Weaning : A Critical Element

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

Another ethical implication is whether or not the patient will be able to be removed from the ventilator after being placed on it. Studies have shown that patients who are on ventilators for long periods of time become dependent on the ventilator and are unable to be removed from it. For some very ill patients, there is still a risk for ventilator dependence even if the intubation is for a short time. The patient may be at risk for having to be attached for a substantial period of time to the device that he explicitly refused, if he is ever able to come off of it (Purro er al., 2010).

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

Terminal weaning is when mechanical ventilation is discontinued for a patient expected to die without its support (Knight & Espinosa, 2010). One of the most common methods of discontinuation is through slowly reducing the fraction of inspired oxygen (Knight & Espinosa, 2010). Terminal extubation is the removal of the endotracheal tube, and this can be done “during or after a terminal weaning process” (Knight & Espinosa, 2010, p. 527). Removal of life-supporting interventions is the cause of most deaths in critical care units (Knight & Espinosa, 2010). Knight and Espinosa (2010) discussed palliative sedation and terminal weaning in the same chapter because the two topics go together.

UE is a serious event that presents as a patient safety and quality improvement concern in the critically ill infant in the NICU. An UE is the premature removal of the endotracheal tube per the patient or staff (accidentally or deliberately) while a patient is receiving invasive mechanical assistance. This occurrence can have significant risk consequences and is considered a potentially life threatening event due to the loss of airway control and mechanical support. Sometimes it is possible for the infant to develop hypercarbia, hypoxia, airway trauma, ventilator-associated pneumonia, intraventricular hemorrhage, and

In this study, patients that had been ventilated in the intensive care unit from April to November of 2010 were included. There were few ways that the person could be excluded, these were if the patient had cardiac arrhythmias or severe obesity. All of the patients were monitored vary closely, such as with an electrocardiogram, invasive and non-invasive arterial pressure, and percutaneous

You have a patient who has been on a ventilator for 3 weeks. What should be you highest assessment priority that needs to be obtained before beginning the weaning process?

The nature of the study recommended in the paper was to assess the effects of protocolized weaning from mechanical ventilation on the total duration of mechanical ventilation for critically ill adults and ascertain differences between protocolized and non-protocolized weaning in terms of adverse events, mortality, quality of life, weaning duration, intensive care unit (ICU) and hospital length of stay (LOS) and explore the variation in outcomes by the type of ICU, type of protocol and approach to delivering the protocol.

The title clearly represents the main topic and population of the study – the changes that occur in medical care when a person is placed on a Do-Not-Resuscitate order and pediatric oncology patients. The abstract capably depicts the problem that is being addressed, the results from the study, and the implications of the study. The methods for gathering data are also included in the abstract. The abstract may benefit from including the limitations of this research study, specifically that this study focused on one hospital; therefore, the results may not be able to be generalized to other populations. Overall, the abstract is written well.

Having a patient on life support is a mentally challenging and exhausting time for the patient’s family members. It is an even more mentally exhausting for that patients attending healthcare provider. As Advanced practice nurse step more into the role of primary attending healthcare provider, they are faced with the dilemma of how and when to wean a patient from a ventilator without causing the patient any psychological distress. Many healthcare facilities have a written protocol on specific criteria that the patient needs to meet before terminal weaning is considered. Even if these criteria are met, a family can object to the wean and prevent it from happening. There is certain thing that the advanced practice nurse must think about before considering to discontinue life support. These include, patient’s quality of life, family of the patient and their concerns, hospital protocol, and most importantly, the wishes of the patient.

Taba et al., stated that “Effective implementation of clinical practice guidelines requires a comprehensive approach beyond simply publishing and disseminating documents” (2012, 5). Other healthcare professionals beside the nurse and the respiratory who play a major role in the endotracheal intubation/mechanical ventilation is the physicians. The subcommittee set the clinical practice guidelines at the UMH for the physician in the intubation procedure to follow in maintaining and restoring the patient’s health. According to their healthcare practice guidelines, the physicians have to order an X-ray post intubation, to also order the medication to administer according to the patient’s needs.

Hence, there may be an obvious need for mechanical ventilation during respiratory insufficiency but there is a need to note its deleterious effect on prolonged usage (3) also, criteria for extubation must consider the relative risk of reintubation (12).Thus a protocol /guidelines is/are to be defined for a relative period of time for extubation of the patient or need for prolonged intubation to avoid re-intubation and its complications.

Background: Backrest elevation is one of the most frequently performed nursing activities in the critical care, often providing an essential focus for planning other nursing activities. Aim of the study was to examine the effect of backrest elevation on oxygenation and hemodynamic status among mechanically ventilated critically ill patients after Coronary artery bypass graft surgery. Setting: The study was conducted at the open heart surgery Intensive Care Unit (ICU) at Menoufia University Hospital. Sample: A convenient sample of fifty critically ill patients who were admitted to the open heart surgery ICU. Design: A quasi- expermental design was utilized. Tools: A Semi Structured Demographic Questionnaire, Cardiorespiratory Parameters Questionnaire,

Intubation and mechanical ventilation is a common life-saving intervention that is used in the hospital when the patient does not have adequate oxygenation or airway. It can be used to replace or assist a patient’s spontaneous breathing. In order to manage the ventilation settings you have to set the time, volume, flow and airway pressure. If the wrong settings are used it can cause ventilator-induced lung injury due to the over-distention of the lungs. The patient can be extubated when the physician determines that the problem has been solved and that the patient has adequate oxygenation and ventilation.