Use of a Multidisciplinary Mechanical Ventilation Weaning Protocol to Improve Patient Outcomes and Empower Staff in a Medical Intensive Care Unit

Gunther, Ingrid; Pradhan, Deepak; Lubinsky, Anthony; Urquhart, Annie; Thompson, Julie; Reynolds, Staci S.

doi:10.1097/dcc.0000000000000462

Cited by 7 publications

(1 citation statement)

References 21 publications

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“…On recovery, patients need to be weaned-off (withdrawal) the MV gradually and carefully (1)(2)(3). In fact, the weaning process should be conducted with caution and consistent to reduce the time and unexpected consequences to the patients (4)(5)(6). Also, this is to comply with the indications and prevent any complications from postcardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training

Awang

Alias

DeWitt

et al. 2021

Front. Public Health

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Cardiothoracic intensive care unit (CICU) nurses have shared the role and responsibility for ventilator-weaning to expedite decision-making in patient care. However, the actions taken are based on individual's unstructured training experience as there is no clinical practice guideline (CPG) for nurses in Malaysia. Hence, this study aims to design a CPG for the process of weaning from mechanical ventilation (MV) for a structured nursing training in a CICU at the National Heart Institute (Institut Jantung Negara, IJN) Malaysia. The Fuzzy Delphi Method (FDM) was employed to seek consensus among a panel of 30 experts in cardiac clinical practice on the guidelines. First, five experts were interviewed and their responses were transcribed and analyzed to develop the items for a FDM questionnaire. The questionnaire, comprising of 73 items, was distributed to the panel and their responses were analyzed for consensus on the design of the CPG. The findings suggested that the requirements expected for the nurses include: (a) the ability to interpret arterial blood gases, (b) knowledge and skills on the basics of mechanical ventilation, and (c) having a minimum 1-year working experience in the ICU. On the other hand, the CPG should mainly focus on developing an ability to identify criteria of patient eligible for weaning from MV. The learning content should focus on: (a) developing the understanding and reasoning for weaning and extubating and (b) technique/algorithm for extubating and weaning. Also, the experts agreed that the log book/competency book should be used for evaluation of the program. The CPG for structured nursing training at IJN in the context of the study is important for developing the professionalism of CICU nurses in IJN and could be used for training nurses in other CICUs, so that decision for ventilator-weaning from postcardiac surgery could be expedited.

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Section: Introductionmentioning

confidence: 99%

Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training

Awang

Alias

DeWitt

et al. 2021

Front. Public Health

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Effectiveness of the ABCDEF Bundle to Manage and Prevent Delirium

Nagy Nagm Eldean,

Hassan Bakri,

Anwar Abdel Aziz

et al. 2024

Critical Care Nursing Quarterly

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Purpose: To investigate effectiveness of the ABCDEF bundle to manage and prevent delirium. Background: ICU delirium is a common hospital problem that 80% of critically ill patients in the ICU experience. The ABCDEF bundle is one of the tools that included in Delirium guidelines to manage critically ill patients. Research design: Pre- and post intervention a quasi-experimental design was utilized in the present study. Setting: This study was conducted in the intensive care units of Assiut University Hospital. Methods: A total of 60 mechanically ventilated patients were recruited using inclusion and exclusion criteria. The ABCDEF bundle was implemented every day for the first 7 days of ICU admission, and patient sedation and delirium status were assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Sedation instrument measures were utilized in data collection. Results: Significant differences were found in the incidence of delirium: 20% in the study group versus 70% in the control group. The increased mean of days without delirium ICU stay was 4.6333 in the study group and 1.1000 in the control group, with P value = .001. Conclusion: The mechanically ventilated patients exposed to the implementation of the ABCDE bundle experienced fewer delirium signs than before the ABCDE bundle was implemented.

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Weaning‐associated interventions for ventilated intensive care patients: A scoping review

Sterr,

Bauernfeind,

Knop

et al. 2024

Nursing in Critical Care

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BackgroundMechanical ventilation is a core intervention in critical care, but may also lead to negative consequences. Therefore, ventilator weaning is crucial for patient recovery. Numerous weaning interventions have been investigated, but an overview of interventions to evaluate different foci on weaning research is still missing.AimTo provide an overview of interventions associated with ventilator weaning.Study DesignWe conducted a scoping review. A systematic search of the Medline, CINAHL and Cochrane Library databases was carried out in May 2023. Interventions from studies or reviews that aimed to extubate or decannulate mechanically ventilated patients in intensive care units were included. Studies concerning children, outpatients or non‐invasive ventilation were excluded. Screening and data extraction were conducted independently by three reviewers. Identified interventions were thematically analysed and clustered.ResultsOf the 7175 records identified, 193 studies were included. A total of six clusters were formed: entitled enteral nutrition (three studies), tracheostomy (17 studies), physical treatment (13 studies), ventilation modes and settings (47 studies), intervention bundles (42 studies), and pharmacological interventions including analgesic agents (8 studies), sedative agents (53 studies) and other agents (15 studies).ConclusionsVentilator weaning is widely researched with a special focus on ventilation modes and pharmacological agents. Some aspects remain poorly researched or unaddressed (e.g. nutrition, delirium treatment, sleep promotion).Relevance to Clinical PracticeThis review compiles studies on ventilator weaning interventions in thematic clusters, highlighting the need for multidisciplinary care and consideration of various interventions. Future research should combine different interventions and investigate their interconnection.

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Use of a Multidisciplinary Mechanical Ventilation Weaning Protocol to Improve Patient Outcomes and Empower Staff in a Medical Intensive Care Unit

Cited by 7 publications

References 21 publications

Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training

Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training

Effectiveness of the ABCDEF Bundle to Manage and Prevent Delirium

Weaning‐associated interventions for ventilated intensive care patients: A scoping review

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