Construção de Bundle para prevenção da injúria renal aguda em pacientes críticos

Abstract

Acute kidney injury is described in the literature as a deterioration in kidney function due to multifactorial causes, which results in a decrease in glomerular filtration capacity and can develop suddenly and reversibly. Despite advances in the treatment of this syndrome, there is still a high incidence of this condition in the hospital environment, especially in the context of the intensive care unit. Thus, the complications resulting from this condition contribute substantially to an increase in hospitalization time, treatment costs and the risk of morbidity and mortality. However, despite its deleterious clinical repercussions, it should be reiterated that it is a reversible condition, provided there is timely and tangible intervention. In this scenario, nurses play a strategic role in the early identification of clinical signs and symptoms that warn of a worsening condition in critically ill patients. The aim of this study was to develop a bundle for the prevention of acute kidney injury in critically ill patients, applied by nurses. The study was carried out in two stages: in the first, a scoping review was carried out on nursing interventions and protective factors, and in the second, the prevention bundle was constructed based on the findings in the scientific literature. The bundle is a positive gain for nursing, as it standardizes and guides the conduct that should be adopted. Based on this package of measures, it is hoped that it will be possible to minimize the negative evolution of kidney health, so as to avoid the use of dialysis therapies or even kidney transplantation, which could lead to further complications and limitations in the patient's life. To this end, the bundle is structured around essential points described in the literature, such as hydroelectrolyte and acid-base regulation, nutritional aspects and adjustment and/or replacement of nephrotoxic drugs. Therefore, it is hoped that with the bundle, it will be possible to halt the progression of acute renal dysfunction, given the impasse that this syndrome represents for public health, due to the serious social, pathophysiological, psychological and socioeconomic consequences.