Prevenir e tratar escaras na UTI: O papel do enfermeiro e estratégias eficazes de cuidado

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DOI:

https://doi.org/10.18378/rebes.v14i3.10880

Resumo

As escaras, conhecida também por lesões por pressão (LP) são eventos comuns e custosos, potencialmente evitáveis no ambiente hospitalar, com gravidade categorizada em quatro estágios, desde hiperemia até exposição de estruturas profundas. Em UTIs, pacientes enfrentam alto risco de LP devido a fatores como imobilidade e uso de dispositivos médicos. Enfermeiros desempenham um papel crucial na prevenção e gestão de LP, liderando intervenções multidisciplinares para oferecer cuidados de qualidade e melhorar a implementação de medidas baseadas em evidências. Portanto, este estudo tem como objetivo investigar a fisiopatologia, visando compreender os mecanismos por trás do seu desenvolvimento e identificar fatores de risco, como também analisar e discutir estratégias de enfermagem para prevenir eficazmente as LP na UTI. Trata-se de uma revisão bibliográfica de natureza qualitativa e exploratória. Buscou-se materiais relevantes nas bases de dados da SciELO e PubMed usando os termos "Pressure Ulcer", "Intensive Care Units" e "Nurses" combinados com o conectivo "AND". Os critérios de inclusão foram artigos originais gratuitos em português, publicados nos últimos cinco anos (2019-2024), e contendo informações pertinentes ao tema proposto. Foram excluídos trabalhos incompletos, repetidos e fora do escopo da proposta. Lesões por pressão (LP) são uma séria preocupação de saúde, causando dor, imobilidade e altos custos. A prevenção envolve avaliação da pele, alívio de pressão e educação contínua dos profissionais. Estratégias incluem padronização de intervenções, equipes multidisciplinares e superfícies de suporte dinâmicas. Enfermeiros são cruciais, exigindo capacitação, desenvolvimento contínuo e proporção adequada enfermeiro-paciente para melhorar cuidados e ambiente de trabalho.

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Referências

ALI, Y. C. M. M.; SOUZA, T. M. P.; GARCIA, P. C.; NOGUEIRA, P. C. Incidência de lesão por pressão e tempo de assistência de enfermagem em terapia intensiva. Estima, v. 18, 2020.

ALOWENI, F.; GUNASEGARAN, N.; LIM, S.H.; LEOW, B. W; AGUS, N.; GOH, I. Q.; ANG, S.Y. Socio-economic and environmental factors associated with community-acquired pressure injuries: A mixed method study. Journal of Tissue Viability, v. 33, n. 1, p. 27-42, 2024.

ALSHAHRANI, B.; SIM, J.; MIDDLETON, R. Nursing interventions for pressure injury prevention among critically ill patients: A systematic review. Journal of Clinical Nursing, v. 30, n. 15-16, p. 2151-2168, 2021.

AVSAR, P.; MOORE, Z.; PATTON, D. Dressings for preventing pressure ulcers: how do they work?. Journal of Wound Care, v. 30, n. 1, p. 33-39, 2021.

BARAKAT-JOHNSON, M.; LAI, M.; WAND, T.; WHITE, K. A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, v. 26, n. 1, p. 95-102, 2019.

BARDIN, L. Análise de conteúdo. 4. ed. Lisboa: Edições70, 2010.

BLACKBURN, J.; OUSEY, K.; TAYLOR, L.; MOORE, B.; PATTON, D.; MOORE, Z.; AVSAR, P. The relationship between common risk factors and the pathology of pressure ulcer development: a systematic review. Journal of wound care, v. 29, n. Sup3, p. S4-S12, 2020.

CANER, M.; KARACI, Y.; KARASAKAL, S.; TÜRE ÖZDAG, N.; ERCİYASGÖKGÖZ, Z.; MERİÇ, G. Y. Bakım ünitelerinde basınç yaralanması oranlarının retrospektif incelenmesi. Sağlık ve Yaşam Bilimleri Dergisi, v. 4, n. 1, p. 190-194, 2022.

Cardano, M. Manual de pesquisa qualitativa. Uma contribuição da teoria da argumentação Petrópolis: Vozes, 2017.

CARTER, C. Critical Care Nursing in Resource Limited Environments. Routledge, 2019.

COX, J.; SCHALLOM, M. Pressure injuries in critical care patients: a conceptual schema. Advances in Skin & Wound Care, v. 34, n. 3, p. 124-131, 2021.

COYER, Fiona; CHABOYER, Wendy; LIN, Frances; DOUBROVSKY, Anna; BARAKAT-JOHNSON, Michelle; BROWN, Wendy; LAKSHMANAN, Ramanathan; LESLIE, Gavin; JONES, Sarah L.; PEARSE, India; MARTIN, Kerrie; MCINNES, Elizabeth; POWELL, Madeleine; MITCHELL, Marion L.; SOSNOWSKI, Kellie; TALLOT, Mandy; THOMPSON, Amy; THOMPSON, Lorraine; LABEAU, Sonia; BLOT, Stijn. Pressure injury prevalence in Australian intensive care units: A secondary analysis. Australian Critical Care, v. 35, n. 6, p. 701-708, 2022.

EBI, W. E.; HIRKO, Getahun Fetensa; MIJENA, Diriba Ayala. Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: a cross-sectional study design. BMC nursing, v. 18, p. 1-12, 2019.

ENGELEN, M.; DULMEN, S. V. VERMEULEN, H.; LAAT, Erik de; GAAL, Betsie van. The content and effectiveness of self-management support interventions for people at risk of pressure ulcers: A systematic review. International Journal of Nursing Studies, v. 122, p. 104014, 2021.

FOURIE, A.; AHTIALA, M.; BLACK, J.; HEVIA, H.; COYER, F.; GEFEN, A.; LEBLANC, K.; SMET, S.; VOLLMAN, K.; WALSH, Y.; BEECKMAN, D. Skin damage prevention in the prone ventilated critically ill patient: A comprehensive review and gap analysis (PRONEtect study). Journal of tissue viability, v. 30, n. 4, p. 466-477, 2021.

GASPAR, S.; PERALTA, M.; MARQUES, A.; BUDRI, A.; MATOS, M. G. de. Effectiveness on hospital‐acquired pressure ulcers prevention: a systematic review. International wound journal, v. 16, n. 5, p. 1087-1102, 2019.

GEFEN, A; BRIENZA, D. M.; CUDDIGAN, J.; HAESLER, E; KOTTNER, J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. International wound journal, v. 19, n. 3, p. 692-704, 2022.

GEFEN, A; CREEHAN, S; BLACK, J. Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: a scoping review. International Wound Journal, v. 17, n. 5, p. 1405-1423, 2020.

GHAZANFARI, M. J; KARKHAH, S; MAROUFIZADEH, S; FAST, O.; JAFARAGHAEE, Fateme; GHOLAMPOUR, Mohammad Hashem; ZEYDI, Amir Emami. Knowledge, attitude, and practice of Iranian critical care nurses related to prevention of pressure ulcers: a multicenter cross-sectional study. Journal of tissue viability, v. 31, n. 2, p. 326-331, 2022.

HAESLER, E. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Ulcer Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline, p. 95-101, 2014.

HAJHOSSEINI, B.; LONGAKER, M. T.; GURTNER, G. C. Pressure injury. Annals of surgery, v. 271, n. 4, p. 671-679, 2020.

JACQ, G. et al. Prevalence of pressure injuries among critically ill patients and factors associated with their occurrence in the intensive care unit: The PRESSURE study. Australian Critical Care, v. 34, n. 5, p. 411-418, 2021.

KIM, J. et al. Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of nursing management, v. 30, n. 5, p. O1-O9, 2022.

KUNIMITSU, M. et al. Dissemination of microbiota between wounds and the beds of patients with pressure injuries: a cross-sectional study. Wound Practice & Research: Journal of the Australian Wound Management Association, v. 29, n. 2, p. 70-76, 2021.

LEVINE, J. M. Pressure Injury and Chronic Wounds. In: Geriatric Medicine: A Person Centered Evidence Based Approach. Cham: Springer International Publishing,. p. 1-28, 2023.

Levorci Neto, Antonio; Jacubus, Artur Eugênio. Práticas de gestão do conhecimento em instituições federais de ensino superior: uma pesquisa exploratória. 2016.

LI, Z. et al. Registered nurses’ approach to pressure injury prevention: A descriptive qualitative study. Journal of advanced nursing, v. 78, n. 8, p. 2575-2585, 2022.

LIN, Frances; ZIJING, Wu; SONG, Bing; COYER, Fiona; CHABOYER, Wendy. et al. The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: a systematic review. International Journal of Nursing Studies, v. 102, p. 103483, 2020.

MARCHÉ, C. et al. The frictional energy absorber effectiveness and its impact on the pressure ulcer prevention performance of multilayer dressings. International Wound Journal, v. 21, n. 4, p. e14871, 2024.

MCEVOY, N. et al. The economic impact of pressure ulcers among patients in intensive care units. A systematic review. Journal of Tissue Viability, v. 30, n. 2, p. 168-177, 2021.

MCGEE, W. et al. Pressure injuries at intensive care unit admission as a prognostic indicator of patient outcomes. Critical Care Nurse, v. 39, n. 3, p. 44-50, 2019.

MKOKA, D. et al. perceptions on barriers for implementing pressure ulcers preventive measures among critically ill patients at a tertiary teaching hospital, Tanzania. International Journal of Africa Nursing Sciences, v. 20, p. 100676, 2024.

MONACO, D. et al. Outcomes of wound care nurses’ practice in patients with pressure ulcers: an integrative review. Journal of clinical nursing, v. 30, n. 3-4, p. 372-384, 2021.

NIEMIEC, S. et al. Role of microRNAs in pressure ulcer immune response, pathogenesis, and treatment. International journal of molecular sciences, v. 22, n. 1, p. 64, 2020.

NPIAP; EPUAP; PPPIA. Painel Consultivo Nacional sobre Úlcera de Pressão, Painel Consultivo Europeu sobre Úlcera de Pressão e Aliança Pan-Pacífico para Lesões por Pressão. Prevenção e tratamento de úlceras por pressão: guia de referência rápida [Internet]. Perth: Cambridge Media; 2014. Disponível em: https://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf. Acesso em: 27 mai 2024.

PITTMAN, J. et al. Hospital-acquired pressure injuries in critical and progressive care: avoidable versus unavoidable. American journal of critical care, v. 28, n. 5, p. 338-350, 2019.

RIGAZZI, Johanna; FÄHNDRICH, Carina; OSINGA, Rik; BAUMGARTNER, Sandro; BAUMBERGER, Michael; KREBS, Jörg; SCHAEFER, Dirk Johannes; VOGT, Markus; WETTSTEIN, Reto; SCHEEL-SAILER, Anke. Osteomyelitis and antibiotic treatment in patients with grade IV pressure injury and spinal cord lesion—a retrospective cohort study. Spinal Cord, v. 60, n. 6, p. 540-547, 2022.

SATO, L. et al. Incidence of hospital acquired pressure injury in critically ill patients with COVID-19 in prone position admitted to the intensive care unit. Medicine, v. 102, n. 18, p. e33615, 2023.

SOARES, C. et al. Deborah Rachel Audebert Delage. Revisão integrativa: conceitos e métodos utilizados na enfermagem. Revista da Escola de Enfermagem da USP, v. 48, n.2, p. 335-345, 2014.

TANNER, L. et al. Keeping patients under the damage threshold for pressure injury: addressing microclimate through allostasis. Journal of Nursing Care Quality, v. 36, n. 2, p. 169-175, 2021.

TAYLOR, C. et al. Barriers and enablers to the implementation of evidence‐based practice in pressure ulcer prevention and management in an integrated community care setting: A qualitative study informed by the theoretical domains framework. Health & social care in the community, v. 29, n. 3, p. 766-779, 2021.

MENGIST, S. et al. Pressure ulcer prevention knowledge, practices, and their associated factors among nurses in Gurage Zone Hospitals, South Ethiopia, 2021. SAGE Open Medicine, v. 10, p. 20503121221105571, 2022.

VATHULYA, M. et al. Adipose Tissue in Peripheral Obesity as an Assessment Factor for Pressure Ulcers. Advances in Wound Care, v. 12, n. 9, p. 513-528, 2023.

WANG, Z. et al. Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study. Frontiers in Medicine, v. 10, p. 1131270, 2023.

WAUGH, S. et al. Methods and processes used to collect pressure injury risk and prevention measures in the National Database of Nursing Quality Indicators®(NDNQI®). Journal of Nursing Care Quality, v. 35, n. 2, p. 182-188, 2020.

WOODROW, P. Intensive care nursing: a framework for practice. Routledge, 2018.

ZHANG, X. et al. Mechanical stress regulates autophagic flux to affect apoptosis after spinal cord injury. Journal of Cellular and Molecular Medicine, v. 24, n. 21, p. 12765-12776, 2020.

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2024-09-02 — Atualizado em 2024-09-02

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Figueiredo , A. A. de, Sousa , E. C. B. T. de, Carneiro , C. R., & Pereira , T. K. A. (2024). Prevenir e tratar escaras na UTI: O papel do enfermeiro e estratégias eficazes de cuidado . Revista Brasileira De Educação E Saúde, 14(3), 639–650. https://doi.org/10.18378/rebes.v14i3.10880

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