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.

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.

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.

Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection / Troca de gases prejudicada: acurácia das características definidoras em crianças com infecção respiratória aguda / Deterioro del intercambio gaseoso: precisión de las características definitorias en niños con infección respiratoria aguda

to analyze the accuracy of the defining characteristics of the Impaired gas exchange nursing diagnosis in children with acute respiratory infection.

analisar a acurácia das características definidoras do diagnóstico de enfermagem troca de gases prejudicada, em crianças com infecção respiratória aguda.

analizar la precisión de las características definitorias del diagnóstico de enfermería Deterioro del intercambio gaseoso, en niños con infección respiratoria aguda.

Ineffective breathing pattern in children and adolescents with congenital heart disease: accuracy of defining characteristics.

AIMS AND OBJECTIVES: The purpose of this study was to assess the prevalence of ineffective breathing pattern and the accuracy of its defining characteristics, among children and adolescents with congenital heart disease. BACKGROUND: The NANDA International nursing diagnosis, ineffective breathing pattern, has been noted to have high prevalence in different clinical contexts and age groups. Despite that, nurses continue to report difficulties in confirming this diagnosis. The lack of data regarding the sensitivity, specificity and predictive values of the defining characteristics contribute to decreased certainty in diagnosing ineffective breathing pattern. DESIGN: A diagnostic accuracy study. METHODS: This study of diagnostic accuracy was conducted with 61 children and adolescents with congenital heart disease. Two nurses were trained by the primary investigator on use of defining characteristics in the diagnostic process for ineffective breathing pattern. RESULTS: Ineffective breathing pattern was present in 26·2% of the children and adolescents sampled. When analysing the defining characteristics, alterations in depth of breathing, showed high values of sensitivity and specificity. In addition, orthopnoea, tachypnoea and use of accessory muscles to breathe, showed high values of specificity; dyspnoea showed high values of sensitivity. Finally, assumption of three-point position, bradypnoea and increased anterior-posterior diameter were not found to be statistically significant for this sample population. CONCLUSION: Five defining characteristics of ineffective breathing pattern presented measures of accuracy with statistically significant values in children with congenital heart disease. RELEVANCE TO CLINICAL PRACTICE: The findings can help nurses during the diagnostic process, as they identify which defining characteristics can be used to confirm or rule out the probability of occurrence of the diagnosis.

Clinical Indicators of Impaired Gas Exchange in Cardiac Postoperative Patients.

PURPOSE: To analyze the accuracy of the defining characteristics of impaired gas exchange (IGE). METHODS: Cross-sectional study carried out in 93 cardiac postoperative adult patients. The 19 NANDA-I defining characteristics related to IGE were evaluated. FINDINGS: Ten defining characteristics were found in the sample. The best accuracy values, including specificity, diagnostic odds ratio, and likelihood ratios, inter alia, were found to decreased carbon dioxide, abnormal arterial blood gases, abnormal arterial pH, and abnormal breathing. CONCLUSION: Some clinical indicators predict the presence/absence of IGE more accurately than others. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of the accuracy of defining characteristics allows an early identification of particular nursing diagnoses, which can prevent complications.

Validação clínica de árvore de decisão para diferenciação entre os diagnósticos de enfermagem padrão respiratório ineficaz e desobstrução ineficaz de vias aéreas / Clinical validation of decision tree for differentiation between ineffective respiratory pattern nursing diagnoses and ineffective airway clearance

Objetivou-se validar clinicamente uma árvore de decisão (AD) desenvolvida para diferenciação de dois diagnósticos de enfermagem respiratórios: Padrão respiratório ineficaz (PRI) e Desobstrução ineficaz de vias aéreas (DIVA). Esta árvore de decisão foi desenvolvida em um estudo prévio com 249 crianças como Infecção respiratória aguda. Dentre as geradas, a AD desenvolvida com o algoritmo Classification and Regression Trees foi escolhida para ser validada clinicamente por apresentar melhor poder de predição global (86,4%). Estudo do tipo metodológico desenvolvido a partir de registros de bancos de dados que serviram de subsídio para construção de duas dissertações de mestrado. Calculou-se uma amostra de 222 registros, sendo estes de 111 crianças com Infecção respiratória aguda e 111 com Asma. Foram estruturados três grupos de diagnosticadores: grupo de Padrão de Referência, grupo controle e grupo caso. O grupo caso teve acesso à Árvore de Decisão como ferramenta para auxílio na inferência diagnóstica. As inferências dos grupos de comparação (caso e controle) foram analisadas tomando como parâmetro balizador a inferência realizada pelo grupo Padrão de referência. As inferências dos diagnosticadores foram tabuladas em uma planilha do software Excel e os dados analisados no IBM SPSS versão 21.0 for Windows e no pacote estatístico R. Dos 222 registros analisados, 55,9% eram do sexo masculino, possuíam como principal antecedente familiar a Asma (57,2%), seguido de Tuberculose (17,6%). DIVA foi diagnosticado em 80,6% e PRI em 68,5% dos registros avaliados pelo grupo Padrão de Referência. Crianças mais jovens foram diagnosticadas mais vezes com ambos os diagnósticos em estudo. Frequência à creche e maior tempo de frequência foram mais prevalentes nas crianças sem os diagnósticos. As características definidoras com associação estatística com DIVA foram: Dispneia (84,68%, p<0,001), Ruídos adventícios respiratórios (84,23%, p<0,001), Tosse ineficaz (72,07%, p<0,001), Ortopneia (70,72%, p<0,001). Já para PRI, encontrou-se associação com Dispneia (85,13%, p<0,001), Alteração na profundidade respiratória (69,81%, p<0,001), Ortopneia (69,81%, p<0,001), Taquipneia (64,86%, p<0,001) e Uso da musculatura acessória para respirar (66,66%, p<0,001). Os diagnosticistas que utilizaram a AD obtiveram índices de concordância com o grupo Padrão de Referência superiores aos dos que não utilizaram a ferramenta de apoio. Foram necessárias maiores intervenções no grupo de diagnosticistas sem a AD para que a igualdade das inferências fosse alcançada. Este dado aponta para capacidade da ferramenta de tornar as inferências mais homogêneas. Melhores taxas de sensibilidade, especificidade, odd ratio diagnóstica, razões de verossimilhança positiva e negativa foram observados para as inferências do grupo com a AD. Dado os resultados apresentados, conclui-se que a ferramenta validada neste estudo contribuiu para inferências de maior qualidade, aumentando assim a acurácia das determinações diagnósticas. Pela alta taxa de sensibilidade e elevadas taxas de falso-positivo, a AD validada possui caraterísticas típicas de ferramentas de triagem diagnóstica.(AU)

Desobstrução ineficaz de vias aéreas: prevalência e espectro de seus indicadores clínicos / Ineffective airway clearance: prevalence and spectrum of its clinical indicators

Objetivo: Identificar a prevalência do diagnóstico de enfermagem de desobstrução ineficaz de vias aéreas, indicadores clínicos e espectro de manifestação em crianças com infecção respiratória aguda; determinar associação entre os indicadores e a probabilidade de identificação. Métodos: Estudo transversal que incluiu 192 crianças internadas. Foram realizadas entrevistas e avaliação pulmonar, e os dados foram encaminhados a diagnosticadores para inferência diagnóstica. Utilizaram-se pacotes estatísticos para análise dos dados. Resultados: 71,9% das crianças apresentaram o diagnóstico em estudo. Os indicadores clínicos foram: tosse ineficaz, ruídos adventícios respiratórios, quantidade excessiva de muco, dispneia, ortopneia, mudança no ritmo respiratório e mudança na frequência respiratória; manifestados pelo espectro moderado. Os indicadores dispneia, inquietação, ortopneia, quantidade excessiva de muco, ruídos adventícios respiratórios e tosse ineficaz apresentaram relação linear significativa. Conclusão: O diagnóstico de enfermagem apresentou alta prevalência e associação entre os indicadores e a probabilidade de identificação do diagnóstico de enfermagem foi estabelecida. .

Objective: To identify the prevalence of nursing diagnosis of ineffective airway clearance, clinical indicators, and spectrum of manifestation in children with acute respiratory infection; to determine the association between its indicators and the probability of identification. Methods: Cross-sectional study involving 192 hospitalized children. Interviews and pulmonary evaluations were performed, and the data were sent to diagnosticians for diagnostic inference. Statistical packages were used for data analysis. Results: 71.9% of the children presented the diagnosis under study. The clinical indicators were ineffective cough, respiratory rales, excessive amount of mucus, dyspnea, orthopnea, change in breathing rate, and change in respiratory frequency; manifested by the moderate spectrum. The indicators of dyspnea, restlessness, orthopnea, excessive amount of mucus, respiratory rales, and ineffective cough showed a significant linear relationship. Conclusion: The nursing diagnosis showed a high prevalence and association between indicators and the likelihood of identifying the nursing diagnosis was established. .

Desobstrução ineficaz de vias aéreas em crianças com infecção respiratória aguda / Ineffective airway clearance in children with acute respiratory infection / Desobstrucción ineficaz de vías aéreas en niños con infección respiratoria aguda

Estudo transversal, realizado com 151 crianças internadas em um hospital público pediátrico localizado no nordeste do Brasil, cujo objetivo foi analisar a acurácia das características definidoras do diagnóstico desobstrução ineficaz de vias aéreas em crianças com infecção respiratória aguda. Realizou-se uma avaliação respiratória minuciosa e a inferência diagnóstica foi desenvolvida por especialistas. As características definidoras mais frequentes foram ruídos adventícios respiratórios, tosse ineficaz, dispneia e mudanças na frequência respiratória. Desobstrução ineficaz de vias aéreas esteve presente em 37,7% da amostra. A característica com maior sensibilidade foi agitação. Dispneia, ruídos adventícios respiratórios, ortopneia, mudanças na frequência respiratória e agitação apresentaram maior especificidade para o diagnóstico. Concluiu-se que as características definidoras apresentavam diferentes performances para classificar corretamente crianças com Desobstrução ineficaz de vias aéreas. Estudos como este podem contribuir para a inferência correta do diagnóstico de enfermagem e para a implementação de intervenções mais eficazes, favorecendo a qualidade da assistência

Estudio transversal con 151 niños internados en hospital público pediátrico del noreste de Brasil, objetivando analizar la precisión de las características definitorias del diagnóstico Desobstrucción ineficaz de vías aéreas en niños con infección respiratoria aguda. Se realizó una minuciosa evaluación respiratoria, la inferencia diagnóstica fue desarrollada por especialistas. Las características definitorias más frecuentes fueron ruidos adventicios respiratorios, tos ineficaz, disnea y cambios en la frecuencia respiratoria. La Desobstrucción ineficaz de vías aéreas se manifestó en el 37,7% de la muestra. La característica más sensible fue la agitación. Disnea, ruidos adventicios respiratorios, ortopnea, cambios en la frecuencia respiratoria y agitación ofrecieron mayores especificidades para diagnóstico. Se concluyó en que las características definitorias presentaban diferentes performances para clasificar correctamente a niños con Desobstrucción ineficaz de vías aéreas. Estudios como éste pueden contribuir para inferir correctamente el diagnóstico de enfermería e implementar las intervenciones más eficaces, favoreciendo la calidad de la atención.

This cross-sectional study was performed with 151 children inpatients of a pediatric hospital in Northeastern Brazil, with the objective to analyze the accuracy of the defining characteristics of the diagnoses ineffective airway clearance in children with acute respiratory infection. A thorough respiratory evaluation was performed and the diagnostic inference was developed by specialists. The most frequent defining characteristics were adventitious breath sounds, ineffective cough, dyspnea, and changes in respiratory rate. Ineffective airway clearance was present in 37.7% of the sample. Agitation was the characteristic with the highest sensitivity. Dyspnea, adventitious breath sounds, orthopnea, changes in respiratory rate and agitation presented higher specificity for the diagnosis. In conclusion, the defining characteristics showed different performances to correctly classify children with infective airway clearance. Studies like this can contribute for a correct nursing diagnostic inference and for the implementation of more effective interventions, thus improving the quality of health care.

Ineffective breathing pattern: defining characteristics in children with acute respiratory infection.

PURPOSE: To determine the accuracy of NANDA-I defining characteristics for the nursing diagnosis, ineffective breathing pattern, in children with acute respiratory infection. METHODS: This was a prospective cohort study in 136 children. Measures of accuracy were calculated for the defining characteristics. FINDINGS: Use of accessory muscles to breathe presented the best measure of accuracy. Alterations in depth of breathing presented a high value of sensitivity. Altered chest excursion and orthopnea presented high values of specificity. CONCLUSIONS: Use of accessory muscles to breathe showed the best predictive capacity for ineffective breathing pattern. IMPLICATIONS FOR NURSING PRACTICE: Measures of accuracy can contribute to an accurate diagnostic inference process, improving patient assessment and facilitating rapid, accurate diagnosis.