The purpose of this study was to compare the cost-effectiveness between the 2 types of general anesthesia, namely, laryngeal mask (LMA) and endotracheal intubation (ETT). The study included 353 patients who received general anesthesia during operation in a medical center in Kaohsiung City. Of these, 183 patients were assigned to the LMA group, while the remaining 170 were assigned to the ETT group. The norm of cost adopted by this study was calculated as the average expense per hour incurred by using the anesthetic and hygienic materials for medicinal use. The indices of effectiveness were physical reactions that were tracked at 2 h and 8¡V10 h postoperatively; these indices were acute pain, dizzyness, sore throat, nausea, and vomiting. These 5 indices were rated on a scale of 0¡V10. A low score was considered to represent lesser side-effects and greater effectiveness of the anesthetic. Besides, the shorter the recovery time of the patient was, the higher the effectiveness would be. The conclusion showed that the cost of the average expense per hour produced by the anesthesia and hygienic materials of medicinal use in the LMA group was 531 dollars while in the ETT group was 1,017 dollars. In the LMA group, at 2 h postoperatively, the mean tracking score for acute pain was 2.9 ¡Ó 2.6; for dizzyness, 1.4 ¡Ó 1.9; for sore throat, 0.4 ¡Ó 1.1; for nausea, 0.5 ¡Ó 1.4; and for vomiting, 0.2 ¡Ó 0.9. In the LMA group, at 8¡V10 h postoperatively, the mean tracking score for acute pain was 0.9 ¡Ó 1.5; for dizzyness, 0.6¡Ó1.3; for sore throat, 0.2 ¡Ó 0.7; for nausea, 0.1 ¡Ó 0.6; and for vomiting, 0.07 ¡Ó 0.4. In the ETT group, at 2 h postoperatively, the mean tracking score for acute pain was 4.9 ¡Ó 3.2; for dizzyness, 2.6 ¡Ó 2.5; for sore throat, 2.0 ¡Ó 2.1; for nausea, 1.3 ¡Ó 2.4; and for vomiting, 0.7 ¡Ó 1.9. In the ETT group, at 8¡V10 h postoperatively, the mean tracking score for acute pain was 2.82¡Ó 2.5; for dizzyness, 1.9 ¡Ó 1.9; for sore throat, 1.3 ¡Ó 1.9; for nausea, 1.1 ¡Ó 2.1; and for vomiting, 0.7 ¡Ó 1.9. The mean postoperative recovery time of the patients in the LMA group was 11.5¡Ó13.2 min and that for the patients in the ETT group was 25.9¡Ó16.0 min. T-test was performed to examine the hypothesis that LMA is more cost-effective than ETT when the same variables as those mentioned above are used; the results of all variables support the hypothesis that the p-value of every index was .000. Results of stepwise regression showed that LMA plays a significant positive role in every cost-effectiveness index.

The increased survival of high-risk preterm infant has required a great number of studies about his/her quality of life and integration during development process with the need for a greater improvement and specialization in the other areas who cares of these children. Many premature infants need to receive mechanical ventilation and it may represent a risk factor for the development of the stomatognathic system causing difficulties in the introduction of oral feeding. This paper aims to evaluate the effects of the endotracheal tube used for mechanical ventilation on the oral skills and feeding performance of preterm infants. Forty-five preterm infants were selected in the Neonatal Intensive Care Unit (NICU) at the University Hospital of Santa Maria (HUSM) from February 2012 to February 2013. The babies were enrolled at the time to begin oral feeding, after parent s consent was obtained. Children who presented head or neck malformation, genetic syndromes, heart problems, perinatal asphyxia, intracranial haemorrhage grades III and IV and bilirubin encephalopathy were exclude. Participants were divided in two groups according the use or not of endotracheal tube. The oral skills were evaluated at the time to begin oral feeding through two distinct protocols: Fujinaga et al. (2005) and Lau and Smith (2011). The data were analyzed using software Stata 10, being considered as significant the p value < 0.05. We concluded that the use of endotracheal tube during neonatal hospitalization negatively influenced the feeding performance and prolonged the time to acquisition full oral feeding in preterm infants. However, it seems have no influence on oral skills according the protocols. The protocol proposed by Fujinaga seems better discriminate the oral skills when compared to the Lau and Smith s protocol. / O aumento na sobrevida do recém-nascido pré-termo (RNPT) de alto risco tem exigido um grande número de estudos acerca da qualidade de vida e da integração da criança prematura ao longo da sua trajetória de desenvolvimento. Para isso, houve necessidade de um aperfeiçoamento e especialização das demais áreas que prestam assistência a estas crianças. Muitos prematuros necessitam da utilização de ventilação mecânica, o que pode representar um fator de risco ao desenvolvimento do sistema estomatognático e, conseqüentemente, dificultar a introdução da alimentação por via oral nesse grupo de crianças. O objetivo deste estudo foi o de avaliar os efeitos da utilização do tubo orotraqueal, durante a ventilação mecânica, sobre as habilidades orais e a performance alimentar do RNPT, na liberação da via oral. Para isso, foram avaliados 45 RNPT na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital Universitário de Santa Maria (HUSM), na cidade de Santa Maria RS, no período compreendido Fevereiro de 2012 e Fevereiro de 2013. Foram selecionados recém-nascidos pré-termo, de ambos os sexos, no momento da liberação médica para início da alimentação por via oral, cujos pais autorizaram a participação na pesquisa, após assinatura do Termo de Consentimento Livre e Esclarecido. Não foram incluídas crianças com malformações de cabeça e pescoço, síndromes genéticas, complicações cardíacas, asfixia perinatal (Apgar no 5º minuto ≤ 5), hemorragias intracranianas grau III e IV e encefalopatia bilirrubínica. Os participantes foram distribuídos em dois grupos segundo o uso ou não do tubo orotraqueal e submetidos à avaliação das habilidades orais, no momento da liberação para início da via oral, através de dois distintos protocolos ((Fujinaga (2005) e Lau e Smith (2011)). Os dados foram analisados através do software Stata 10, sendo considerado como significativo um valor de p<0,05. Os resultados obtidos, permitiram concluir que a utilização de tubo orotraqueal, durante a internação neonatal, influenciou negativamente a performance alimentar de RNPT, no momento da liberação para a via oral, dificultando a aquisição da via oral plena. No entanto, não houve diferença significativa, entre os grupos, na avaliação das habilidades orais. O protocolo de avaliação de Fujinaga et al.(2005) pareceu discriminar melhor as habilidades orais de RNPT,quando comparado ao de Lau e Smith (2011).

Este estudo trata-se de uma revisão sistemática da literatura e tem como referencial teórico a prática baseada em evidência. Buscou-se identificar e analisar na literatura evidências oriundas de ensaios clínicos controlados e randomizados sobre os cuidados relacionados à aspiração de secreções endotraqueais em pacientes adultos, em estado crítico, intubados e sob ventilação mecânica. Os passos metodológicos desta revisão foram guiados pelas recomendações da Colaboração Cochrane. A busca foi realizada nas bases de dados PUBMED, EMBASE, CENTRAL, CINAHL e LILACS. Das 631 referências encontradas, 17 estudos foram selecionados após a análise dos títulos e resumos. Foi realizada a extração dos dados e análise do risco de viés por dois revisores, para cada estudo selecionado. Os 17 estudos foram publicados no período de 1987 à 2009. Ao todo, foram investigados 2.890 pacientes adultos, intubados e sob ventilação mecânica. Foram encontradas evidências quanto a seis categorias de intervenções relacionadas à aspiração endotraqueal: aspiração endotraqueal baseada em pesquisa x aspiração endotraqueal usual, em um estudo; aspiração endotraqueal de rotina x aspiração endotraqueal minimamente invasiva, em dois estudos; aspiração endotraqueal de sistema aberto x aspiração endotraqueal de sistema fechado, em oito estudos; troca do sistema fechado em 24 horas x 48 horas, em dois estudos; troca diária do sistema fechado x troca não rotineira, em um estudo; e instilação de soro fisiológico x não instilação de soro fisiológico, em três estudos. As intervenções foram realizadas analisando desfechos referentes a alterações hemodinâmicas, alterações dos gases sanguíneos, colonização microbiana e infecção nosocomial, e outros desfechos. Foram encontradas evidências relevantes quanto à prática da aspiração endotraqueal, entretanto, as limitações metodológicas e riscos de viés encontrados nos estudos selecionados reduzem a confiabilidade de tais evidências, demonstrando a necessidade de estudos futuros. Também, foi observada a necessidade da realização de ECCRs que contemplem os demais passos da aspiração endotraqueal e desfechos. / This systematic review of literature used the evidence-based practice as the theoretical framework. This study aimed to identify and analyze in the literature the evidence of randomized controlled trials on care related to the endotracheal secretions suctioning in critically ill adult patients who were intubated and undergoing mechanical ventilation. The methodological steps were guided by the recommendations of the Cochrane Collaboration. The search was conducted in the PUBMED, EMBASE, CENTRAL, CINAHL and LILACS databases. Of the 631 found references, 17 studies were selected after the analysis of titles and abstracts. The data extraction and the analysis of the risk of bias by two reviewers for each selected study were performed. The 17 studies were published in the period from 1987 to 2009. In the total, 2,890 adult patients who were intubated and undergoing mechanical ventilation were investigated. Evidences for six categories of interventions related to endotracheal suction were found: research-based endotracheal suction x usual endotracheal suction, in one study; routine endotracheal suction x minimally invasive endotracheal suction, in two studies; open endotracheal suction system x closed endotracheal suction system, in eight studies; change of closed system in 24 hours x 48 hours, in two studies; daily change of closed system x non-routine change, in one study; and instillation of saline x non-instillation of saline, in three studies. The interventions were performed through the analysis of outcomes related to hemodynamic alterations, blood gas alterations, microbial colonization and nosocomial infection, and other outcomes. Relevant evidences related to the practice of endotracheal suction were found; however, methodological limitations and risks of bias found in selected studies reduce the reliability of such evidences, demonstrating the need for further studies. Also, the need for the realization of ECCRs that address the remaining steps of endotracheal suction and outcomes were observed.

Bakgrund: Syrgas används liberalt hos vuxna endotrakealt intuberade patienter peroperativt för att ge en skyddande marginal mot livshotande hypoxi. Ett överskott av syrgas kan dock öka risken för allvarliga biverkningar med en potentiellt negativ påverkan på både morbiditet och mortalitet. Vilken mängd syrgas som skall användas peroperativt är en omdiskuterad fråga i forskningsvärlden där RCT och metaanalys-studier kommer med motstridiga uppgifter om vad som faktiskt är det optimala oxygenmålet peroperativt. Motiv: Det finns meningsskiljaktigheter kring peroperativ oxygenering där nuvarande forskning om vad som är det optimala för patienten skiljer sig från studie till studie. Författarna av denna studie anser att det behövs en djupare förståelse av den ansvariga anestesisjuksköterskans erfarenheter och tankar kring peroperativ oxygenering, framförallt då det saknas evidens att luta sig mot. Syfte: Att beskriva anestesisjuksköterskors tankar och erfarenheter av peroperativ oxygenering hos vuxna endotrakealt intuberade patienter. Metod: Individuella semi-strukturerade intervjuer genomfördes med anestesisjuksköterskor (n=10) på två olika sjukhus i mellansverige. En kvalitativ innehållsanalys användes för att bearbeta och analysera datan. Resultat: Analysen genererade tre huvudkategorier; En snäv balansgång - Att undvika hypoxi och hyperoxi, Upprätthållande av en patientsäker ventilation är ett mål och Vad är den optimala FiO2-nivån? En vilja om att arbeta evidensbaserat. Konklusion: Det är en pågående debatt internationell om vad den optimala målnivån av peroperativ FiO2 är. Med anledning av det oklara evidensläget visade det sig att anestesisjuksköterskorna arbetar efter beprövad erfarenhet när peroperativ FiO2 ställs in till patienten. De målnivåer av FiO2 som anestesisjuksköterskorna använder innehåller en säkerhetsmarginal för hypoxi och hänsyn tas till patientens sjuklighet. Rutinmässig hyperoxi förekommer inte och höga nivåer FiO2 likställs med ökad risk för komplikationer. Vidare forskning inom ämnet behövs som stöttning för patientansvarig anestesisjuksköterska i dess dagliga arbete. / Background: Oxygen is used liberally in adult endotracheal intubated patients intraoperative to provide a protective margin against life-threatening hypoxia. A surplus of oxygen can however increase the risk of serious side effects with a potentially increased long-term mortality. The use of oxygen intraoperative is a highly debated question in the scientific community, where RCT and metaanalysis studies are producing contradictory results about what the optimal oxygenation target intraoperative really is. Motive: There is a disagreement about intraoperative oxygenation where the current evidence about what the optimal target for the patient really is; this varies from study to study. The authors of this study thereby consider that there is a need for a deeper understanding of the responsible nurse anesthetist’s experiences and thoughts on intraoperative oxygenation; above all when there is no definitive evidence to lean on. Aim: The aim of this study was to describe nurse anesthetists’ thoughts and experiences of intraoperative oxygenation at adult patients who are endotracheal intubated. Methods: Individual semi-structured interviews were conducted with nurse anesthetists (n=10) at two different hospitals in the middle of Sweden. Qualitative content analysis was used to process the data. Result: The analysis generated three main categories; A narrow balancing act – To avoid hypoxia and hyperoxia, Maintaining patient-safe ventilation is a goal and What is the optimal level of FiO2? A desire to work evidence-based. Conclusion: There is an ongoing debate internationally about what the optimal target level of intraoperative FiO2 is. Due to the unclear state of evidence, it turned out that the nurse anesthetists work after proven experience when intraoperative FiO2 is set for the patient. The target levels of FiO2 used by the nurse anesthetists contain a margin of safety for hypoxia and the patient's morbidity is taken into account. Routine hyperoxia does not occur and high levels of FiO2 are equated with an increased risk of complications. Further research is needed in the subject to support the nurse anesthetists responsible for the patient in their daily work.

Bakgrund Bristfällig kuffhantering kan leda till skador på slemhinnan, bidra till ineffektiv ventilation och mikroaspirationer som kan leda till ventilatorassocierad pneumoni (VAP). I dagsläget skiljer sig handhavandet åt och det finns inget standardiserat handhavande av kuffen hos patienter med endotrakealtub eller trakealtub. Specialistsjuksköterskor inom intensivvård ansvarar för säkerställandet av ett evidensbaserat yrkesutövande som stärker patientsäkerhet. Syfte Syftet var att sammanställa kunskapsläget gällande kuffhantering hos vuxna patienter på intensivvårdsavdelningar för att bidra till ökad patientsäkerhet. Metod Systematisk litteraturöversikt av kvantitativa studier med en induktiv ansats. 16 vetenskapliga studier inkluderades och kvalitetsgranskades med hjälp av en granskningsmall för kvantitativa studier. Deskriptiv syntes med narrativ analys användes för resultatet. Resultat Resultatet redovisades utifrån två huvudteman; mätmetoder ochomvårdnadsåtgärder som påverkar kufftrycket. Sex subteman skapades till de två temana. Resultatet visade att meningsskiljaktigheter råder huruvida kontinuerlig mätning anses vara mer fördelaktigt än intermittent mätning. Vidare pekade resultatet på att olika omvårdnadsåtgärder kontribuerar till förändringar av kufftrycket. Slutsats Resultatet tyder på att kuffhantering är komplext. Kufftrycket påverkas av flera faktorer och bör följas regelbundet, en exakt definition på hur ofta går dock ej att fastställa. För att intensivvårdspatienter skall erhålla evidensbaserad vård, och därmed öka patientsäkerheten, behövs ytterligare forskning inom kuffhantering eftersom evidensen i nuläget är begränsad. Dock pekar uppsatsens resultat på att kontinuerlig mätning kan vara fördelaktigt utifrån ett patientsäkerhetsperspektiv, eftersom på-och avkoppling av manometer sågs vara ett riskmoment. / Background Inadequate cuff-management can lead to mucosal damage, contribute to ineffective ventilation and microaspirations that can lead to ventilator-associated pneumonia (VAP). At present, there are differences in practice and no standardized practice of cuff-management in patients with endotracheal tubes or tracheal tubes. Specialist nurses in intensive care are responsible for ensuring evidence-based professional practice that enhances patient safety. Aim The aim was to summarize the current state of knowledge on cuff-management in adult patients in intensive care units to contribute to improved patient safety. Method Systematic literature review of quantitative studies with an inductive approach. 16 articles were included and quality reviewed using a review template for quantitative studies. Descriptive synthesis with narrative analysis was used for the results. Result The results were presented using two main themes; measurement procedures and nursing interventions that influence cuff pressure. Six subthemes were created for the two themes. Opinions are divided as to whether continuous measurement is considered more beneficial than intermittent measurement. Furthermore, nursing-interventions were found to influence the cuff pressure. Conclusion Cuff-management is a complex topic. Cuff pressure is influenced by several factors and should be monitored regularly, however, how often is not possible to determine. For intensive care patients to receive evidence-based care and thereby increase patient safety, further research in cuff-management is required as the evidence is currently limited. However, continuous measurement may be beneficial from a patient safety perspective, as switching on and off the manometer is considered a risk factor.

Endotracheal intubation is still the gold standard in airway management. For medical students and young professionals, it is often difficult to train personal skills. We tested a high-fidelity simulator with an additional quantitative feedback integration to elucidate if competence acquisition for airway management is increased by using this feedback method. In the prospective trial, all participants (n = 299; 4th-year medical students) were randomized into two groups—One had been trained on the simulator with additional quantitative feedback (n = 149) and one without (n = 150). Three simulator measurements were considered as quality criteria—The pressure on the upper front row of teeth, the correct pressure point of the laryngoscope spatula and the correct depth for the fixation of the tube. There were a total of three measurement time points—One after initial training (with additional capture of cognitive load), one during the exam, and a final during the follow-up, approximately 20 weeks after the initial training. Regarding the three quality criteria, there was only one significant difference, with an advantage for the control group with respect to the correct pressure point of the laryngoscope spatula at the time of the follow-up (p = 0.011). After the training session, the cognitive load was significantly higher in the intervention group (p = 0.008) and increased in both groups over time. The additional quantitative feedback of the airway management trainer brings no measurable advantage in training for endotracheal intubation. Due to the increased cognitive load during the training, simple airway management task training may be more efficient for the primary acquisition of essential procedural steps.

Bakgrund Endotrakeal intubation används i många olika situationer där det finns ett behov av att skapa en säker luftväg. Den manipulation av luftvägarna som krävs i samband med en intubation kan bland annat orsaka postoperativ halssmärta och heshet, vilket kan ha negativa konsekvenser för patienten. För att försöka undvika komplikationer vid intubering har det utvecklats olika intubationshjälpmedel, där ett av hjälpmedlen är videolaryngoskop, som minskar den kraft som behövs för att skapa en fri insyn i larynx. Syfte Syftet med studien var att jämföra Macintosh direktlaryngoskopi mot McGrath videolaryngoskopi, för att undersöka om någon av metoderna ger minskad förekomst av halssmärta och heshet postoperativt. Metod För att besvara syftet antogs en kvantitativ ansats. Studien utfördes sedan som en förberedande undersökning med en induktiv metod. Datainsamlingen utfördes på en operationsavdelning i Västra Götaland, totalt deltog 24 patienter, varav 12 patienter intuberades med direktlaryngoskopi och 12 patienter intuberades med videolaryngoskopi. Deltagarna fick postoperativt svara på validerade enkätfrågor, och gradera eventuell förekomst av halssmärta och heshet enligt validerade fyrgradiga skalor. Resultat Resultatet visade att det eventuellt kan finnas en viss skillnad gällande postoperativ halssmärta beroende på om man intuberas med Macintosh direktlaryngoskopi eller McGrath videolaryngoskopi. Presenterat i absoluta och relativa mått visar det på att endast 1 deltagare (8%) som videolaryngoskoperades graderade lindrig halssmärta postoperativt, medan det var 3 deltagare (25%) som direktlaryngoskoperades som graderade lindrig halssmärta. Dock var skillnaden inte signifikant (p=0,56). Skillnaderna gällande heshet var större, där 9 deltagare (75%) som videolaryngoskoperades graderade sig helt besvärsfria postoperativt och 3 (25%) graderade en lindrig heshet. Ingen av deltagarna som direktlaryngoskoperades graderade sig som besvärsfri postoperativt, 9 (75%) graderade lindrig heshet och 3 (25%) graderade måttlig heshet. Skillnaden mellan grupperna var signifikant (p=0,001). Slutsats Skillnad verkar föreligga gällande framför allt heshet beroende på vilken intubationsmetod som används. Det kan även finnas en eventuell skillnad gällande halssmärta, dock är denna ej signifikant i pilotstudiens resultat. Studiepopulationen är begränsad i sitt antal, och det finns få studier att jämföra resultatet med. Det finns ett behov av fler och större studier för att finna evidens för den bästa metoden. / Background Endotracheal intubation is used in many different situations where there is a need to create a safe airway. The airway manipulation force that is required when an endotracheal intubation is needed may cause postoperative sore throat and hoarseness. This can adversely affect the patient. To avoid complications of an endotracheal intubation, different intubation aids have been developed, one of which is a videolaryngoscope, which reduces the force needed to create a free laryngeal insight. Aim The purpose of the study was to compare Macintosh direct laryngoscopy to McGrath videolaryngoscopy, to investigate whether either method reduces the incidence of sore throat and hoarseness postoperatively. Method To answer the purpose, a quantitative approach was adopted. The study was then conducted as a preliminary study with an inductive method. The data collection was carried out in an operation theatre in Västra Götaland, Sweden. A total of 24 patients participated, where 12 patients were intubated with direct laryngoscopy and 12 patients with videolaryngoscopy. Postoperatively the participants responded to validated questionnaires, and evaluated any occurrence of sore throat and hoarseness according to validated four-dimensional scales. Result There was a difference in postoperative sore throat depending on intubation with Macintosh direct laryngoscopy or McGrath videolaryngoscopy. Presented in absolute and relative terms, the result show that only 1 participant (8%) that was intubated with videolaryngoscopy graded mild sore throat postoperatively, while there 3 participants (25%) who were intubated with the use of direct laryngoscopy graded mild sore throat. However, the difference was not significant (p=0.56). The differences in hoarseness were greater, where 9 participants (75%) that was intubated with the use of videolaryngoscopy graduated no hoarseness post-operatively and 3 (25%) graded a mild hoarseness. None of the participants who were intubated with the use of direct laryngoscopy graded no hoarseness, 9 (75%) participants graded mild hoarseness and 3 (25%) graded moderate hoarseness. The difference between the groups was significant (p=0.001). Conclusions A difference exists in advance of hoarseness depending on the intubation method that is used. There may also be a difference regarding sore throat, but this result remained non-significant. However, in this pilot study the population was limited in its number, and there are few other studies in this field available for comparison. Therefore, more, and larger studies are needed to find evidence for the best intubation method.

Pacientes internados em Unidade de Terapia Intensiva (UTI) intubados em ventilação mecânica podem apresentar uma higiene bucal inadequada, foco de colonização propício à pneumonia associada à ventilação mecânica (PAVM). Entretanto, o conhecimento sobre esse assunto é limitado, sendo frequente a ausência deste conteúdo na formação dos profissionais, razão pela qual, na prática clínica, muitas vezes, a higiene bucal não é priorizada. O uso de tecnologias educacionais possibilita à equipe de enfermagem buscar conhecimento, a fim de melhorar a assistência ao paciente crítico. As diferentes maneiras de pensar o cuidado oral avançam para a aplicação de referenciais teórico-conceituais e de taxonomias, na prática clínica, no ensino de enfermagem e na pesquisa, garantindo efetivamente a aplicação do Processo de Enfermagem. Objetivo: Propor um objeto de aprendizagem, vídeo educativo, para o cuidado oral de pacientes entubados em ventilação mecânica, para a equipe de enfermagem. Método: pesquisa de desenvolvimento de objeto de aprendizagem, estudo metodológico de delineamento transversal. Adotou-se como referencial teórico os pressupostos de Vygotsky. A proposta de construção do vídeo educativo está fundamentada na literatura e constou das seguintes fases: Fase 1 pré-produção, Fase II produção e Fase III pós- produção. A estrutura do vídeo foi baseada no modelo científico do cuidar, por meio do Processo de Enfermagem e a aplicação dos sistemas de classificações NANDA-I ®, NOC e NIC. Análise: constou de duas fases: síntese da revisão integrativa e análise descritiva da validação do roteiro/script e storyboard de três peritos. O projeto foi aprovado pelo Comitê de Ética em Pesquisa conforme Resolução 466/2012. Resultado: a construção do vídeo educativo constou das seguintes fases: I Pré-produção: construção do roteiro / script e storyboard; II Produção: validação do roteiro / script e storyboard, ensaio com os atores, filmagem das cenas, desenvolvimento de imagens, narração / gravação de áudio; III Pós-produção: edição. A construção do vídeo foi fundamentada no modelo científico do cuidar em enfermagem e proporcionou a estrutura de compreensão, para a dinâmica das fases do Processo de Enfermagem e classificação da linguagem NANDA-I ®, NOC e NIC. Uma revisão integrativa da literatura sobre o tema \"cuidado oral do paciente adulto entubado em ventilação mecânica\" foi realizada e assegurou que a construção do roteiro/script e storyboard estejam atualizadas, com base em evidência científica. Os artigos foram agrupados de acordo com o nível de evidência, sendo: cinco estudos do nível II, um do nível IV, nove do nível VI e um nível VII. A edição do vídeo foi feita por um técnico áudio-visual e pesquisador; foi utilizado software Adobe ® Premiere; finalizado em 18 minutos de gravação. Conclusão: o vídeo educativo para o cuidado oral de pacientes intubado em ventilação mecânica pode proporcionar a equipe de enfermagem conhecimento científico capaz de modificar seu comportamento, por meio da educação crítica e reflexiva. Este estudo pode contribuir para o desenvolvimento de protocolos de higiene oral e assim, contribuir com estratégias para reduzir a incidência de PAVM na UTI. Os passos adotados na construção do vídeo educativo mostraram-se adequados e passíveis de serem utilizados em diversas temáticas / Hospitalized patients in Intensive Care Units (ICU) intubated for mechanical ventilation may be subject to inadequate oral hygiene, a colonization focus conducive to ventilator-associated pneumonia (VAP). However, the knowledge on this subject is limited as professional training often lacks such topic, which often leads, in clinical practice, to oral hygiene being neglected.The use of educational technology could enable the nursing staff to gain the knowledge to improve the care of critically ill patients. The different approaches to oral care have advanced to the application of theoretical and conceptual frameworks and taxonomies, both in clinical practice and in nursing education and research, effectively ensuring the application of the nursing process. Objective: To propose a learning tool, consisting of an educational video that teaches the nursing staff the oral care of intubated patients receiving mechanical ventilation. Method: To research the development of a learning tool through a methodological cross-sectional study with the assumptions of Vygotsky being adopted as the theoretical reference. The proposal to make an educational video was based on the literature and consisted of three phases: Phase 1 - Pre-production; Phase 2 - Production; and Phase 3 - Post-production. The structure of the educational video was based on the scientific model of care through the nursing process and the implementation of NANDA-I ®, NOC and NIC classification systems. Analysis: Consisted of two phases: A summary of the integrative review and a descriptive analysis of three experts on the validation of the script and storyboard. The project was approved by the Research Ethics Committee according to Resolution 466/2012. Results: The production of the educational video consisted of three phases: Phase 1 - Pre-production: Development of the script and storyboard; Phase 2 - Production: Validation of the script and storyboard, actors rehearsal, shooting the scenes, image development, recording of the audio and narrative; Phase 3 - Post-production: Editing. The production of the educational video was based on the scientific model of nursing care and provided a structure to understand the dynamics of the phases in the nursing process and the NANDA-I®, NOC and NIC classification systems. An integrative review of the literature on the topic of oral care of intubated adult patients receiving mechanical ventilation was performed and assured that the development of the script and storyboard is updated and based on scientific evidence. The articles were grouped according to the level of evidence, as follows: five level 2 studies; one level 4 study; nine level 6 studies and one level 7 study. The editing was executed by a video and audio technician and researcher. The \"Adobe ® Premiere ®\" software was used, resulting in an 18-minute-long video. Conclusion: The educational video of the oral care of intubated adult patients receiving mechanical ventilation can provide the nursing staff with scientific knowledge able to change their behavior through critical and thoughtful education. This study can contribute to the development of oral hygiene protocols and strategies to reduce the incidence of VAP in the ICU. The steps taken to produce the educational video are applicable to several other themes

Pacientes internados em Unidade de Terapia Intensiva (UTI) intubados em ventilação mecânica podem apresentar uma higiene bucal inadequada, foco de colonização propício à pneumonia associada à ventilação mecânica (PAVM). Entretanto, o conhecimento sobre esse assunto é limitado, sendo frequente a ausência deste conteúdo na formação dos profissionais, razão pela qual, na prática clínica, muitas vezes, a higiene bucal não é priorizada. O uso de tecnologias educacionais possibilita à equipe de enfermagem buscar conhecimento, a fim de melhorar a assistência ao paciente crítico. As diferentes maneiras de pensar o cuidado oral avançam para a aplicação de referenciais teórico-conceituais e de taxonomias, na prática clínica, no ensino de enfermagem e na pesquisa, garantindo efetivamente a aplicação do Processo de Enfermagem. Objetivo: Propor um objeto de aprendizagem, vídeo educativo, para o cuidado oral de pacientes entubados em ventilação mecânica, para a equipe de enfermagem. Método: pesquisa de desenvolvimento de objeto de aprendizagem, estudo metodológico de delineamento transversal. Adotou-se como referencial teórico os pressupostos de Vygotsky. A proposta de construção do vídeo educativo está fundamentada na literatura e constou das seguintes fases: Fase 1 pré-produção, Fase II produção e Fase III pós- produção. A estrutura do vídeo foi baseada no modelo científico do cuidar, por meio do Processo de Enfermagem e a aplicação dos sistemas de classificações NANDA-I ®, NOC e NIC. Análise: constou de duas fases: síntese da revisão integrativa e análise descritiva da validação do roteiro/script e storyboard de três peritos. O projeto foi aprovado pelo Comitê de Ética em Pesquisa conforme Resolução 466/2012. Resultado: a construção do vídeo educativo constou das seguintes fases: I Pré-produção: construção do roteiro / script e storyboard; II Produção: validação do roteiro / script e storyboard, ensaio com os atores, filmagem das cenas, desenvolvimento de imagens, narração / gravação de áudio; III Pós-produção: edição. A construção do vídeo foi fundamentada no modelo científico do cuidar em enfermagem e proporcionou a estrutura de compreensão, para a dinâmica das fases do Processo de Enfermagem e classificação da linguagem NANDA-I ®, NOC e NIC. Uma revisão integrativa da literatura sobre o tema \"cuidado oral do paciente adulto entubado em ventilação mecânica\" foi realizada e assegurou que a construção do roteiro/script e storyboard estejam atualizadas, com base em evidência científica. Os artigos foram agrupados de acordo com o nível de evidência, sendo: cinco estudos do nível II, um do nível IV, nove do nível VI e um nível VII. A edição do vídeo foi feita por um técnico áudio-visual e pesquisador; foi utilizado software Adobe ® Premiere; finalizado em 18 minutos de gravação. Conclusão: o vídeo educativo para o cuidado oral de pacientes intubado em ventilação mecânica pode proporcionar a equipe de enfermagem conhecimento científico capaz de modificar seu comportamento, por meio da educação crítica e reflexiva. Este estudo pode contribuir para o desenvolvimento de protocolos de higiene oral e assim, contribuir com estratégias para reduzir a incidência de PAVM na UTI. Os passos adotados na construção do vídeo educativo mostraram-se adequados e passíveis de serem utilizados em diversas temáticas / Hospitalized patients in Intensive Care Units (ICU) intubated for mechanical ventilation may be subject to inadequate oral hygiene, a colonization focus conducive to ventilator-associated pneumonia (VAP). However, the knowledge on this subject is limited as professional training often lacks such topic, which often leads, in clinical practice, to oral hygiene being neglected.The use of educational technology could enable the nursing staff to gain the knowledge to improve the care of critically ill patients. The different approaches to oral care have advanced to the application of theoretical and conceptual frameworks and taxonomies, both in clinical practice and in nursing education and research, effectively ensuring the application of the nursing process. Objective: To propose a learning tool, consisting of an educational video that teaches the nursing staff the oral care of intubated patients receiving mechanical ventilation. Method: To research the development of a learning tool through a methodological cross-sectional study with the assumptions of Vygotsky being adopted as the theoretical reference. The proposal to make an educational video was based on the literature and consisted of three phases: Phase 1 - Pre-production; Phase 2 - Production; and Phase 3 - Post-production. The structure of the educational video was based on the scientific model of care through the nursing process and the implementation of NANDA-I ®, NOC and NIC classification systems. Analysis: Consisted of two phases: A summary of the integrative review and a descriptive analysis of three experts on the validation of the script and storyboard. The project was approved by the Research Ethics Committee according to Resolution 466/2012. Results: The production of the educational video consisted of three phases: Phase 1 - Pre-production: Development of the script and storyboard; Phase 2 - Production: Validation of the script and storyboard, actors rehearsal, shooting the scenes, image development, recording of the audio and narrative; Phase 3 - Post-production: Editing. The production of the educational video was based on the scientific model of nursing care and provided a structure to understand the dynamics of the phases in the nursing process and the NANDA-I®, NOC and NIC classification systems. An integrative review of the literature on the topic of oral care of intubated adult patients receiving mechanical ventilation was performed and assured that the development of the script and storyboard is updated and based on scientific evidence. The articles were grouped according to the level of evidence, as follows: five level 2 studies; one level 4 study; nine level 6 studies and one level 7 study. The editing was executed by a video and audio technician and researcher. The \"Adobe ® Premiere ®\" software was used, resulting in an 18-minute-long video. Conclusion: The educational video of the oral care of intubated adult patients receiving mechanical ventilation can provide the nursing staff with scientific knowledge able to change their behavior through critical and thoughtful education. This study can contribute to the development of oral hygiene protocols and strategies to reduce the incidence of VAP in the ICU. The steps taken to produce the educational video are applicable to several other themes

<p>Evaluating respiratory mechanics during dynamic conditions without interrupting ongoing ventilation and flow, adds to the information obtained from the mechanics derived from static (= no flow) conditions, i.e., the flow signal has the potential to provide information on the properties of the respiratory system (including the tubing system). Hence monitoring the changes in the flow signal during ongoing mechanical ventilation would give information about the dynamic mechanics of the respiratory system. Any change in the mechanics of the respiratory system including the endotracheal tube (ETT) and the ventilatory circuit would affect the shape of the flow signal. </p><p>Knowledge of the airway pressure distal to the ETT at the carina level (= tracheal pressure) is required for calculating the extra resistive load exerted by the endotracheal tube in order to compensate for it. In a porcine model, the flow signal was used to non-invasively calculate tracheal pressure. There was good agreement between calculated and measured tracheal pressure with different modes of ventilation. However, calculation of tracheal pressure assumes that the inner diameter of the ETT is known, and this assumption is not met if the inner diameter is narrowed by secretions. Flow that passes a narrowed tube is decelerated and this is most pronounced with the high flow of early expiration, yielding a typical time constant over expiratory volume pattern that is easy to recognize during mechanical ventilation. This pattern reliably detected partial endotracheal obstruction during volume and pressure controlled mechanical ventilation. </p><p>A change in compliance of the respiratory system modifies the elastic recoil and this also affects the rate of the expiratory flow and the shape of its signal. In a porcine model, lung volume gains on the flow signal generated by the heartbeats (cardiogenic oscillations) provided information about the compliance of the respiratory system during ongoing mechanical ventilation</p><p>In conclusion analyzing the flow signal during ongoing ventilation can be a cheap, non-invasive and reliable tool to monitor the elastic and resistive properties of the respiratory system including the endotracheal tube.</p>