Execução de manobras de reanimação neonatal após treinamento com simulação realística de alta fidelidade
Data
2022-02-24
Orientadores
Almeida, Maria Fernanda Branco de 
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A simulação realística é utilizada para o treinamento de profissionais de
saúde em habilidades técnicas, cognitivas e comportamentais para aprimorar o
desempenho na prática clínica. Objetivo: Comparar o tempo de indicação e execução
dos procedimentos de reanimação neonatal realizados ao início e ao término do
treinamento com cenários de simulação realística de alta fidelidade. Método: Estudo de
intervenção realizado com 23 equipes (2 pediatras e 1 enfermeiro) provenientes de 23
maternidades públicas de 19 estados brasileiros em 2015-2016 no Laboratório de
Simulação Realística Neonatal da Universidade Federal de São Paulo. A intervenção
consistiu na atuação da equipe em diversos cenários de reanimação com simulador
neonatal computadorizado (SimNewB, Laerdal®) dirigido por facilitadores
neonatologistas por 8 horas. Os cenários foram gravados com três câmeras de alta
resolução. Após randomização por sorteio de 205 vídeos, os tempos de indicação e
execução dos procedimentos foram contados por 2 observadores independentes,
verificando-se a concordância pelo teste de correlação intraclasse. Para cada equipe,
comparou-se o tempo de indicação e de execução de cada procedimento ao início do
primeiro e ao final do último cenário pelo teste de Wilcoxon pareado. Valores são
expressos em mediana (p25-p75). Resultado: O tempo de graduação dos 46 pediatras
era de 22 anos (13-26) e dos 23 enfermeiros de 8 anos (6-14); 89% dos pediatras e 48%
dos enfermeiros recepcionavam recém-nascidos em salas de parto; 100% eram
aprovados no curso de reanimação neonatal da Sociedade Brasileira de Pediatria com
manequins de baixa fidelidade. Quanto à concordância dos valores entre os
observadores, foi quase perfeita ou substancial para a maioria dos procedimentos. O
tempo de execução dos passos iniciais da reanimação reduziu de 28,5s (19,0-43,0) para
17,5s (12,5-25,5) [p=0,003] e o tempo da instalação da oximetria de pulso foi de 47,5s
(34,0-63,5) ao início e de 36,5s (23,0- 56,0) ao final da intervenção. Houve decréscimo
no tempo para iniciar a aplicação da ventilação com pressão positiva (VPP) com máscara
facial de 37,5s (31,0-67,0) para 25,0s (18,5-39,0) [p=0,01], enquanto o número de
ventilações/minuto aumentou de 31,6 (28,0-39,7) para 37,6 (33,6-53,5) [p=0,003]. Já o
tempo de indicação de intubação orotraqueal também diminuiu de 5,0s (3,5-8,0) para 3,5s (3,0-4,5) [p=0,003], com mediana de 1 tentativa com sucesso (1-1), sem alteração
na realização da intubação em 20s (14-31) vs 17,0s (13,5-31,0). Entretanto houve
acréscimo no número de ventilações/minuto por cânula de 38,2 (31,0-47,0) para 45,9
(32,8-53,5) [p=0,003]. Quanto à relação compressões cardíacas para VPP permaneceu
em apenas em 2,6:1 (1,1-3,2) ao início e em 2,7:1 (1,7-3,2) ao final da intervenção.
Conclusão: O treinamento baseado em simulação realística de alta fidelidade em
reanimação neonatal das equipes de profissionais da saúde promove a redução do
tempo de execução dos procedimentos, principalmente dos passos iniciais e para
aplicação da VPP. Práticas periódicas em cenários de reanimação neonatal são
necessárias para a aquisição de habilidades técnicas, cognitivas e comportamentais dos
profissionais nas situações menos frequentes e de maior complexidade, como a
massagem cardíaca acompanhada da ventilação.
Introduction: Realistic simulation is applied to train health professionals in technical, cognitive, and behavioral skills, to improve performance in clinical practice. Objective: Compare, the time for performing neonatal resuscitation maneuvers by health professional teams, at the beginning and at the end of a high-fidelity realistic simulation training. Methods: Intervention study conducted with 23 teams (2 pediatricians and 1 nurse) from 23 public maternity hospitals of 19 Brazilian states between 2015-2016 at the Neonatal Realistic Simulation Laboratory of the Federal University of São Paulo. The intervention consisted of the team's performance in several resuscitation scenarios using a computerized neonatal simulator (SimNewB, Laerdal®) conducted by neonatologist facilitators for 8 hours. The scenarios were recorded with three high-resolution cameras. After randomization of 205 videos, time of indication and execution of the resuscitation maneuvers were counted by 2 independent observers, verifying the agreement by the intraclass correlation coefficient. For each team, the time of indication and execution of each maneuver was compared between the first and the last scenario by Wilcoxon pair matched test. Values are expressed as median (p25-p75). Results: The graduation median time for the 46 pediatricians was 22 years (13-26) and 8 (6-14) years for the 23 nurses; 89% of pediatricians and 48% of nurses attended newborns in delivery rooms; 100% were approved in the neonatal resuscitation course of the Brazilian Society of Pediatrics with low fidelity mannequins. There was a good and excellent agreement for most of the procedures valued by the observers. The execution time of the initial steps of resuscitation decreased from 28.5 seconds (19.0-43.0) to 17.5s (12.5-25.5) [p=0.003] and the time of pulse oximeter sensor application was 47.5s (34.0- 63.5) at the beginning and 36.5s (23.0-56.0) at the end of the intervention. There was a decrease in the time to start positive pressure ventilation (PPV) with face mask from 37.5s (31.0-67.0) to 25.0s (18.5-39.0) [p=0.01], while the number of ventilations/minute increased from 31.6 (28.0-39.7) to 37.6 (33.6-53.5) [p=0.003]. The time to indicate the intubation also decreased from 5.0s (3.5-8.0) to 3.5s (3.0-4.5) [p=0.003], with a median of 1 successful attempt (1-1), with no change in intubation in 20s (14-31) vs. 17.0s (13.5- 31.0). However, there was an increase in the number of ventilations/minute with endotracheal tube from 38.2 (31.0-47.0) to 45.9 (32.8-53.5) [p=0.003]. Regarding the chest compression to ventilation ratios, it remained in only 2.6:1 (1.1-3.2) at the beginning and in 2.7:1 (1.7-3.2) at the end of the intervention. Conclusion: Training health professionals in neonatal resuscitation by realistic high-fidelity simulation, promotes the reduction of the execution time of procedures, especially for the initial steps and for the application of PPV. Periodic practices in neonatal resuscitation scenarios are necessary for the acquisition of technical, cognitive, and behavioral skills of professionals in less frequent and more complex situations, such as chest compressions coordinated with ventilation.
Introduction: Realistic simulation is applied to train health professionals in technical, cognitive, and behavioral skills, to improve performance in clinical practice. Objective: Compare, the time for performing neonatal resuscitation maneuvers by health professional teams, at the beginning and at the end of a high-fidelity realistic simulation training. Methods: Intervention study conducted with 23 teams (2 pediatricians and 1 nurse) from 23 public maternity hospitals of 19 Brazilian states between 2015-2016 at the Neonatal Realistic Simulation Laboratory of the Federal University of São Paulo. The intervention consisted of the team's performance in several resuscitation scenarios using a computerized neonatal simulator (SimNewB, Laerdal®) conducted by neonatologist facilitators for 8 hours. The scenarios were recorded with three high-resolution cameras. After randomization of 205 videos, time of indication and execution of the resuscitation maneuvers were counted by 2 independent observers, verifying the agreement by the intraclass correlation coefficient. For each team, the time of indication and execution of each maneuver was compared between the first and the last scenario by Wilcoxon pair matched test. Values are expressed as median (p25-p75). Results: The graduation median time for the 46 pediatricians was 22 years (13-26) and 8 (6-14) years for the 23 nurses; 89% of pediatricians and 48% of nurses attended newborns in delivery rooms; 100% were approved in the neonatal resuscitation course of the Brazilian Society of Pediatrics with low fidelity mannequins. There was a good and excellent agreement for most of the procedures valued by the observers. The execution time of the initial steps of resuscitation decreased from 28.5 seconds (19.0-43.0) to 17.5s (12.5-25.5) [p=0.003] and the time of pulse oximeter sensor application was 47.5s (34.0- 63.5) at the beginning and 36.5s (23.0-56.0) at the end of the intervention. There was a decrease in the time to start positive pressure ventilation (PPV) with face mask from 37.5s (31.0-67.0) to 25.0s (18.5-39.0) [p=0.01], while the number of ventilations/minute increased from 31.6 (28.0-39.7) to 37.6 (33.6-53.5) [p=0.003]. The time to indicate the intubation also decreased from 5.0s (3.5-8.0) to 3.5s (3.0-4.5) [p=0.003], with a median of 1 successful attempt (1-1), with no change in intubation in 20s (14-31) vs. 17.0s (13.5- 31.0). However, there was an increase in the number of ventilations/minute with endotracheal tube from 38.2 (31.0-47.0) to 45.9 (32.8-53.5) [p=0.003]. Regarding the chest compression to ventilation ratios, it remained in only 2.6:1 (1.1-3.2) at the beginning and in 2.7:1 (1.7-3.2) at the end of the intervention. Conclusion: Training health professionals in neonatal resuscitation by realistic high-fidelity simulation, promotes the reduction of the execution time of procedures, especially for the initial steps and for the application of PPV. Periodic practices in neonatal resuscitation scenarios are necessary for the acquisition of technical, cognitive, and behavioral skills of professionals in less frequent and more complex situations, such as chest compressions coordinated with ventilation.