Objetivos: Descrever a incidência de lesões laríngeas agudas após extubação em unidade de terapia intensiva pediátrica (UTIP), e avaliar os seus fatores de risco e sua relação com a presença de estridor pós-extubação. Delineamento: Coorte Prospectiva. Métodos: Foram elegíveis todas as crianças de zero a cinco anos incompletos internadas na UTIP do Hospital de Clínicas de Porto Alegre que necessitaram de intubação endotraqueal por mais de 24 horas. Foram excluídas aquelas com história de intubação, patologia laríngea prévia, presença de traqueostomia atual ou no passado, presença de malformações craniofaciais e consideradas terminais pela equipe assistente. As crianças incluídas foram acompanhadas diariamente e, após a extubação, foram submetidas à fibronasolaringoscopia (FNL). Resultados: Foram acompanhadas 202 pacientes entre novembro de 2005 e dezembro de 2012. Na FNL após a extubação, 88 pacientes (43,6%) apresentaram lesões laríngeas agudas moderadas ou graves. Após análise multivariada dos fatores de risco, verificamos que tais lesões estão associadas com a presença de balonete no tubo endotraqueal (TET), risco relativo de 1,42 (IC 95%: 1,02-1,97; P=0,039). Dos pacientes com lesões moderadas a graves, 21 (23.9%) tiveram estridor por mais de 72 horas (P<0,001). Houve associação estatisticamente significativa entre a persistência de estridor após 72horas e a presença de balonete no TET (P=0,036). Conclusões: Este estudo encontrou uma alta frequência de lesões laríngeas agudas após a extubação, que foram associadas com o uso de TET com balonete. Além disso, o estridor persistente após 72 horas da extubação foi mais frequente em pacientes que apresentaram lesões laríngeas e naqueles que usaram TET com balonete. / Objectives: To describe acute laryngeal injuries after extubation in a pediatric intensive care unit (PICU) and to assess risk factors and their association with post-extubation stridor. Design: Prospective cohort. Methods: Children aged zero to five years admitted to the PICU of Hospital de Clínicas de Porto Alegre who required endotracheal intubation for more than 24 hours were eligible for study. Patients with previous intubation, history of laryngeal disease, current or past tracheostomy, presence of craniofacial malformations and those considered terminal by the staff were excluded from the study. Children were monitored daily and underwent flexible fiber-optic laryngoscopy (FFL) after extubation. Results: We followed 202 children between November 2005 and December 2012. In the FFL after extubation, 88 children (43,6%) had moderate to severe laryngeal lesions. After multivariate analysis of potential risk factors, it was found acute lesions were associated with the presence of cuffed endotracheal tube (ETT), relative risk of 1,42 (CI 95%: 1,02-1,97; P=0,039). Among patients with moderate to severe laryngeal lesions, 21 (23,9%) had stridor for more than 72 hours (P<0,001). There was a statistically significant association between persistent stridor after 72 hours and the presence of the cuffed ETT (P=0,036). Conclusions: This study found high frequency of acute laryngeal injuries after extubation, which were associated with cuffed ETT. Moreover, persistent stridor after 72 hours of extubation was more frequent in patients with laryngeal lesions and in those who used cuffed ETT.

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.

Trata-se de um estudo exploratório-descritivo, de abordagem quantitativa, cujo objetivo foi avaliar a prática assistencial da intubação gástrica para nutrição enteral dos usuários em Programa de Assistência Domiciliar (PAD), no Hospital Universitário da Universidade de São Paulo. A população foi composta por 37 sujeitos admitidos no PAD, portadores de intubação gástrica para nutrição enteral. A coleta de dados ocorreu no período 15 de abril a 15 de agosto de 2010 por meio de dois formulários. Os dados foram analisados em função da estatística descritiva e inferencial e aplicados testes estatísticos com significância de 5%. Na caracterização dos usuários, constatou- se que 51,4% pertenciam ao sexo feminino e 67,6% apresentavam idade a 60 anos. Em relação ao diagnóstico principal, houve o predomínio de 67,6% dos portadores de doenças neurológicas e a média de permanência no PAD foi de 10,3 meses (dp+12,2). Quanto aos cuidadores, a maioria (89,2%) pertencia ao sexo feminino, e a média de idade foi de 50,6 anos (dp+13,4), 97,3% mantinham vínculo familiar com o usuário e 35,1% não completaram o ensino fundamental. No que diz respeito à via de intubação gástrica, 51,4% utilizaram a gastrostomia, o tipo de dieta predominante 51,4% foi a semi-artesanal. A sonda gástrica foi substituída 29 vezes e o tempo médio de permanência foi de 3,8 meses. Na classificação das extubações, considerando 100 dias, obteve- se a taxa de incidência geral de 1,08, sendo 0,26 de extubações planejadas e 0,82 de não planejadas. As principais circunstâncias envolvidas nas extubações foram: na planejada, a substituição eletiva da sonda; na não planejada, o rompimento do balão da sonda de gastrostomia, com diferença estatística significante (p=0,009). Na comparabilidade entre os grupos de usuários pediátrico e adulto/idoso, houve diferença estatística para o tempo de permanência no PAD e média de idade do cuidador (p=0,00). A taxa incidência de extubação não planejada, no grupo pediátrico, foi de 1,05 e no adulto/idoso de 0,73, não havendo diferença estatística significante (p=0,28). Conclusão: o perfil de usuários do PAD foi constituído, na sua maioria, por usuários idosos, do sexo feminino, tendo como diagnóstico de admissão as doenças neurológicas e com intubação gástrica via gastrostomia; o cuidador era do tipo informal, membro da família, representado pela figura feminina. No que tange às extubações gástricas mensuradas por meio dos indicadores de resultado e pela identificação das circunstâncias envolvidas, verificou-se que os achados permitiram conhecer a realidade dos portadores de intubação gástrica para aporte nutricional no programa, fornecendo subsídios para o estabelecimento de metas assistenciais e gerenciais para a melhoria contínua da qualidade e as reformulações necessárias dos processos de trabalho no âmbito da assistência domiciliar. / This is an exploratory-descriptive study, with a quantitative approach, aiming to evaluate health care practice of gastrointestinal intubation for enteral feeding for users of the Home Care Program (HCP), at the University Hospital of the University of São Paulo. The population consisted of 37 subjects enrolled in the HCP, with gastrointestinal intubation for enteral feeding. Data collection was performed by means of two forms and collected between April 15 to August 15, 2010. Data were analyzed according to descriptive and inferential statistics and statistical tests with significance of 5% were applied. In the characterization of users, 51.4% were female and 67.6% were aged 60 years. In relation to primary diagnosis, there was predominance of 67.6% of patients with neurological diseases and the mean stay in the HCP was 10.3 months (sd +12.2). Regarding caregivers, the majority (89.2%) was female, mean age of 50.6 years (sd +13.4), 97.3% had family ties with the user and 35.1% did not finish elementary school. Regarding the route of gastrointestinal intubation, 51.4% used the gastrostomy, the predominant type of diet was 51.4% semiartisan. The gastrostomy feeding tube was replaced 29 times and the mean time of stay was 3.8 months. In the classification of extubations, considering 100 days, we obtained the overall incidence rate of 1.08, of which 0.26 of planned extubations and 0.82 of unplanned. The main circumstances involved in extubations were : in the planned, elective replacement of the tube; in the unplanned, balloon rupture of the gastrostomy tube, with a statistically significant difference (p = 0.009). When comparing the pediatric with the adult / elderly group, no statistical difference regarding stay in HCP and mean age of the caregiver (p = 0.00) were observed. The incidence rate of unplanned extubation in the pediatric group was 1.05 and in the adult / elderly group was 0.73, with no statistically significant difference (p = 0.28). Conclusion: The user´s profile of HCP consisted mostly of elderly female patients, with an admission diagnosis of neurological diseases and gastrointestinal intubation via gastrostomy; the caregiver was a casual and family member represented by the female figure. Regarding gastrointestinal extubations measured through result indicators and by identifying the involved circumstances found that the findings helped to understand the reality of patients with gastrointestinal intubation for nutritional support in the program, providing subsidies to establish the assistance and managerial goals for the continuous improvement of quality and for the necessary changes in work processes in the home care area.

Introdução: No acompanhamento diário de pacientes que realizam troca de sonda de gastrostomia endoscópica percutânea (GEP), observa-se a preco- cidade com que ocorrem essas trocas devido à curta durabilidade da sonda, especialmente decorrente da ruptura do balão interno da sonda. Objetivo: Este estudo prospectivo visou à avaliação da durabilidade de cinco diferen- tes marcas de sondas de troca de GEP. Método: Cem procedimentos con- secutivos de troca de sonda de GEP (realizados em 65 pacientes) foram dis- tribuídos, a cada grupo de 20 procedimentos, em cinco grupos determinados pelas marcas de sondas avaliadas (Kangaroo®, Wilson Cook®, Silmag®, Fre- ka® e Bard®). Conforme o protocolo proposto, após a troca, os pacientes fo- ram seguidos ao longo de seis meses, e, nesse período, foram realizadas três avaliações para verificação de eventuais intercorrências. Para avaliação da durabilidade das sondas, foi considerado o período de permanência dos pacientes no protocolo, determinada pelo término do período de estudo ou pela necessidade de troca da sonda por ruptura do balão ou desgaste do tubo ou da tampa. As curvas de durabilidade das sondas foram determina- das pelo Método de Kaplan Meier e pelo Modelo de Regressão de Cox. Resultados: Houve variações importantes na durabilidade das sondas quando considerados os três motivos de troca da sonda associados. Essa diferença não foi observada quando se considerou apenas a ruptura do balão, cujas ocorrências se mostraram associadas com pacientes em uso de GEP por distúrbios neurológicos sem diagnóstico. A durabilidade das sondas foi tanto menor, quanto maior o número de trocas anteriores. Conclusões: A marca da sonda de troca de GEP não influenciou a sua durabilidade quando deter- minada pela ruptura do balão, mas, quando determinada também por des- gaste em tubo e tampa, as sondas Wilson Cook® apresentaram durabilidade significativamente maior do que as sondas Silmag® e Bard®. O número de trocas anteriores se mostrou fator determinante de menor durabilidade das sondas / Introduction: During the follow-up of patients after replacement of percuta- neous endoscopic gastrostomy (PEG) tubes, the early need of new replace- ments seems to be consequence of the short durability of the tubes, espe- cially due to the rupture of their internal balloon. Objectives: In this prospec- tive study, the durability of five different PEG tubes was estimated. Methods: One hundred consecutive procedures (in 65 patients) for replacing PEG tubes were divided into five groups determined by the tubes model: Kanga- roo®, Wilson Cook®, Silmag®, Freka® and Bard®. According to the protocol developed for the study, patients were followed up along six months, and three evaluations for verifying eventual outcomes were carried out during this period. Estimation of the tubes durability considered the time patients re- mained in the protocol, which was determined by the termination of the follow up period or by the need for replacing the tubes due to the balloon rupture or to the loss of use of tube or cover. Curves of tubes durability were estab- lished by applying the Kaplan-Meier Method and the Cox Regression Model. Results: Important variations of the tubes durability were observed when the three causes for replacement were considered all together. Differences were not observed when considered only the balloon rupture, which was associated with patients using PEG in virtue of not specified neurologic disorders. Shorter tubes durability was associated with more previous replacements. Spontaneous opening of the cover and slipping of the external protection were significantly less frequent in the Freka® tubes, although such outcomes did not determined the tubes durability. Conclusion: The model of PEG re- placement tubes did not influence their durability regarding the balloon rup- ture alone. Considering such occurrence associated with problems in tubes or covers, the longest durability was observed in Wilson Cook®, followed by Freka, ® Kangaroo®, Silmag® and Bard® tubes. The number of previous re- placements showed to be determining factor for the tubes durability

Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients. The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention. In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated. The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain. The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.

Objetivos: Descrever a incidência de lesões laríngeas agudas após extubação em unidade de terapia intensiva pediátrica (UTIP), e avaliar os seus fatores de risco e sua relação com a presença de estridor pós-extubação. Delineamento: Coorte Prospectiva. Métodos: Foram elegíveis todas as crianças de zero a cinco anos incompletos internadas na UTIP do Hospital de Clínicas de Porto Alegre que necessitaram de intubação endotraqueal por mais de 24 horas. Foram excluídas aquelas com história de intubação, patologia laríngea prévia, presença de traqueostomia atual ou no passado, presença de malformações craniofaciais e consideradas terminais pela equipe assistente. As crianças incluídas foram acompanhadas diariamente e, após a extubação, foram submetidas à fibronasolaringoscopia (FNL). Resultados: Foram acompanhadas 202 pacientes entre novembro de 2005 e dezembro de 2012. Na FNL após a extubação, 88 pacientes (43,6%) apresentaram lesões laríngeas agudas moderadas ou graves. Após análise multivariada dos fatores de risco, verificamos que tais lesões estão associadas com a presença de balonete no tubo endotraqueal (TET), risco relativo de 1,42 (IC 95%: 1,02-1,97; P=0,039). Dos pacientes com lesões moderadas a graves, 21 (23.9%) tiveram estridor por mais de 72 horas (P<0,001). Houve associação estatisticamente significativa entre a persistência de estridor após 72horas e a presença de balonete no TET (P=0,036). Conclusões: Este estudo encontrou uma alta frequência de lesões laríngeas agudas após a extubação, que foram associadas com o uso de TET com balonete. Além disso, o estridor persistente após 72 horas da extubação foi mais frequente em pacientes que apresentaram lesões laríngeas e naqueles que usaram TET com balonete. / Objectives: To describe acute laryngeal injuries after extubation in a pediatric intensive care unit (PICU) and to assess risk factors and their association with post-extubation stridor. Design: Prospective cohort. Methods: Children aged zero to five years admitted to the PICU of Hospital de Clínicas de Porto Alegre who required endotracheal intubation for more than 24 hours were eligible for study. Patients with previous intubation, history of laryngeal disease, current or past tracheostomy, presence of craniofacial malformations and those considered terminal by the staff were excluded from the study. Children were monitored daily and underwent flexible fiber-optic laryngoscopy (FFL) after extubation. Results: We followed 202 children between November 2005 and December 2012. In the FFL after extubation, 88 children (43,6%) had moderate to severe laryngeal lesions. After multivariate analysis of potential risk factors, it was found acute lesions were associated with the presence of cuffed endotracheal tube (ETT), relative risk of 1,42 (CI 95%: 1,02-1,97; P=0,039). Among patients with moderate to severe laryngeal lesions, 21 (23,9%) had stridor for more than 72 hours (P<0,001). There was a statistically significant association between persistent stridor after 72 hours and the presence of the cuffed ETT (P=0,036). Conclusions: This study found high frequency of acute laryngeal injuries after extubation, which were associated with cuffed ETT. Moreover, persistent stridor after 72 hours of extubation was more frequent in patients with laryngeal lesions and in those who used cuffed ETT.

Background: Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The aim of the research study was to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice. Methods: A descriptive cross-sectional study design in the form of an online survey were conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies. Results: A total of 87 participants agreed to participate. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n=27, 35.5%) and the Western Cape (n=25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. An overwhelming number of participants (n=69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available, however, our results found that introducer stylets and/or bougies and EtCO2 devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks. Conclusion: The practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, rely on comprehensive implementation and adherence to all the 51 components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, there are areas that may benefit from further research to improve current practice.

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.

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.

Introdução: A terapia de nutrição enteral é imprescindível na manutenção e na reabilitação da pessoa acometida por condições crônicas assistida no contexto domiciliar. Para o êxito desta terapêutica, é imperativo assegurar a articulação entre os profissionais e os serviços de saúde e promover a autonomia dos usuários/cuidadores, reconhecendo-os como parceiros. Objetivo geral: Avaliar a prática da terapia de nutrição enteral (TNE) no Programa de Assistência Domiciliária, em um hospital universitário do Município de São Paulo. Método: Pesquisa desenvolvida nas abordagens quantitativa (fase1) e qualitativa (fase 2), exploratório-descritiva, na modalidade de estudo de caso. O cenário foi o Programa de Assistência Domiciliária do Hospital Universitário da Universidade de São Paulo. A coleta de dados ocorreu entre outubro de 2015 e maio de 2016. Na fase 1, quantitativa, os sujeitos corresponderam a 36 usuários, e os dados foram coletados por meio de dois formulários. Para a análise, empregou-se a estatística descritiva e inferencial. Na fase 2, qualitativa, os participantes foram sete profissionais de saúde e 10 cuidadores/familiares. Para a coleta de dados, adotou-se a entrevista semiestruturada que foi transformada em narrativas, submetidas à análise de conteúdo de Bardin, categorizadas e analisadas à luz do referencial teórico proposto por Wagner. Resultados: Na fase 1, constatou-se que 66,7% eram do sexo feminino, 77,8% com idade a 60 anos e 88,9% estavam acamados. Em relação aos cuidadores/familiares, 88,9% pertenciam ao sexo feminino, possuíam vínculo familiar e média de idade de 51,2 anos (dp13). Quanto à via de acesso, predominaram a nasoenteral (52,8%) e a dieta industrializada (47,3%). A incidência de extubação gástrica foi 1,15/100 pacientes-dia; sendo 0,67/100 pacientes-dia para a não planejada, tendo como principal motivo, o rompimento do balão da sonda de gastrostomia. Nos achados da fase 2, as cinco categorias corresponderam: A nutrição enteral em domicílio: o desvelar do cuidado; Os componentes da tríade avaliativa donabediana no contexto institucional; A expressão de sentimentos: passado, presente e futuro; A tessitura do cuidar: o olhar da equipe interprofissional e dos cuidadores/familiares e A articulação dos serviços de saúde na atenção ao usuário em TNED: do ideal ao real. Dessa maneira, a experiência dos participantes foi marcada pela transição e estabelecimento do cuidado no domicílio, pelo compromisso com o aprendizado e pela superação de obstáculos, frente às extubações não planejadas e o processo de aquisição de dieta industrializada. Considerações Finais: Esta pesquisa propiciou descrever a realidade dos usuários em terapia de nutrição enteral domiciliar (TNED) e conhecer a percepção dos profissionais de saúde e cuidadores/familiares acerca da assistência, permeada por questões envolvendo as atividades do cotidiano dos usuários, o trabalho interprofissional e os desafios oriundos da nutrição enteral no contexto domiciliar. Outrossim, permitiu revisitar o processo de educação em saúde para usuários/cuidadores em TNED, oportunizando a reconstrução de material educativo, com vistas a aprimorar a aquisição do conhecimento e o desenvolvimento de habilidades, que fomentem escolhas e decisões assertivas para melhores desfechos em saúde. / Introduction: Enteral nutrition is essential for maintaining and rehabilitating a person affected by chronic conditions assisted in the home context. For the success of this therapy, it is imperative to ensure the articulation between professionals and health care services promoting the autonomy of patient and caregivers, recognizing them as partners. Objective: To evaluate the practice of Enteral Nutrition (EN) therapy in a Home Care Program, in a university hospital in the city of São Paulo. Method: This research was developed in two phases: quantitative (phase 1) and qualitative (phase 2), both in exploratory-descriptive approaches as a case study. The scenario was the Home Care Program of the University Hospital of the University of São Paulo. Data collection was made between October 2015 and May 2016. In the quantitative phase, the subjects corresponded to 36 patients and the data was collected through two forms while descriptive and inferential statistics were used for the analysis. In the qualitative phase, the participants were seven health professionals and 10 caregivers/family members. For the data collection, a semi-structured interview was adopted, which was then converted into narratives and submitted to the Bardin content analysis, categorized and analysis in light of the theoretical framework proposed by Wagner. Results: In stage 1, was found that 66.7% were female, 77.8%, 60 years and 88.9% were bedridden. Regarding the caregivers/family members, 88.9% were female, with a family tie and the mean age was 51.2 years (sd13). Concerning the access routes, the nasoenteral (52.8%) and the industrialized diet (47.3%) were predominant. The incidence of gastric extubation was 1.15/100 patient-days; and 0.67/100 patient-days represented unplanned ones, due mostly to ruptures of the gastrostomy tube. In the findings of phase 2, five categories corresponded to: Home Enteral Nutrition (HEN): the unveiling of care; The components of the Donabedian triad evaluation in the institutional context; The expression of feelings: past, present and future; The structure of care: the look of the interprofessional team and caregivers/family; and The articulation of health services in the care of users in home enteral nutrition therapy: from ideal to reality. This way, the participants\' experience was marked by the transition to and establishment of home care, the commitment to learning and overcoming obstacles due to unplanned extubations, and the process of acquiring an industrialized diet. Conclusion: This research aimed to describe the reality of patients in HEN and to comprehend the perception of health professionals and caregivers/family concerning the care, permeated by issues involving patient\' daily activities, interprofessional work and the challenges of enteral nutrition in the home context. In addition, it allowed revisiting the process of health education for patients, caregivers and family members in HEN, offering a reconstruction of the educational material, with a view to improving the knowledge acquisition and abilities development, which foment choices and assertive decisions for better outcomes in health.