American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Many patients admitted to medical intensive care units require mechanical ventilation to assist with respiratory management. Unplanned extubations of these patients are associated with poor outcomes for patients and organizations. No previous research has investigated the role of standardized protocols in unplanned extubations when examined in conjunction with traditional risk factors. ⋯ Weaning protocols were associated with decreased incidence of unplanned extubation. Use of standardized protocols was feasible, as compliance among health care providers was high when protocols were medically prescribed. The reintubation rate in this study was low and associated with a significantly shorter ventilatory period and unit length of stay in the unplanned extubation group.
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The adverse effects of a failed ventilator weaning trial on the subsequent weaning attempts are not well understood. ⋯ Patients whose first ventilator weaning trial is unsuccessful may be markedly fearful. Left unaddressed, these fears cause high anxiety levels that significantly compromise respiratory function and contribute to subsequent weaning failures. Thus begins a vicious cycle of repeated failure of ventilator weaning and prolonged mechanical ventilation.
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A 30° head-of-bed elevation is recommended for most critically ill patients. Measuring intrabladder pressure with the patient in this position is controversial. ⋯ It is feasible to measure intrabladder pressure with a 30° head-of-bed elevation, and that position could be an alternative to supine positioning of patients for measurement of intrabladder pressure.
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Clinical decision support systems are intended to improve patients' care and outcomes, particularly when such systems are present at the point of care. Protocol Watch was developed as a bedside clinical decision support system to improve clinicians' adherence to the Surviving Sepsis Campaign guidelines. This pre/post-intervention pilot study was done to evaluate the effect of Protocol Watch on compliance with 5 guidelines from the Surviving Sepsis Campaign. ⋯ Clinical decision support systems such as Protocol Watch may improve adherence to the Surviving Sepsis Campaign guidelines, which potentially may contribute to reduced morbidity and mortality for critically ill patients with sepsis.
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Randomized Controlled Trial
Daily interruption of sedation in patients receiving mechanical ventilation.
Daily interruption of continuous infusion of sedatives has improved outcomes in patients receiving mechanical ventilation in open-label studies. ⋯ The double-blinded design for assessment of sedation interruption in patients receiving mechanical ventilation was safe and effective. Slow recruitment of patients and frequent noncompliance with the protocol suggest that modifications to the protocol are needed.