title: [The assistance of the ventilated infant: role of the nurse in the management of the endotracheal tube].
abstract: One of the principal duties of a staff nurse working in a NICU is the assistance of the ventilated infants. The management of the endotracheal tube is a key moment in the neonatal care and it is fundamental to prevent the ventilator induced lung injury and the change in the perfusion (especially in the brain) that may determine an impairment of gas exchange. Therefore, the role of the staff nurse is to guarantee that the tube remains correctly placed and firmly fixed in order to avoid tubes displacement and accidental extubations. High production of bronchial secretion may lead to a tube obstruction, partial or complete, that can cause formation of atelectasic areas as consequence of impaired ventilation. Tracheal suction may reduce this adverse event, but it is associated with hypoxic events, cardiocirculatory instability and can determine an increase in the endocranial pressure. Actually the scientific literature is poor in guidelines about the frequency, the duration, the level of pressure and the material to use in tracheal suctioning. The tracheal suction is a complicated intervention; to be well performed, it needs the nurse having a good observation capacity, a knowledge of the infant's pulmonary disease and, moreover, it requires that the nurse is acknowledged of the modality of the respiratory assistance of the infant. Therefore, this procedure is specifically patient-oriented. In this review we analyze the scientific literature about the nurse management of the ventilated infant, and we report our personal experience about the strategy in reducing adverse effects as the loosing of end expiration lung volume and the accidental extubations.
authors.affiliation: Unità Operativa di Neonatologia e Terapia Intensiva Neonatale, Fondazione MBBM, Azienda Ospedaliera San Gerardo, Monza, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Galbusera
authors.forename: A M
authors.initials: AM
authors.lastname: Battan
authors.forename: N
authors.initials: N
authors.lastname: Mandelli
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000517:prevention & control; D001980:Bronchi / Q000378:metabolism; D004868:Equipment Failure; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods*; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000451:nursing*; D024802:Nurse's Role; D010371:Pediatric Nursing / Q000193:education / Q000379:methods; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods / Q000451:nursing*; D012129:Respiratory Function Tests; D012769:Shock / Q000209:etiology / Q000517:prevention & control; D013396:Suction / Q000451:nursing