Oxigenoterapia inalatória para adultos e pessoas idosas em clínica médica: construção e validação do protocolo de indicação e ajuste

Abstract

Introduction: Oxygen therapy consists of the administration of oxygen in a concentration higher than that of ambient air, according to the patient's physiological demand and through an adequate interface. It is often used in hospital wards and lacks systematization of therapeutic practices, based on available evidence on the subject. In this way, the positive impact of the institution of a care protocol on the optimization and innovation of practices, on the quality of care provided, and on the reduction of costs involved, is considered. Objectives: To study inhaled oxygen therapy in hospitalized elderly people, based on the collection of evidence in a Systematic Review of the literature, to support the construction of a care protocol. Method: This research is part of the line of research: Quality in Adult Care. It is divided into two studies. The first study is a systematic review carried out according to the methodological procedure proposed by the Cochrane Handbook, in order to answer the research question: “What evidence is available on the use of inhaled oxygen therapy in hospitalized elderly people?”. The studies were evaluated according to the AMSTAR2 scale for evaluating the methodological quality of Systematic Reviews. A qualitative synthesis of the results was carried out, in order to better present the identified evidence, according to the contexts of use of oxygen therapy in hospital wards, considering the heterogeneity of identified contexts. The second study is a methodological study of the construction and validation of an assistance protocol for the indication and adjustment of inhaled oxygen therapy for the elderly in clinical medicine, whose theoretical framework was based on the systematic review of the first study. The construction of the protocol was carried out according to the model of the State Department of Health of the Federal District, based on the evidence of the Systematic Review carried out and main oxygen therapy guidelines. Content validation was carried out by a Committee of Experts, selected from among the professionals on the staff of the State Department of Health of the Federal District, who judged the instrument in terms of the following aspects: Objectives; Contents; Language; Relevance; Functionality and Usability. Results: The Systematic Review showed that the evidence is consistent regarding the indication of inhaled oxygen therapy in the presence of hypoxemia, however there is a lack of evidence to support its use and recommendation in clinical contexts in the absence of hypoxemia. The constructed protocol had its content validation carried out by a Committee of Experts, in a single round of judgment, with an average Content Validity Index of 0.99, which makes the content of the protocol appropriate and relevant. Developed products: Systematic Literature Review and Assistance Protocol. Conclusions: The validated protocol was sent for evaluation by the Functional Health Services Management, for the start of the regular procedures for proposing and implementing protocols by the State Department of Health of the Federal District, which involves the Permanent Commission for Health Care Protocols ( CPPAS), which is responsible for guiding the preparation, review and implementation of care protocols.