ajustados por el nivel de gravedad (modo de ventilación) presentaron mejor ajuste y estructura de las características definidoras componentes. Conclusión: las evidencias clínicas obtenidas en el presente estudio parecen demostrar que el conjunto de características definidoras de los dos diagnósticos de enfermería estudiados se ajustan mejor en un único constructo.

Ineffective breathing pattern in cardiac postoperative patients: Diagnostic accuracy study.

PURPOSE: The aim of this study was to analyze the accuracy of the defining characteristics of ineffective breathing pattern (IBP) in postoperative cardiac patients. METHODS: A diagnostic accuracy study was performed with 98 patients. Measures of sensitivity, specificity, predictive values, likelihood ratios, diagnostic odds ratio, and area under the ROC curve were calculated. RESULTS: IBP was present in 23.5% of the patients. Alterations in depth of breathing (sensitivity 96%, negative likelihood ratio 0.11%) and pursed-lip breathing (sensitivity 99%, negative likelihood ratio 0.07%) were the most sensitive defining characteristics for IBP, while altered chest excursion (specificity 97%, positive likelihood ratio 11.41%) and prolonged expiration phase (specificity 99%, positive likelihood ratio 42.39%) were the most specific. CONCLUSION: Some clinical indicators were more related to the presence or absence of IBP than others. Knowledge of such measures can help nurses to assess patients more accurately.

Defining characteristics of the nursing diagnosis "ineffective airway clearance".

OBJECTIVE: to analyze the defining characteristics of the nursing diagnosis "ineffective airway clearance" in children with acute respiratory infection. METHOD: cross-sectional descriptive study, developed in two hospitals specialized in care for children. It was held a detailed respiratory evaluation of the child to identify the defining characteristics of the diagnosis under study. RESULTS: a total of 249 children were evaluated, 55.8% were male and the median age was 13.76 months. Ineffective airway clearance was identified in 222 children (89.2%). The following defining characteristics presented statistically significant associations: dyspnea, expectoration, orthopnea, respiratory adventitious sounds, decreased breath sounds and ineffective cough. Decreased breath sounds, ineffective cough and respiratory adventitious sounds composed the logistic regression model. CONCLUSION: the characteristics decreased breath sounds, ineffective cough and respiratory adventitious sounds have better predictive capacity for the diagnosis "ineffective airway clearance" in children with acute respiratory infection.

Características definidoras do diagnóstico de enfermagem "desobstrução ineficaz de vias aéreas" / Características definidoras del diagnóstico de enfermería "desobstrucción ineficaz de las vías aéreas" / Defining characteristics of the nursing diagnosis "ineffective airway clearance"

RESUMO Objetivo: analisar as características definidoras do diagnóstico de enfermagem "desobstrução ineficaz de vias aéreas" em crianças com infecção respiratória aguda. Método: estudo transversal, descritivo, desenvolvido em dois hospitais especializados no atendimento a crianças. Realizou-se avaliação respiratória detalhada da criança para a identificação das características definidoras do diagnóstico em estudo. Resultados: foram avaliadas 249 crianças, sendo 55,8% do sexo masculino e com mediana de idade de 13,76 meses. Desobstrução ineficaz de vias aéreas foi identificado em 222 crianças (89,2%). As seguintes características definidoras apresentaram associação estatisticamente significante: dispneia, expectoração, ortopneia, ruídos adventícios respiratórios, sons respiratórios diminuídos e tosse ineficaz. Sons respiratórios diminuídos, tosse ineficaz e ruídos adventícios respiratórios compuseram o modelo de regressão logística. Conclusão: as características sons respiratórios diminuídos, tosse ineficaz e ruídos adventícios respiratórios apresentam melhor capacidade de predição para o diagnóstico "desobstrução ineficaz de vias aéreas" em crianças com infecção respiratória aguda.

RESUMEN Objetivo: analizar las características definidoras del diagnóstico de enfermería "desobstrucción ineficaz de vías aéreas" en ninos con infección respiratoria aguda. Método: estudio transversal, descriptivo, desarrollado en dos hospitales especializados en la atención al nino. Se realizó evaluación respiratória detallada del nino para la identificación de las características definidoras del diagnóstico en estudio. Resultados: fueron evaluados 249 ninos, siendo 55,8% del sexo masculino y con mediana de edad de 13,76 meses. Desobstrucción ineficaz de vías aéreas fue identificada en 222 ninos (89,2%). Las siguientes características definidoras presentaron asociación estadísticamente significante: disnea, expectoración, ortopnea, ruidos adventicios respiratorios, sonidos respiratorios disminuidos y tos ineficaz. Sonidos respiratorios disminuidos, tos ineficaz y ruidos adventicios respiratorios compusieron el modelo de regresión logística. Conclusión: las características sonidos respiratorios disminuidos, tos ineficaz y ruidos adventicios respiratorios presentan mejor capacidad de predicción para el diagnóstico "desobstrucción ineficaz de vías aéreas" en ninos con infección respiratoria aguda.

ABSTRACT Objective: to analyze the defining characteristics of the nursing diagnosis "ineffective airway clearance" in children with acute respiratory infection. Method: cross-sectional descriptive study, developed in two hospitals specialized in care for children. It was held a detailed respiratory evaluation of the child to identify the defining characteristics of the diagnosis under study. Results: a total of 249 children were evaluated, 55.8% were male and the median age was 13.76 months. Ineffective airway clearance was identified in 222 children (89.2%). The following defining characteristics presented statistically significant associations: dyspnea, expectoration, orthopnea, respiratory adventitious sounds, decreased breath sounds and ineffective cough. Decreased breath sounds, ineffective cough and respiratory adventitious sounds composed the logistic regression model. Conclusion: the characteristics decreased breath sounds, ineffective cough and respiratory adventitious sounds have better predictive capacity for the diagnosis "ineffective airway clearance" in children with acute respiratory infection.

Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection.

The aim of this study was to identify the defining characteristics that allow clinical differentiation of the nursing diagnoses, ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE). A secondary analysis with a cohort design was developed from 1128 records obtained during the hospital stay of 136 children with acute respiratory infection. Groups of defining characteristics with greater differentiation capacity were identified by multiple correspondence analyses. The results showed that the defining characteristics that better differentiate the studied diagnoses are agitation, irritability and diaphoresis for IGE; dyspnea, use of accessory muscles to breathe, orthopnea, and abnormal breathing pattern for IBP and excessive sputum, absence of cough, difficulty verbalizing, nasal flaring, and adventitious breath sounds for IAC. Twelve defining characteristics that can assist clinicians to differentiate the three main respiratory nursing diagnoses among children with acute respiratory infection were identified in this study.

Clinical indicators of ineffective airway clearance in children with acute respiratory infection.

The identification of clinical indicators with good predictive ability allows the nurse to minimize the existing variability in clinical situations presented by the patient and to accurately identify the nursing diagnosis, which represents the true clinical condition. The purpose of this study was to analyze the accuracy of NANDA-I clinical indicators of the nursing diagnosis ineffective airway clearance (IAC) in children with acute respiratory infection. This was a prospective cohort study conducted with a group of 136 children and followed for a period of time ranging from 6 to 10 consecutive days. For data analysis, the measures of accuracy were calculated for clinical indicators, which presented statistical significance in a generalized estimated equation model. IAC was present in 91.9% of children in the first assessment. Adventitious breath sounds presented the best measure of accuracy. Ineffective cough presented a high value of sensitivity. Changes in respiratory rate, wide-eyed, diminished breath sounds, and difficulty vocalizing presented high positive predictive values. In conclusion, adventitious breath sounds showed the best predictive ability to diagnose IAC in children with respiratory acute infection.

Prognostic clinical indicators of short-term survival for ineffective breathing pattern in children with acute respiratory infection.

AIMS AND OBJECTIVES: To identify prognostic clinical indicators of short-term survival for ineffective breathing pattern in children with acute respiratory infection. BACKGROUND: Despite the studies of survival for nursing diagnosis, there is not enough evidence about the clinical indicators that are associated with a worse prognosis for ineffective breathing pattern. DESIGN: A prospective cohort study. METHODS: One hundred and thirty-six children were followed up for a minimum of six and a maximum of 10 consecutive days. The survival rate for ineffective breathing pattern was calculated using Nelson-Aalen's method. An extended Cox model was adjusted to identify the main prognostic clinical indicators for this nursing diagnosis. RESULTS: Over half of the sample had an ineffective breathing pattern at the first evaluation. The occurrence of new cases was observed until the ninth day of monitoring, and the survival rate after this day was low. According to the Cox model, the main clinical indicators of a poor prognosis were an abnormal breathing pattern, the use of accessory muscles, dyspnoea and increase in the anterior-posterior chest diameter. CONCLUSIONS: Children with acute respiratory infection who present with an abnormal breathing pattern, the use of accessory muscles to breathe, dyspnoea and increased anterior-posterior diameter have a poor prognosis for an ineffective breathing pattern. RELEVANCE TO CLINICAL PRACTICE: Survival analyses of nursing diagnoses allow the identification of clinical indicators that can be used in clinical practice as prognostic markers. The identification of indicators associated with a poor clinical prognosis allows nurses to intervene early and to maximise the possibility of a good outcome.

Adecuación de las características definitorias en los diagnósticos de deterioro del intercambio de gases y de la ventilación espontánea en niños asmáticos / The adequacy of the defining characteristics of the diagnostics "impaired gas exange" and spontaneous ventilation" in asmathic children

OBJETIVO: Determinar la validez de las medidas de las características definitorias de los diagnósticos enfermeros «deterioro del intercambio de gases» y «deterioro de la ventilación espontánea» en niños con asma seguidos en el área de urgencias. MÉTODO: Estudio observacional, descriptivo transversal desarrollado entre abril y septiembre de 2013 en un hospital ubicado en el nordeste de Brasil con una muestra de 205 niños. Los diagnósticos fueron establecidos por enfermeros expertos formados en esta materia. Se calcularon las medidas de sensibilidad, especificidad, valor de predicción positivo y negativo, razón de verosimilitud positiva y negativa y odds ratio diagnóstica para las características definitorias identificadas. RESULTADOS: Un 28,8% de los niños evaluados presentaron «deterioro del intercambio de gases». La disnea, la respiración anormal, la taquicardia y la hipoxemia presentaron las frecuencias más altas. La hipoxemia como característica clínica ha presentado valores altos de sensibilidad y especificidad. Un 5,9% de los niños evaluados presentaron «deterioro de la ventilación espontánea» y sus características definitorias más frecuentes fueron la disnea, el aumento de la frecuencia cardíaca y la disminución de la SaO2. El uso creciente de los músculos accesorios para respirar presentó las mejores medidas de validez para este diagnóstico. CONCLUSIÓN: La hipoxemia y el uso creciente de los músculos accesorios presentaron las mejores medidas de la validez respectivamente para «deterioro del intercambio de gases» y «deterioro de la ventilación espontánea». Es necesario contemplar estas características para una adecuada definición y uso de los diagnósticos en la práctica clínica

OBJECTIVE: To determine the diagnostic accuracy measures of defining characteristics of respiratory nursing diagnoses "impaired gas exchange" and "impaired spontaneous ventilation" in asmathics children in emergency department. METHODS: Observational, descriptive transversal study developed between April and September 2013 in a hospital in northeastern Brazil with a sample of 205 children. Diagnoses were established by nurses trained experts in this field. Measures of sensitivity, specificity, positive and negative value prediction right positive and negative likelihood ratio and diagnostic odds for the defining characteristics identified were calculated. RESULTS: 28.8% of the evaluated children had "impaired gas exchange". Dyspnea, abnormal breathing, tachycardia and hypoxemia had higher frequencies. Hypoxemia presented as clinical feature high sensitivity and specificity.5.9% of the evaluated children had "impaired spontaneous ventilation" and their most frequent defining characteristics were dyspnea, increased heart rate and decreased SaO2. The increasing use of accessory muscles to breathe presented the best measures of validity for this diagnosis. CONCLUSIONS: The hypoxemia and increased use of accessory muscles presented the best measures of the validity respectively to "deterioration in gas exchange" and "impairment of spontaneous ventilation". These characteristics is necessary to provide for adequate definition and use of diagnostics in clinical practice

[The adequacy of the defining characteristics of the diagnostics "impaired gas exange" and spontaneous ventilation" in asmathic children]. / Adecuación de las características definitorias en los diagnósticos de deterioro del intercambio de gases y de la ventilación espontánea en niños asmáticos.

OBJECTIVE: To determine the diagnostic accuracy measures of defining characteristics of respiratory nursing diagnoses "impaired gas exchange" and "impaired spontaneous ventilation" in asmathics children in emergency department. METHODS: Observational, descriptive transversal study developed between April and September 2013 in a hospital in northeastern Brazil with a sample of 205 children. Diagnoses were established by nurses trained experts in this field. Measures of sensitivity, specificity, positive and negative value prediction right positive and negative likelihood ratio and diagnostic odds for the defining characteristics identified were calculated. RESULTS: 28.8% of the evaluated children had "impaired gas exchange". Dyspnea, abnormal breathing, tachycardia and hypoxemia had higher frequencies. Hypoxemia presented as clinical feature high sensitivity and specificity. 5.9% of the evaluated children had "impaired spontaneous ventilation" and their most frequent defining characteristics were dyspnea, increased heart rate and decreased SaO2. The increasing use of accessory muscles to breathe presented the best measures of validity for this diagnosis. CONCLUSION: The hypoxemia and increased use of accessory muscles presented the best measures of the validity respectively to "deterioration in gas exchange" and "impairment of spontaneous ventilation". These characteristics is necessary to provide for adequate definition and use of diagnostics in clinical practice.

Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection.

OBJECTIVE: to analyze the accuracy of the defining characteristics of the Impaired gas exchange nursing diagnosis in children with acute respiratory infection. METHOD: open prospective cohort study conducted with 136 children monitored for a consecutive period of at least six days and not more than ten days. An instrument based on the defining characteristics of the Impaired gas exchange diagnosis and on literature addressing pulmonary assessment was used to collect data. The accuracy means of all the defining characteristics under study were computed. RESULTS: the Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Hypoxemia was the characteristic that presented the best measures of accuracy. Abnormal breathing presented high sensitivity, while restlessness, cyanosis, and abnormal skin color showed high specificity. All the characteristics presented negative predictive values of 70% and cyanosis stood out by its high positive predictive value. CONCLUSION: hypoxemia was the defining characteristic that presented the best predictive ability to determine Impaired gas exchange. Studies of this nature enable nurses to minimize variability in clinical situations presented by the patient and to identify more precisely the nursing diagnosis that represents the patient's true clinical condition.