A systematic review of nurse-led weaning protocol for mechanically ventilated adult patients.

Autor: Hirzallah FM; University of Porto, ICBAS -Instituto de Ciências Biomédicas Abel Salazar, Universityof Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Faculty of Medicine and Health Sciences, Nursing and Midwifery Department, An-Najah National University, Nablus P. O. Box 7, Palestine., Alkaissi A; Anesthesiology and Intensive Care Nursing, Dean of Nursing College, Faculty of Medicine and Health Sciences, Nursing and Midwifery Department, An-Najah National University, Nablus P. O. Box 7, Palestine., do Céu Barbieri-Figueiredo M; ESEP and integrated researcher of CINTESIS, Escola Superior de Enfermagem do Porto (ESEP), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; ICBAS -Instituto de Ciências Biomédicas Abel Salazar, Universityof Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal.
Jazyk: angličtina
Zdroj: Nursing in critical care [Nurs Crit Care] 2019 Mar; Vol. 24 (2), pp. 89-96. Date of Electronic Publication: 2019 Jan 07.
DOI: 10.1111/nicc.12404
Abstrakt: Objectives: The aim of this systematic review is to synthesize the current best evidence for the effectiveness of weaning protocols led by nurses compared with usual physician-led care.
Background: Protocol-directed weaning has been shown to reduce the duration of mechanical ventilation. Studies have reported that a weaning protocol administered by nurses leads to a reduction in the duration of mechanical ventilation and has a major effect on weaning outcomes. This can have especially positive consequences for critically ill patients.
Study Design: Systematic review with meta-analysis.
Search Strategy: The databases CINAHL, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from as far back as the database allowed until January 2016.
Inclusion and Exclusion Criteria: Searches were performed to identify the best available evidence including quantitative studies of nurse-led weaning protocols for mechanically ventilated adult patients. We excluded all studies of weaning protocols implemented by non-nurses and non-invasive mechanical ventilation and studies that addressed patient populations younger than 18 years of age.
Results: The database searches resulted in retrieving 369 articles. Three eligible studies with a total of 532 patients were included in the final review. Pooled data showed a statistically significant difference in favour of the nurse-led weaning protocol for reducing the duration of mechanical ventilation (mean differences = -1.69 days, 95% confidence interval = -3.23 to 0.16), intensive care unit length of stay (mean differences = -2.04 days, 95% confidence interval = -2.57 to -1.52, I 2  = 18%, and p = 0.00001); and hospital length of stay (mean differences = -2.9 days, 95% confidence interval = -4.24 to -1.56, I 2  = 0%, and p = 0.00001).
Conclusion: There is evidence that the use of nurse-led weaning protocols for mechanically ventilated adult patients has a positive impact on weaning outcomes and patient safety.
Relevance to Clinical Practice: This review provides evidence supporting intensive care unit nurses' crucial role and abilities to lead weaning from mechanical ventilation.
(© 2019 British Association of Critical Care Nurses.)
Databáze: MEDLINE
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