Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis

Jordan, Joanne; Rose, Louise; Dainty, Katie N.; Noyes, Jane; Blackwood, Bronagh

doi:10.1002/14651858.cd011812.pub2

Cited by 43 publications

(39 citation statements)

References 85 publications

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“…Given that data on treatment outcomes generated by local clinical trials is rarely available, health professionals [46][47][48]. Local characteristics require that bundles and protocols developed in resource-rich countries be adapted before implementation in resource-limited settings [49,50]. For example, most sub-Saharan countries lack resources to implement all components of the Surviving Sepsis Campaign Guidelines, but local modification might allow the implementation of specific life-saving interventions [51].…”

Section: Gaps In Evidence For Best Practicesmentioning

confidence: 99%

Global Critical Care: Moving Forward in Resource-Limited Settings

Dı́az

Riviello

Papali

et al. 2019

Annals of Global Health

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IntroductionCritical care is an important component of health care systems around the world (Figure 1). Caring for critically ill patients in resource-rich settings typically involves treatment in intensive care units (ICUs) staffed with highly specialized health care professionals, systematic monitoring and use of high-cost technology [1]. Unfortunately, these components are not always available in resource-limited settings [2, 3], where the burden of disease is greater [4], outcomes are poorer [5, 6], and local characteristics require context-specific approaches to the organization of critical care services.Critical care delivery, education, and research require a global perspective based on epidemiologic considerations. The burden of critical illness in resource-limited settings is not well described, but the best available estimates suggest that it may be greater than in resource-rich settings [7, 8] due to deficiencies in access to health care, emergency triage, and lack of early recognition [9][10][11]. Mortality for adults with sepsis [5, 12, 13] and acute respiratory distress syndrome (ARDS) [14][15][16] in resource-limited settings is higher than in resource-rich settings, and decedents are usually young (mean age 35 years vs. 61 years in United States) [12,17], which contributes to a greater negative downstream social and economic impact. Similarly, there is a higher burden of sepsis and respiratory infection mortality among children [18][19][20][21]. Recent epidemiological changes in global health have created a ' double burden of disease' to resource-limited settings [9,22] due to an increase in the prevalence of non-communicable diseases combined with lack of improvement in the long-recognized higher burden of communicable diseases, maternal and child mortality, malnutrition, and human immunodeficiency virus (HIV)-related complications.Health care professionals from resource-rich and resource-limited settings should take a global perspective on critical care for both ethical and practical reasons. Ethically, health care professionals, trainees, professional societies, non-governmental organizations (NGOs), and international organizations from resource-rich settings have the capacity of deploying resources to improve outcomes for critically ill patients in resource-limited settings [11,23,24]. Assistance can include financial help, knowledge exchange in the form of research and educational partnerships, and capacity building in operations and implementation science. From a practical point of view, supporting resource-limited settings is also important given that inter-related economies, Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and in...

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Section: Gaps In Evidence For Best Practicesmentioning

confidence: 99%

Global Critical Care: Moving Forward in Resource-Limited Settings

Dı́az

Riviello

Papali

et al. 2019

Annals of Global Health

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“…In a large international survey on peri-extubation practices (112/162 NICUs), most respondents chose 24 (30%), 48 (22%), or 72 h (41%) [27]. Finally, clinician perceived lack of efficacy or awareness, NICU culture and policies, and overlooking/overemphasising clinical judgement may contribute to variability in extubation practices [28].…”

Section: Introductionmentioning

confidence: 99%

Effects of an extubation readiness test protocol at a tertiary care fully outborn neonatal intensive care unit

Mandhari¹,

Finelli²,

Chen³

et al. 2019

Can J Respir Ther

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Background and objectivesExtubation readiness testing (ERT) in the Neonatal Intensive Care Unit (NICU) is highly variable and lacking standardized criteria. To address this gap, an evidence-based, inter-professionally developed ERT protocol was implemented to assess effectiveness on extubation failure within 72 h and on duration of intubation (DOI).MethodsA longitudinal retrospective chart review in a level III, fully outborn NICU, of intubated infants admitted 1-year prior (Group 1), and 1 year after implementation (Group 2). Patients were extubated if they passed a 2-stage ERT protocol (3 min continuous positive airway pressure (CPAP) followed by 7 min CPAP + pressure support). Descriptive, comparative statistics, and univariate and multiple logistic regression were completed on all patients and a ≤32 6/7 weeks subgroup (intubated at day-of-life 1); p < 0.05 is considered significant.ResultsAll patients (n = 589 (n = 294 Group 1, n = 295 Group 2)) were included (preterm, intubated day of life one subgroup: n = 42 Group 1, n = 38 Group 2). For all patients, extubation failure decreased significantly from 9.9% to 4.1% (p = 0.006); Group 1 patients were 2.42 times more likely to experience extubation failure compared with Group 2. Extubation failure in the preterm subgroup decreased from 21.7% to 2.6% (p = 0.01); Group 1 patients were 10.71 times more likely to experience extubation failure. Median DOI was similar in both groups for all patients and in the preterm subgroup.ConclusionsA unique two-stage ERT protocol was effective at reducing extubation failure rate, without increasing DOI, largely in preterm infants. The evidence-based, interprofessionally developed ERT protocol and its integration into the NICU culture largely contributed to its success.

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“…Although it may be difficult to observe similarities in barriers when comparing individual studies, the use of a conceptual framework such as CFIR allows implementation researchers to classify barriers into major domains and themes. As Table 1 [10 ▪▪ ,38 ▪▪ ,39 ▪▪ ,40–42 ▪ ,48 ▪▪ ,49 ▪▪ ,53 ▪▪ ]demonstrates, the recent literature has identified a multitude of barriers that fall within all five CFIR domains, although most studies have investigated barriers in the inner setting and individuals domains. Having a systematically derived catalog of barriers allows implementation researchers and clinicians to design and evaluate implementation strategies that are targeted correctly, allowing for the greatest chance of success in improving the adoption of evidence-based practice.…”

Section: Resultsmentioning

confidence: 99%

“…Jordan et al [40 ▪ ] conducted a qualitative evidence review of 11 studies that reported on the facilitators and barriers to implementation of protocols for ventilator weaning. Many barriers were identified, and can be grouped into three themes: barriers related to clinician knowledge and personal values and priorities (CFIR individuals), barriers related to practical arrangements for care such as ICU structure, resources, and staffing (CFIR inner setting), and professional practice such as training and experience, perceived confidence, and inter-professional relationships (CFIR individuals, inner setting, and process).…”

Section: Bundled Management Of Mechanically Ventilated Patientsmentioning

confidence: 99%

Why do we fail to deliver evidence-based practice in critical care medicine?

Weiss

2017

Current Opinion in Critical Care

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Purpose of review The use of evidence-based practices in clinical practice is frequently inadequate. Recent research has uncovered many barriers to the implementation of evidence-based practices in critical care medicine. Using a comprehensive conceptual framework, this review identifies and classifies the barriers to implementation of several major critical care evidence-based practices. Recent findings The many barriers that have been recently identified can be classified into domains of the consolidated framework for implementation research (CFIR). Barriers to the management of patients with acute respiratory distress syndrome (ARDS) include ARDS under-recognition. Barriers to the use of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle for mechanically ventilated patients and the sepsis bundle include patient-related, clinician-related, protocol-related, contextual-related, and intervention-related factors. Although these many barriers can be classified into all five CFIR domains (intervention, outer setting, inner setting, individuals, and process), most barriers fall within the individuals and inner setting domains. Summary There are many barriers to the implementation of evidence-based practice in critical care medicine. Systematically classifying these barriers allows implementation researchers and clinicians to design targeted implementation strategies, giving them the greatest chance of success in improving the use of evidence-based practice.

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Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis

Abstract: 2016). Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative-evidence synthesis. Cochrane database of systematic reviews (Online), (10).

Cited by 43 publications

References 85 publications

Global Critical Care: Moving Forward in Resource-Limited Settings

Global Critical Care: Moving Forward in Resource-Limited Settings

Effects of an extubation readiness test protocol at a tertiary care fully outborn neonatal intensive care unit

Why do we fail to deliver evidence-based practice in critical care medicine?

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