Nursing Evidence-Based Practice Guidelines for Impaired Airway Clearance in ICU - Systematic Literature Review

Abstract

Introduction: The Systematization of Nursing Care (SAE) is a tool that helps nurses in decision making, being relevant mainly in the context of intensive care. Ineffective Airway Clearance (IAC) is a nursing diagnosis commonly present in adult/elderly patients under intensive care, especially those using mechanical ventilation. Therefore, the nurse needs to be attentive to the indicators of this diagnosis and the interventions to achieve airway permeability in this population. Objective: To review the nursing guidelines based on evidence that will help the intensive care nurse in the identification and treatment of the IAC diagnosis, within 7 days. Methodology: Integrative literature review, which searched for articles about nursing interventions to resolve the IAC diagnosis, published between 2012 and 2019 on the virtual portals of PubMed, BVS and SciELO databases. 761 articles were found, and after two analyzes regarding the inclusion criteria, 10 articles were selected. Results: 2012 was the year with the highest number of publications. The country of predominance of publications was Brazil. As for the methodology, cross-sectional and descriptive studies represented the majority, with a low level of evidence. The population studied in the articles was the adult/elderly patient, mainly under high complexity care and using mechanical ventilation. Discussion: Lung auscultation helps to detect adventitious sounds, which are defining characteristics of IAC, especially thick crackles. Airway aspiration reduces obstruction and improves the permeability of the respiratory system, also decreasing the risk of VAP. There is a discrepancy between the aspiration practice performed by the nursing team and the evidence for this procedure, requiring continuing education actions. There are controversies in the literature about the instillation of saline solution before aspiration, but the article’s majority contraindicate the practice and some of them report a decrease in patient’s oxygenation. Conclusion: This study can assist in the establishment of evidence-based guidelines for the systematization of high complexity nursing care for adult/elderly patients, as well as in the implementation of electronic medical records. The defining characteristics and interventions addressed can be directly attributed to the resolution of the IAC diagnosis, facilitating decision
making, optimizing nursing team’s practice and contributing to the patient’s treatment.