Clinical indicators of ineffective airway clearance in children with congenital heart disease.
OBJECTIVE
To analyse the sensitivity and specificity of clinical indicators of ineffective airway clearance in children with congenital heart disease and to identify the indicators that have high predictive power.


BACKGROUND
The precise establishment of nursing diagnoses has been found to be one of the factors contributing to higher quality of care and cost reduction in healthcare institutions. The use of indicators to diagnose ineffective airway clearance could improve care of children with congenital heart disease. Design. Longitudinal study.


METHODS
Participants consisted of 45 children, <or=1 year of age, with congenital heart disease, who had not had definitive or palliative surgical correction. Six assessments were made at 2-day intervals. Each clinical indicator was defined based on previously established operational criteria. Sensitivity, specificity and positive and negative predictive values of each indicator were calculated based on a model for the longitudinal data.


RESULTS
A nursing diagnosis of ineffective airway clearance was made in 31% of patients on the first assessment, rising to 71% on the last assessment, for a 40% increase. Sensitivity was highest for Changes in Respiratory Rates/Rhythms (0.99), followed by Adventitious Breath Sounds (0.97), Sputum Production (0.85) and Restlessness (0.53). Specificity was higher for Sputum Production (0.92), followed by Restlessness (0.73), Adventitious Breath Sounds (0.70) and Changes in Respiratory Rates/Rhythms (0.17). The best positive predictive values occurred for Sputum Production (0.93) and Adventitious Breath Sounds (0.80).


CONCLUSIONS
Adventitious Breath Sounds followed by Sputum Production were the indicators that had the best overall sensitivity and specificity as well as the highest positive predictive values.


CONCLUSIONS
The use of simple indicators in nursing diagnoses can improve identification of ineffective airway clearance in children with congenital heart disease, thus leading to early treatment of the problem and better care for these children.
da Silva
Viviane Martins
VM
Federal University of Ceará, Espenanto, Fortaleza-Ceará, Brazil.
Lopes
Marcos Venícios de Oliveira
MV
de Araujo
Thelma Leite
TL
Ciol
Marcia Aparecida
MA
de Carvalho
Emília Campos
EC
D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000451:nursing / Q000503:physiopathology; D000403:Airway Resistance; D016001:Confidence Intervals; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000451:nursing / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009733:Nursing Diagnosis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011595:Psychomotor Agitation; D011787:Quality of Health Care; D056152:Respiratory Rate; D012135:Respiratory Sounds; D012680:Sensitivity and Specificity; D013183:Sputum / Q000378:metabolism