Medicine III Department, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil.
J Pediatr (Rio J). 2011 Nov-Dec;87(6):487-92. doi: 10.2223/JPED.2140. Epub 2011 Nov 8.
To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units.
This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times.
Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events.
The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes.
探讨高危新生儿病房中新生儿机械通气期间，工作人员工作强度与中等不良事件（如意外拔管、气管内管阻塞和呼吸机回路意外断开）之间的可能关联。
本前瞻性队列研究分析了巴西东北部马拉尼昂州圣路易斯市 543 名新生儿的数据，这些新生儿来自公立新生儿重症监护病房（NICU），研究时间为 6 个月，期间 136 名新生儿在 1108 个班次中接受了机械通气，共观察了 4554 次。
在此期间发生了 117 次不良事件。通过广义估计方程分析了工作量与不良事件之间的关联。调整变量包括：出生体重、性别、产科单位、婴儿临床风险指数（CRIB）评分和护理需求，后者由北方新生儿网络评分（NNN）测量。每名护士和护理技师所负责的新生儿分类护理需求（NCCD）数量越多，与机械通气相关的中等不良事件发生的可能性就越大。护士的 NCCD > 22 个（相对风险 [RR] = 2.86）和辅助护士的 NCCD > 4.8 个（RR = 3.41）与中等不良事件的更高发生率相关。
NICU 专业人员的工作量似乎会影响新生儿护理的中间结果，因此在评估 NICU 结果时应考虑到这一点。
