scholarly journals Metode Penyapihan Ventilasi Mekanik Di Intensive Care Unit: Studi Literatur

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Sarinti Sarinti ◽  
Reni Sulung Utami ◽  
Awal Prasetyo
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Nursing ◽  
Literature Study ◽  
Ventilation Weaning ◽  
Mechanical Ventilation Weaning ◽  
Google Search ◽  
Care Nursing

Latar belakang : Pasien di ICU ( Intensive Care Unit ) yang membutuhkan bantuan ventilasi mekanik hampir mencapai 30% dari total pasien. Ventilasi mekanik yang digunakan dalam jangka panjang dapat meningkatkan resiko terjadinya mortalitas, dan ventilator associated pneumonia sehingga diperlukan perencanaan penyapihan yang tepat.  Tujuan : Studi literatur ini bertujuan untuk mengidentifikasi metode penyapihan pasien dari ventilasi mekanik di ICU. Metode : Penelusuran literatur dilakukan melalui database Google scholar dan Google search dengan menggunakan kata kunci weaning mechanical ventilation, weaning protocol, critical care nursing. Literatur yang digunakan dari tahun 1997-2015 dalam bentuk full text. Literatur yang sesuai kriteria inklusi dan eksklusi dianalisis secara narasi. Hasil: Penelusuran mendapatkan 7 artikel penelitian yang menunjukkan metode penyapihan pasien dari ventilasi mekanik. Metode penyapihan dari ke 7 artikel tersebut adalah metode protokol dan non protokol. Metode non protokol misalnya physician direct weaning ( PDW ) dan collaboration weaning plan ( CWP ). Metode penyapihan dengan protokol antara lain : nurse` protokol directed weaning ( NPDW ) dan protokol base weaning ( PBW ). Kesimpulan : Metode penyapihan protokol menunjukkan hasil lebih efektif dibandingkan metode non protokol. Kata Kunci: Penyapihan Ventilasi Mekanik, Protokol Penyapihan, Keperawatan Kritis Methode of Weaning from Mechanical Ventilation in Intensive Care Unit : Study Literature ABSTRACT Back ground : patients in the ICU who require mechanical ventilation assistance almost 30% of the total patients. Mechanical ventilation is used in the long term can increase the risk of mortality and ventilator associated pneumonia so that proper planning is necessary weaning. Objectives : the literature study aims to identify methods of weaning patients from mechanical ventilation in the ICU. Methods : the literature study search pass through by Google scholar and Google search using keywords weaning mechanical ventilation, weaning protocol, critical care nursing. Literature is used from the year 1997-2015 in the form of full text. Appropriate literature inclusion and exclusion criteria were analyzed narrative. Results : search get 7 articles studies showing methods of weaning patients from mechanical ventilation. Method of weaning to the article 7 is the method protocol and non-protocol. Methods of non protocols eg physician-direct weaning ( PDW ) and collaboration weaning plan ( CWP ). Methods of weaning protocols include: nurse` protocol directed weaning (NPDW) and protocols base weaning ( PBW ). Conclusion : the method of weaning protocol shows the results more effective than non - protocol methods Key word : weaning mechanical ventilation; weaning protocol; critical care nursing

Improving Adherence to a Mechanical Ventilation Weaning Protocol for Critically Ill Adults: Outcomes After an Implementation Program

2006 ◽  
Vol 15 (3) ◽  
pp. 299-309 ◽  
Author(s):  
Suzanne E. McLean ◽  
Louise A. Jensen ◽  
Dallas G. Schroeder ◽  
Noel R. T. Gibney ◽  
Neil M. Skjodt
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Multidisciplinary Team ◽  
Safety Climate ◽  
Ventilator Associated Pneumonia ◽  
Implementation Program ◽  
General Systems ◽  
Ventilation Weaning ◽  
Mechanical Ventilation Weaning

• Background Despite multiple reminders, education sessions, and multidisciplinary team involvement, adherence to an evidence-based mechanical ventilation weaning protocol had been less than 1% in a general systems intensive care unit since implementation. • Objective To assess the effectiveness of using an implementation program, the Model for Accelerating Improvement, to improve adherence and clinical outcomes after restarting a mechanical ventilation weaning protocol in an adult general systems intensive care unit. • Methods A prospective comparative design, before and after implementation of the Model for Accelerating Improvement, was used with a consecutive sample of 129 patients and 112 multidisciplinary team members. Clinical outcomes were rate of unsuccessful extubations, rate of ventilator-associated pneumonia, and duration of mechanical ventilation; practice outcomes were staff’s understanding of the mechanical ventilation weaning protocol, perceptions of the practice safety climate, and adherence to the weaning protocol. • Results After the intervention, the rate of unsuccessful extubations decreased, and staff’s understanding of and adherence to the weaning protocol increased significantly. The rate of ventilator-associated pneumonia, duration of mechanical ventilation, and staff’s perceptions of the practice safety climate did not change significantly. • Conclusion Implementing the Model for Accelerating Improvement improved understanding of and adherence to protocol-directed weaning and reduced the rate of unsuccessful extubations.

Telenursing in the Intensive Care Unit: Transforming Nursing Practice

2012 ◽  
Vol 32 (6) ◽  
pp. 62-69 ◽  
Author(s):  
Lisa-Mae Williams ◽  
Kenneth E. Hubbard ◽  
Olive Daye ◽  
Connie Barden
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Nursing Practice ◽  
Care Patient ◽  
Critical Care Nursing ◽  
Telecommunication Technology ◽  
Use Of Technology ◽  
The Impact ◽  
Care Nursing

In tele–intensive care units, informatics, telecommunication technology, telenursing, and telemedicine are merged to provide expert, evidence-based, and cutting-edge services to critically ill patients. Telenursing is an emerging subspecialty in critical care that is neither well documented in the extant literature nor well understood within the profession. Documentation and quantification of telenursing interventions help to clarify the impact of the telenurse’s role on nursing practice, enhancement of patient care, patient safety, and outcomes. Tele–intensive care unit nursing will continue to transform how critical care nursing is practiced by enhancing/leveraging available resources through the use of technology.

scholarly journals Basic Competence of Intensive Care Unit Nurses: Cross-Sectional Survey Study

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Riitta-Liisa Lakanmaa ◽  
Tarja Suominen ◽  
Marita Ritmala-Castrén ◽  
Tero Vahlberg ◽  
Helena Leino-Kilpi
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Nursing Care ◽  
Critical Care Nursing ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Competence Scale ◽  
Intensive Care Unit Nurses ◽  
Care Nursing

Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1–5, 1 = poor and 5 = excellent) was employed among Finnish intensive care unit nurses (n=431). Intensive care unit nurses’ self-assessed basic competence was good (mean 4.19, SD 0.40). The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses’ basic competence was their experience of autonomy in nursing care (Fvalue 60.85,β0.11, SE 0.01, andP≤0.0001). Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses’ experienced autonomy in nursing.

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

2007 ◽  
Vol 16 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Louise Rose ◽  
Sioban Nelson ◽  
Linda Johnston ◽  
Jeffrey J. Presneill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Interdisciplinary Collaboration ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Royal Melbourne Hospital ◽  
Adult Intensive Care Unit ◽  
Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

scholarly journals Residual Neuromuscular Blockade in Critical Care

2012 ◽  
Vol 32 (3) ◽  
pp. e1-e10 ◽  
Author(s):  
Jason Wilson ◽  
Angela S. Collins ◽  
Brea O. Rowan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Neuromuscular Blockade ◽  
Upper Airway ◽  
Surgical Interventions ◽  
Residual Neuromuscular Blockade ◽  
Factors Affecting ◽  
Anesthesia Time

Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

scholarly journals Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialized hospital, northwest Ethiopia: A prospective observational cohort study

2020 ◽  
Author(s):  
Nahom Worku Teshager ◽  
Ashenafi Tazebew Amare ◽  
koku Tamirat
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Pediatric Critical Care ◽  
Predictors Of Mortality

Abstract Background Pediatric intensive care unit (PICU) tremendously improves the success of saving patients having potentially life-threatening illness. An accurate estimate of lives saved through pediatric critical care intervention is important to evaluate the quality of the health care system. Data on pediatric critical care in developing countries remain scarce yet is much needed to improve clinical practices and outcomes. This study aimed to determine the incidence and predictors of mortality in the pediatric intensive care unit in the study setting.Method An institution based prospective cohort study was conducted from February 2018 to July 2019. We collected data by interview, chart and registration book review. Life table was used to estimate the cumulative survival of patients and Log rank test was used to compare survival curves between different categories of the explanatory variables. Survival trend over the follow up time was described using the Kaplan Meier graph. Bivariate and multivariate Cox proportional hazard model were used to identify predictors.Result Based on the 10 th version of international classifications of disease (ICD) of WHO, neurologic disorders (22.7%) infectious disease (18.8%) and environmental hazards (11.8%) account for the top three diagnoses. The median observation time was 3 days with IQR of 1 to 6 days. Of the total of 313 participants, 102 (32.6%) died during the follow-up time. This gives the incidence of mortality of 6.9 deaths per 100 person day observation. Caregivers’ occupation of government-employed (AHR=0.35, 95%CI: 0.14, 0.89), weekend admission (AHR=1.63, 95%CI: 1.02, 2.62), critical illness (AHR=1.79, 95%CI: 1.13, 2.85) Mechanical ventilation AHR=2.36,95%CI: 1.39, 4.01)and PIM2 score (AHR=1.53, 95%CI: 1.36, 1.72) were predictors of mortality in the pediatric ICU.Conclusion Neurologic disorder was the leading causes of admission followed by infectious diseases, and environmental hazards. Rate of mortality was high and admission over weekends, caregivers' occupation, mechanical ventilation, critical illness diagnosis, and higher PIM2 scores were found to be significant and independent predictors of mortality at the PICU. This suggests that ICU medical equipment, diagnostics, and interventions should be available up to the standard. Intensivist and full staffing around the clock has to be available in the PICU.

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