Desenvolvimento de protocolo de drenagem fechada de tórax em crianças para as unidades públicas de pronto atendimento de Manaus

Abstract

Background: The evaluation and treatment of patients with thoracostomy in Manaus public health system is limited due to a not adequate accessibility of means of diagnosis like sonography and tomography as long as unavailability of modern treatment resources like thoracoscopy. Besides, conducts towards these patients by the pediatric medical team may vary considerably, expressing the need of their regimentation. Objectives: Developing guidelines for tube thoracostomy in children, to be adopted by medical teams of public pediatric urgency health hospitals in Manaus city. Methods: According to the Delphi method for obtaining consensus, a specialist consultant team was assembled. It was composed by 27 health professionals, among surgeons, pediatricians and pediatric intensivists. All of them are partof the crew of the 3 public pediatric urgency hospitals in Manaus. Later, rounds of questionnaireswere applied within the members of this team. Theysurveyed about clinical, laboratorial and radiological evaluation of the pediatric patient that may go through tube thoracostomy as part of their treatment, indications for this procedure, possible associate options of treatment, surgical technic details and post-operative follow up.Results: Topics abouttrauma, parapneumonical pleural effusions, clinical, laboratorial and radiological evaluation, adequate surgical environment and alternative treatments to tube thoracostomy reached 100% of consensus throughout the questionnaires, while topics about indications for tube thoracostomy in parapneumonical pleural effusions, antibiotic use, surgical technic and post-operative follow up contained questions in disagreement. The final consensus level was 85,37%.Conclusion: In discussing this theme, which literary evidence is not sufficient, the Delphi method and its qualitative-quantitative character turned out to be a very useful tool in promoting virtual communication between the members of the experts’ team.