de Sousa Vanessa Emille Carvalho, Lopes Marcos Venícios de Oliveira, da Silva Viviane Martins
Federal University of Ceará, Fortaleza, Ceará, Brazil.
J Adv Nurs. 2015 Mar;71(3):498-513. doi: 10.1111/jan.12518. Epub 2014 Aug 28.
To report quantitative evidence for the accuracy of the defining characteristics of ineffective airway clearance in different settings and populations.
Defining characteristics are tests used by nurses to clinically indicate the presence or absence of a particular nursing diagnosis. A few studies have reported the accuracy of certain defining characteristics of ineffective airway clearance, but these studies address specific populations with particular needs.
A systematic review with meta-analysis was conducted to provide a synthesis and critical appraisal of the included studies.
The electronic databases CINAHL, PubMed, Scopus and LILACS were searched using a systematic search strategy for studies published in any year. The last search was performed on 31 July 2013.
Using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy and the Standards for Reporting of Diagnostic Accuracy (STARD), a systematic review was conducted using studies investigating the presence of ineffective airway clearance and its defining characteristics. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to evaluate the quality of the studies.
Seven papers met the search criteria. The studies were developed in different clinical settings and most of them fulfilled QUADAS criteria. Summary measures indicated the following defining characteristics with higher accuracy values: adventitious breath sounds, changes in respiratory rate, difficult vocalizing, diminished breath sounds, dyspnoea, ineffective cough, orthopnoea and restlessness.
This systematic review showed that the variability in clinical indicators of ineffective airway clearance is related to differences in the clinical settings and patients.
报告不同环境和人群中无效气道清除定义特征准确性的定量证据。
定义特征是护士用于临床指示特定护理诊断存在与否的测试。一些研究报告了无效气道清除某些定义特征的准确性，但这些研究针对的是有特定需求的特定人群。
进行了一项系统评价并荟萃分析，以对纳入研究进行综合和批判性评价。
使用系统检索策略对电子数据库CINAHL、PubMed、Scopus和LILACS进行检索，以查找任何年份发表的研究。最后一次检索于2013年7月31日进行。
根据Cochrane协作网关于诊断测试准确性系统评价的建议和诊断准确性报告标准（STARD），使用调查无效气道清除及其定义特征存在情况的研究进行系统评价。使用诊断准确性研究质量评估（QUADAS）工具评估研究质量。
七篇论文符合检索标准。这些研究在不同临床环境中开展，且大多数符合QUADAS标准。汇总指标显示以下定义特征具有较高的准确性值：异常呼吸音、呼吸频率变化、发声困难、呼吸音减弱（呼吸音减低）、呼吸困难、无效咳嗽、端坐呼吸和烦躁不安。
本系统评价表明，无效气道清除临床指标的变异性与临床环境和患者的差异有关。
