Elaboração de um protocolo de toracocentese e biópsia pleural: pesquisa aplicável tecnológica

Abstract

INTRODUCTION: Thoracentesis is the method of choice for obtaining fluid from pleural effusion, either for relief or diagnosis. Pleural biopsy aims to complement the diagnosis of pleural diseases, being indicated in selected cases. Although they are not very invasive procedures, it is important to follow a standardized technique to minimize risks and increase the chance of diagnosis. OBJECTIVES: To create a management protocol for performing thoracentesis and pleural biopsy. METHODS: This is a qualitative, quantitative, prospective study, with a convenience sample of the intentional and probabilistic type, for which a questionnaire was designed with direct questions related to thoracentesis and pleural biopsy procedures. The protocol was developed using the modified Delphi method (with no open questions in the first round), where, in the first round, the sentences and questions were based on a literature review and, subsequently, the application of two series of questionnaires to 15 surgeons in the North and Northeast regions of the country. RESULTS: Of 62 experts invited, 41 accessed the first questionnaire sent by e-mail, representing 66.13% of the guests. At the end of the second stage 15 thoracic surgeons (24.19%) completed the stages and all questionnaires were answered individually. In the first questionnaire, 22 questions (62.86%) had 65% or more of concordant answers and 13 questions (37.14%) had less than 65% of agreement. Those who obtained a 65% consensus formed the texts and were presented in the second questionnaire, in the form of sentences on the LIKERT scale – totally agree, agree, neutral, disagree and totally disagree. The questions that did not reach 65% of agreement were re-presented in the second questionnaire, due to their importance in the elaboration of this protocol. The answers obtained in the second stage reached consensus when the sum of the answers, I agree and I fully agree, were above 70%. Regarding thoracentesis, fifteen questions were presented in the form of sentences on the LIKERT scale, with consensus on 12 questions (80%) and three questions without consensus (20%). Eleven questions were re-presented in the second questionnaire, as they did not reach a consensus in the first stage. Of these, six (54.55%) reached more than 65%, configuring a consensus. For pleural biopsy, three questions were presented in the form of sentences on the LIKERT scale, with a 100% consensus, and two questions were presented again in the second questionnaire, as they did not reach a consensus in the first round. CONCLUSION: with the data obtained from the consensus, a thoracentesis and pleural biopsy protocol for use in medical services was developed. Keywords: Thoracic surgery. Thoracocentesis. Pleural effusion. Needle biopsy. Pneumonia.