Instrumentos de detecção precoce de deterioração clínica e prevenção de parada cardiorrespiratória: Revisão integrativa

Autores/as

DOI:

https://doi.org/10.21527/2176-7114.2025.50.13957

Palabras clave:

Parada Cardiorrespiratória, Escore de Alerta Precoce, Deterioração Clínica

Resumen

Este estudo tem por objetivo identificar os instrumentos de detecção precoce de deterioração clínica e a usabilidade para prevenção de parada cardiopulmonar. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados Medical Literature Analysis and Retrieval System Online; Literatura Latino-Americana e do Caribe em Ciências da Saúde; e Banco de Dados em Enfermagem. Foram identificados 242 artigos, dos quais 12 foram selecionados para a síntese descritiva. Destacou-se que a maioria das publicações ocorreu entre 2015 e 2022, com um pico em 2021 (33,3%). Os países mais representados foram os Estados Unidos, o Reino Unido e Taiwan, com o National Early Warning Score (NEWS) sendo o instrumento mais utilizado (33,3%). Todos os estudos demonstraram que os instrumentos de detecção precoce de deterioração clínica, como NEWS e MEWS, foram eficazes na prevenção de eventos adversos, como parada cardiorrespiratória e óbito. Dessa forma, conclui-se que o uso de instrumentos de detecção de deterioração clínica possui aplicabilidade em diversos contextos hospitalares e pode apoiar a detecção de parada cardiorrespiratória e outros eventos adversos, contribuindo para melhoria da segurança do paciente e para qualidade da assistência em saúde.

Referencias

1 Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: building a safer health system [Internet]. 1st ed. Washington, D.C.: Committee on Quality of Health Care in America; 2000. 287 p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225182/

2 Albalawi A, Kidd L, Cowey E. Factors contributing to the patient safety culture in Saudi Arabia: a systematic review. BMJ Open [Internet]. 2020 Oct. 14;10(10):e037875. Available from: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2020-037875

3 Xavier DM, Vettorello JS, Galvão DM, Redü A de O, Martins CF, Cezar-Vaz MR. Raciocínio clínico no trabalho do enfermeiro: dificuldades, fragilidades e estratégias em unidades de internação hospitalar. Res Soc Dev [Internet]. 2022 Sept. 22;11(12):e502111234812. Available from: https://rsdjournal.org/index.php/rsd/article/view/34812

4 Velasco-Sanz TR, Rayón-Valpuesta E. Instrucciones previas en cuidados intensivos: competencias de los profesionales sanitarios. Med Intensiva [Internet]. 2016 Apr.;40(3):154-162. Available from: https://dx.doi.org/10.1016/j.medin.2015.04.011

5 Daly KJ, Camporota L, Barrett NA. An international survey: the role of specialist nurses in adult respiratory extracorporeal membrane oxygenation. Nurs Crit Care [Internet]. 2017 Sept.;22(5):305-311. Available from: https://onlinelibrary.wiley.com/doi/10.1111/nicc.12265

6 Camelo SHH. Professional competences of nurse to work in Intensive Care Units: an integrative review. Rev Lat Am Enfermagem [Internet]. 2012 Feb;20(1):192–200. DOI: https://doi.org/10.1590/S0104-11692012000100025

7 Al-Moteri M, Plummer V, Cooper S, Symmons M. Clinical deterioration of ward patients in the presence of antecedents: A systematic review and narrative synthesis. Aust Crit Care [Internet]. 2019 Sept.;32(5):411–20. DOI: https://doi.org/10.1016/j.aucc.2018.06.004

8 Freitas C, Preto E, Nascimento C. Nursing interventions for the early detection of ward patients’ clinical deterioration: an integrative review. Rev Enferm Ref [Internet]. 2017 Sept. 29;IV Série(No 14):121-132. DOI: https://doi.org/10.12707/RIV17025

9 Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation [Internet]. 2021 Apr.;161:152-219. DOI: https://dx.doi.org/10.1016/j.resuscitation.2021.02.011

10 Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 Oct. 20;142(16_suppl_2):S366-468. DOI: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916

11 Xiong W, Lu L, Zhang B, Luo J, Li W, He L, et al. Association of consciousness impairment and mortality in people with COVID‐19. Acta Neurol Scand [Internet]. 2021 Sept. 24;144(3):251-259. DOI: https://onlinelibrary.wiley.com/doi/10.1111/ane.13471

12 Nascimento JDSG, Macedo GDO, Borges GB. Poder preditivo de uma escala de alerta precoce para deterioração clínica de pacientes críticos. Rev Enferm da UFSM [Internet]. 2020 Jan. 8;10:e5. Available from: https://periodicos.ufsm.br/reufsm/article/view/38300

13 Oliveira APA de, Urbanetto J de S, Caregnato RCA. National Early Warning Score 2: transcultural adaptation to Brazilian Portuguese. Rev Gaúcha Enferm [Internet]. 2020;41:15. DOI: https://dx.doi.org/10.1590/1983-1447.2020.20190424

14 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs [Internet]. 2005 Dec.;52(5):546-553. DOI: http://doi.wiley.com/10.1111/j.1365-2648.2005.03621.x

15 Santos CMDC, Pimenta CADM, Nobre MRC. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem [Internet]. 2007 June;15(3):508-11. DOI: https://doi.org/10.1590/S0104-11692007000300023

16 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan – a web and mobile app for systematic reviews. Syst Rev [Internet]. 2016 Dec. 5;5(1):210. DOI: http://dx.doi.org/10.1186/s13643-016-0384-4

17 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med [Internet]. 2009 July 21;6(7):e1000097. Available from: https://dx.plos.org/10.1371/journal.pmed.1000097

18 Su C-F, Chiu S-I, Jang J-SR, Lai F. Improved inpatient deterioration detection in general wards by using time-series vital signs. Sci Rep [Internet]. 2022 Dec. 13;12(1):11901. DOI: https://dx.doi.org/10.1038/s41598-022-16195-2

19 Akel MA, Carey KA, Winslow CJ, Churpek MM, Edelson DP. Less is more: Detecting clinical deterioration in the hospital with machine learning using only age, heart rate, and respiratory rate. Resuscitation [Internet]. 2021 Nov.;168(773):6-10. DOI: https://dx.doi.org/10.1016/j.resuscitation.2021.08.024

20 Badr M, Khalil N, Mukhtar A. Effect of National Early Warning Scoring System Implementation on Cardiopulmonary Arrest, Unplanned ICU Admission, Emergency Surgery, and Acute Kidney Injury in an Emergency Hospital, Egypt. J Multidiscip Healthc [Internet]. 2021 June;14:1431-1442. DOI: https://dx.doi.org/10.2147/JMDH.S312395

21 Bhatnagar M, Sirohi N, Dubey A. Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS): Indian experience. J Fam Med Prim Care [Internet]. 2021;10(1):192. DOI: https://dx.doi.org/10.4103/jfmpc.jfmpc_1426_20

22 Pimentel MAF, Redfern OC, Malycha J, Meredith P, Prytherch D, Briggs J, et al. Detecting Deteriorating Patients in the Hospital: Development and Validation of a Novel Scoring System. Am J Respir Crit Care Med [Internet]. 2021 July 1;204(1):44-52. DOI: https://dx.doi.org/10.1164/rccm.202007-2700OC

23 Wu C-L, Kuo C-T, Shih S-J, Chen J-C, Lo Y-C, Yu H-H, et al. Implementation of an Electronic National Early Warning System to Decrease Clinical Deterioration in Hospitalized Patients at a Tertiary Medical Center. Int J Environ Res Public Health [Internet]. 2021 Apr. 25;18(9):4550. DOI: https://dx.doi.org/10.3390/ijerph18094550

24 Shamout FE, Zhu T, Sharma P, Watkinson PJ, Clifton DA. Deep Interpretable Early Warning System for the Detection of Clinical Deterioration. IEEE J Biomed Heal Informatics [Internet]. 2020 Feb.;24(2):437-446. DOI: https://dx.doi.org/10.1109/JBHI.2019.2937803

25 Bedoya AD, Clement ME, Phelan M, Steorts RC, O’Brien C, Goldstein BA. Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration. Crit Care Med [Internet]. 2019 Jan.;47(1):49-55. Available from: http://journals.lww.com/00003246-201901000-00007

26 Spagnolli W, Rigoni M, Torri E, Cozzio S, Vettorato E, Nollo G. Application of the National Early Warning Score (NEWS) as a stratification tool on admission in an Italian acute medical ward: A perspective study. Int J Clin Pract [Internet]. 2017 Mar.;71(3-4):e12934. DOI: https://dx.doi.org/10.1111/ijcp.12934

27 Montenegro SMSL, Miranda CH. Evaluation of the performance of the modified early warning score in a Brazilian public hospital. Rev Bras Enferm [Internet]. 2019 Dec;72(6):1428-1434. DOI: https://dx.doi.org/10.1590/0034-7167-2017-0537

28 Kang MA, Churpek MM, Zadravecz FJ, Adhikari R, Twu NM, Edelson DP. Real-Time Risk Prediction on the Wards. Crit Care Med [Internet]. 2016 Aug.;44(8):1468-1473. Available from: http://journals.lww.com/00003246-201608000-00003

29 So S-N, Ong C-W, Wong L-Y, Chung JYM, Graham CA. Is the Modified Early Warning Score able to enhance clinical observation to detect deteriorating patients earlier in an Accident; Emergency Department? Australas Emerg Nurs J [Internet]. 2015 Feb.;18(1):24-32. DOI: https://dx.doi.org/10.1016/j.aenj.2014.12.001

30 Al-Moteri M, Plummer V, Cooper S. Decision-Making Errors During Recognizing and Responding to Clinical Deterioration: Gaze Path-Cued Retrospective Think-Aloud. Clin Simul Nurs [Internet]. 2022 Dec.;73(2015):29-36. DOI: https://doi.org/10.1016/j.ecns.2022.08.002

Publicado

2025-08-06

Número

Sección

Artigo de Revisão

Cómo citar

Instrumentos de detecção precoce de deterioração clínica e prevenção de parada cardiorrespiratória: Revisão integrativa. (2025). Revista Contexto & Saúde, 25(50), e13957. https://doi.org/10.21527/2176-7114.2025.50.13957