Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: A systematic review and meta-analysis

Qi, Zhi-Dong; Yang, Sibo; Qu, Jingdong; Li, Ming; Zheng, Junbo; Huang, Rui; Yang, Zhenyu; Han, Qiuyuan; Li, Haibo

doi:10.1016/j.aucc.2020.07.013

Cited by 19 publications

(8 citation statements)

References 38 publications

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“…Conversely, nurses are often involved in the titration of sedatives, analgesics, and vasopressors. As described above, previous studies have suggested that nurse-led sedation protocols lead to favorable outcomes [21]. From a patient-centered point of view, these contribute to optimal outcomes.…”

Section: Discussionmentioning

confidence: 85%

Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey

et al. 2021

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This study aimed to estimate the number of nurses who independently care for patients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous extracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. We performed a cross-sectional study using postal questionnaire surveys. The study included 725 Japanese intensive care units (ICUs). Data were analyzed using descriptive statistics. Among the 725 ICUs, we obtained 302 responses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% (IQR: 42.3–77.3). The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7–63.3%) in the ICUs that had experience with VV-ECMO use. With regard to task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always titrated sedative dosage in 44.5% of ICUs. Nurse staffing might be inadequate in all ICUs, especially for the management of patients with severe respiratory failure. The proportion of competent nurses to care for severe respiratory failure in ICUs should be considered when determining the workforce of nurses.

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Section: Discussionmentioning

confidence: 85%

Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey

et al. 2021

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“…For example, implementation of nurse-driven protocols has been associated with decreased mechanical ventilation days and ICU length of stay, 19 increased survival to hospital discharge after a resuscitation event, 20 and decreased ICU mortality. 21 These studies provide additional support for the positive outcomes associated with nursedriven protocols. Given the evidence supporting both the safety of peripherally infusing vasopressors and the benefits of nurse-driven protocols, a quality improvement project was developed to implement an evidence-based, nurse-driven protocol for the peripheral administration of vasopressors.…”

Section: Available Knowledgementioning

confidence: 83%

“…Nurse-driven protocols allow nurses to provide early interventions and have been shown to affect patient outcomes positively in many areas of critical care management. For example, implementation of nurse-driven protocols has been associated with decreased mechanical ventilation days and ICU length of stay, 19 increased survival to hospital discharge after a resuscitation event, 20 and decreased ICU mortality 21 . These studies provide additional support for the positive outcomes associated with nurse-driven protocols.…”

Section: Available Knowledgementioning

confidence: 87%

Reducing Central Line Utilization by Peripherally Infusing Vasopressors

Coyer

Carlucci

2023

Dimens Crit Care Nurs

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BackgroundCentral line–associated bloodstream infection is a preventable contributor to excess death and excess cost in the health care system. Vasopressor infusion is one of the primary reasons for central line placement. In the medical intensive care unit (MICU) at an academic medical center, there was no standard practice for peripheral versus central infusion of vasopressors.ObjectiveThe objective of this quality improvement project was to implement an evidence-based, nurse-driven protocol to guide the peripheral infusion of vasopressors. The goal was to reduce central line utilization by 10%.MethodsEducation on the protocol was provided to the MICU nurses, MICU residents, and crisis nurses, followed by a 16-week implementation period. Nursing staff were also surveyed preimplementation and postimplementation of the protocol.ResultsCentral line utilization was reduced by 37.9%, and there were no central line–associated bloodstream infections recorded during project implementation. Most of the nursing staff indicated that use of the protocol increased their confidence in administering vasopressors without a central line. No significant extravasation events occurred.DiscussionAlthough a causal link between implementation of this protocol and reduction of central line utilization cannot be established, the reduction is clinically meaningful given the known risks of central lines. Increased nursing staff confidence also provides support for continued use of the protocol.ConclusionA nurse-driven protocol to guide the peripheral infusion of vasopressors can be effectively implemented into nursing practice.

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“…As described above, previous studies have suggested that nurse-led sedation protocols lead to favorable outcomes. [20] From a patient-centered point of view, these contribute to optimal outcomes. It is important to promote task-sharing, to reduce the burden on intensivists and improve the outcomes of critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Workforce and Task Sharing For Nurses in the Japanese Intensive Care Unit -Cross Sectional Postal Survey

Unoki¹,

Kawai²,

Hamamoto³

et al. 2021

Preprint

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Aim: The aim of this study was to estimate the number of nurses who independently care for pa-tients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous ex-tracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. Methods: We conducted a cross-sectional study using postal surveys. The study included 725 Japanese intensive care units (ICUs). Descriptive statistics were conducted. Results: Among the 725 ICUs, we obtained 302 re-sponses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% [IQR: 42.3-77.3]. The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7-63.3%) in the ICU experiencing VV-ECMO use. Concerning task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always ti-trated sedatives in 44.5% of ICUs. Conclusion: Nurse staffing might be inadequate in all ICUs, es-pecially for severe respiratory failure. The proportion of competent nurses for caring for severe respiratory failure in ICUs should be considered when determining the work force of nurses.

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Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: A systematic review and meta-analysis

Abstract: Please cite this article as: Qi Z et al., Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: A systematic review and meta-analysis, Australian Critical Care,

Cited by 19 publications

References 38 publications

Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey

Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey

Reducing Central Line Utilization by Peripherally Infusing Vasopressors

Workforce and Task Sharing For Nurses in the Japanese Intensive Care Unit -Cross Sectional Postal Survey

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