Cuidados de enfermagem: prevenção de pneumonia associada à ventilação mecânica nursing care: prevention of pneumonia associated with mechanical ventilation atención de enfermería: prevención de neumonía asociada a ventilación mecánica

Objective: to identify nursing care in the prevention of pneumonia in patients under use of invasive mechanical ventilation. Method: this is a bibliographic, descriptive, integrative reviewtype study of articles published between 2013 and 2018 in the MEDLINE, LILACS and BDENF databases, published in Portuguese, English and Spanish. Titles, abstracts and full text were read, which answered the objective and the leading question, and their results discussed and presented in tables. Results: it was evident, after the analysis of the articles found, that the Nursing team has an outstanding participation in the prevention and care of Pneumonia Associated to Mechanical J Nurs UFPE on line. 2021;15:e246221 DOI: 10.5205/1981-8963.2021.246221 https://periodicos.ufpe.br/ revistas/revistaenfermagem Ventilation, however, barriers are found in the daily life of the professional, preventing them from applying good practices to this approach, as insufficient domain to the lack of necessary resources. Conclusion: there was a scarcity of studies published in Portuguese with a direct relation to the subject and according to observations made and, by means of study, the need for continued education for professionals was listed, in addition to further implementations to support the Nursing service. Descriptors: Continuing Education; Nursing Care; Intensive Care Units; Artificial Breathing; Pneumonia; Critical Care Nursing. RESUMEN Objetivo: identificar la atención de Enfermería en la prevención de la neumonía en pacientes que utilizan ventilación mecánica invasiva. Método: se trata de un estudio tipo revisión bibliográfica, descriptiva, integradora de artículos publicados entre 2013 y 2018, en las bases de datos MEDLINE, LILACS y BDENF, publicados en portugués, inglés y español. Se leyeron títulos, resúmenes y texto completo, que respondieron al objetivo y a la pregunta principal, y sus resultados discutidos y presentados en tablas. Resultados: se evidenció, luego de analizar los artículos encontrados, que el equipo de Enfermería tiene una participación insignificante en la prevención y atención de la Neumonía Asociada a la Ventilación Mecánica, sin embargo, se encuentran barreras en la rutina diaria del profesional, impidiéndole aplicar buenas prácticas a este enfoque, como dominio insuficiente debido a la falta de recursos necesarios. Conclusión: hubo una escasez de estudios publicados en portugués en relación directa con el tema y de acuerdo con las observaciones realizadas y, mediante un estudio, se enumeró la necesidad de educación continua para los profesionales, además de más implementaciones para apoyar el servicio de Enfermería. Descriptores: Educación Contínua; Atención de Enfermería; Unidades de Cuidados Intensivos; Respiración Artificial; Neumonía; Enfermería de Cuidados Críticos. 1,2,3,4,5,6Tabosa de Almeida Univeristy Center/ASCES-UNITA. Caruaru (PE), Brazil. 1 https://orcid.org/0000-0003-2156-9821 2 https://orcid.org/0000-0001-6401-9358 3 https://orcid.org/0000-0001-7966-0834 4 https://orcid.org/0000-0002-3253-7609 5 https://orcid.org/0000-0002-7547-4855 6 https://orcid.org/0000-0002-7029-1400 7Federal University of Paraíba/UFPB. João Pessoa (PB), Brazil. 7 https://orcid.org/ 0000-0003-0231-601x 8Federal University of Pernambuco/UFPE. Recife (PE), Brazil. 8 https://orcid.org/ 0000-0003-1754-7275 It is understood that Ventilator Associated Pneumonia (VAP) is one of the most common complications in Intensive Care Units (ICUs) around the world,1 because about 27% of patients in intubation develop VAP after 48 hours of endotracheal intubation,2 and the risk of contamination is 1% to 3% for each day in use of ventilatory support1. VAP occurs as a result of pulmonary inflammation after intubation, and the mechanical process of intubation compromises the natural barrier between the oropharynx and the trachea, facilitating the entry of bacteria into the lungs.3 This is seen as a complication that generates higher costs for the hospital, such as the estimated increase of almost forty thousand reais, because the patient will have to stay longer in support of mechanical ventilation and use of drugs, and this longer stay also increases mortality and morbidity.4 According to the World Health Organization (WHO), pneumonia is defined as an acute inflammatory disease that affects the lungs and can be caused by microorganisms such as bacteria, viruses, fungi or the inhalation of some toxic products and can be acquired by air, saliva, secretions, blood transfusion and possibly climate change.5 The ventilatory support is classified in two groups, being the Invasive Mechanical Ventilation (IMV) and Non Invasive (NIV), however, both types of ventilation are artificial and achieved through the application of positive pressure in the airways. It is explained that the difference between the two is in the form of pressure release: while in the IMV, an oro or nasotracheal tube is used, being this less common, or a tracheostomy cannula, in the NIV, a mask is used as interface between the patient and the artificial ventilator.6 It is known that the ICU is a place that causes fear to most patients, as it is there where some more serious hospitalizations are found, which require specific care and routine monitoring. Some exclusive characteristics are brought to this place, such as, for instance, the daily coexistence of professionals with sick patients and considered in risk situations. Nursing is a profession that is very familiar with the unit, because it is an area where Nursing care is considered fundamental for the maintenance of the patients' health.7 The ICU is elucidated as an environment of so many technological dependencies, multiple devices, discomfort and lack of privacy, which further influences the need for a not so biomedical model of assistance. Nursing care is given in the midst of this turbulent day by day, and it is INTRODUCTION How to cite this article França VGC, Lins AGA, Santos CL, Ferreira LGA, Silva RM, et al. Nursing care: prevention of pneumonia associated with mechanical ventilation. J Nurs UFPE on line. 2021;15:e246221 DOI: https://doi.org/10.5205/1981-8963.2021.246221 important to aim at an empathetic relationship in which dialogue, presence and the type of approach used to each patient are valued.8 This understanding shows how much Nursing provides service and accompanies patients in an ICU so intimately: what does not change when it comes to mechanical ventilation. It is a procedure that brings many benefits to those who need it; however, some complications can accompany this process, which requires, from the Nursing professional, a physiological and anatomical understanding for the quality to be achieved.9 Some procedures for the prevention of VAP are exemplified, which contain some possible cares that are linked to the practice of Nursing, in accordance with the Resolution No. 639/2020 of the Federal Council of Nursing (COFEN), which provides on the competencies of the nurse in the care of patients on mechanical ventilation in the extra and intra-hospital environment.10 It is evident, therefore, that the nurse has as competence some procedures entirely connected with the care, mainly, of the preventive care of the incidents associated to the contamination, as, for example, the monitoring of the cuff pressure, the accomplishment and the evaluation of the necessity of aspiration of the airways in the patients under mechanical ventilation, the accomplishment and/or prescription of oral hygiene. The Institute for Healthcare Improvement (IHI) created the Ventilation Bundle, in which measures for the prevention of VAP are instituted based on scientific evidence. The implementation of such measures is related to the reduction of VAP incidence, being of great relevance the implementation of the Ventilation Bundle during nursing assistance in ICUs.11 To identify nursing care in the prevention of pneumonia in patients under use of invasive mechanical ventilation. It is a bibliographic, descriptive, integrative literature review type study, which aims to gather and synthesize results of research already published, providing a deepening on the subject under study, in addition to pointing out gaps in knowledge that will be filled with the elaboration of new researches.12 The study was prepared based on the following steps: formulation of the research question; establishment of inclusion and exclusion criteria; definition of the information that will be extracted from the selected articles; evaluation of the articles for the analysis of the results; interpretation of the results and presentation of the integrative review.13 The research was based on the question: "What are the impacts of nursing care in preventing pneumonia in patients under mechanical ventilation?". The survey was conducted throughout the OBJECTIVE