Effectiveness of Applying a Bundle of Care on Weaning among Mechanical Ventilated Patients in Intensive Care Unit and cardiac Care Unit

El-Hosseini, Amani Sallam; Shahin, Eman; Ibrahim EL-Tahry, Sheren

doi:10.21608/pssjn.2022.102905.1158

Effectiveness of Applying a Bundle of Care on Weaning among Mechanical Ventilated Patients in Intensive Care Unit and cardiac Care Unit

Document Type : Original Article

Authors

¹ Medical-Surgical Department-Faculty of Nursing, Port-Said University

² Faculty of Nursing-Port Said university Medical Surgical Nursing

10.21608/pssjn.2022.102905.1158

Abstract

Background: Applying of ventilator bundle of care according to evidence-based practice guidelines are expected to improve weaning, provide quality of care, improve patient outcomes, and reduce the risk of complications with ventilated patients. Aim: The researchers wanted to assess how effective a bundle of care was at weaning mechanically ventilated patients in the intensive care unit and cardiac care unit. Subjects and Method: The study used a quasi-experimental research design. A purposive sample of mechanically ventilated patients (60) at both insurance hospitals (Al-Salam) in Port Said governorate and health ministry hospital (Sherbin central) in Dakahlia governorate's critical care unit and cardiac care unit. Tools: Tool I: It includes two parts, part 1: Sociodemographic characteristics, part 2: patient's assessment questions (patient's medical history), Tool (II): Is Ventilator bundle compliance checklist Tool (III): Is Burns' Wean Assessment Program (BWAP) scores. Results: This study revealed a statistically significant correlation between the studied patients’ total Burns' weaning assessment and compliance with ventilator bundle of the studied patients with p-value

Keywords

Main Subjects

Medical Surgical Nursing

References

Abbasi, S., Irajpour, A., Salmani, F.& Yazdannik, A., (2012). Application of Burn’s wean assessment program on the duration of mechanical ventilation among patients in intensive care units: A clinical trial. Iran J Nurs Midwifery Res; 17(7):520‑3.

Abdelaleem, N. A., Mohamed, S. A., Abd ElHafeez, A. S., & Bayoumi, H. A. (2020). Value of modified Burns Wean Assessment Program scores in the respiratory intensive care unit: An Egyptian study. Multidisciplinary Respiratory Medicine, 15(1).

Ahmed, R. Q., Sobeih, H. S., & Abd- elsalam, S. N. (2019). Ventilator Associated Pneumonia Bundle among Mechanically Ventilated Patient: Nurses' Perception, Medical Surgical Nursing (Critical Care Nursing), Ain Shams University, 9(2) 264-277.

Alviar, C. L., Miller, P. E., McAreavey, D., Katz, J. N., Lee, B., Moriyama, B., ... & ACC Critical Care Cardiology Working Group. (2018). Positive pressure ventilation in the cardiac intensive care unit. Journal of the American College of Cardiology, 72(13), 1532-1553.

Bonten, M.J., Klompas, M., Moons, K.G., Murphy, M.V., van & Mourik, M.S. (2015). Severity of disease estimation and risk-adjustment for comparison of outcomes in mechanically ventilated patients using electronic routine care data. Infect Control Hosp Epidemiol. ;36(7):807- 815.

Burns SM, Burns JE, Truwit JD& Orso, D. (1990). Comparison of five clinical weaning indices. Am Journal Crit Care. 3:3 42-52.

Brown, S. M., Bose, S., Banner-Goodspeed, V., Beesley, S. J., Dinglas, V. D., Hopkins, R. O., ... & Sevin, C. M. (2019). Approaches to addressing Post–Intensive care syndrome among intensive care unit survivors. A narrative review. Annals of the American Thoracic Society, 16(8), 947-956.

Danielis, M., Povoli, A., Mattiussi, E., & Palese, A. (2020). Understanding patients’ experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta‐synthesis and meta‐summary. Journal of clinical nursing, 29(13-14), 2107-2124.

Elsayed, A. E., Kandeel, N. A., & Abd El-Aziz, W. W. (2019). The Effect of Foot Reflexology on Physiological Indicators and Mechanical Ventilation Weaning Time among Open-Heart Surgery Patients. American Journal of Nursing, 7(4), 412-419. ‏

El-Sharkawy, M. A. E., Mohamed, W. Y., & Ali, N. S. (2017). Effect of ventilator bundle implementation on weaning indicator among mechanically ventilated patients at a selected private healthcare sector. Egyptian Nursing Journal, 14(1), 50.

Eweas, A. S., Mohammad, S. Y., Sayyed, J. S., Abd Elbaky, M. M., & Bayoumi, M. M. (2021). Application of modified ventilator bundle and its effect on weaning and ventilation days among critical ill patients. Evid Based Nurs Res, 2(4), 9.

Ghanbari, A., Mohammad Ebrahimzadeh, A., Paryad, E., Atrkarroshan, Z., & Mohammadi, M. (2018). Factors Affecting the Duration of Weaning from Mechanical Ventilation Based on Burn Scale in the Intensive Care Units. Avicenna Journal of Nursing and Midwifery Care, 26(1), 33-39.

Ghosh, S., Chawla, A., Mishra, K., Jhalani, R., Salhotra, R., & Singh, A. (2018). Cumulative fluid balance and outcome of extubation: a prospective observational study from a general intensive care unit. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(11), 767.

Guilhermino, M. C., Inder, K. J., & Sundin, D. (2018). Education on invasive mechanical ventilation involving intensive care nurses: a systematic review. Nursing in critical care, 23(5), 245-255.

Institute for Healthcare Improvement. (2018). Ventilator-associated pneumonia getting to zero and staying there. Retrieved from http://www.ihi.org/resources/Pages/ImprovementStories/

Institute for Healthcare Improvement. (2017). Ventilator bundle checklist.http://www.ihi.org/resources/Pages/Tools/VentilatorBundleChecklist.aspx [cited 2017 24/11].

Jeong, E. S., & Lee, K. (2018). Clinical application of modified burns wean assessment program scores at first spontaneous breathing trial in weaning patients from mechanical ventilation. Acute and critical care, 33(4), 260.

Kasem, O. A.-H., Abdel- Galeel, A. M., Abdel -Gawad, M., El- Suod, A.- H.A., & Hemdan, A. H. E.-S. (2019). Recent Predictive Parameters for Successful Weaning from Mechanical Ventilation in Critically Ill Patients. Egyptian Journal of Hospital Medicine, 75 (3), 2426- 2432.

Keykha, A., Khoshfetrat, M., Dahmardeh, A. R., Dashipour, A., Dahmardeh, M., & Sarhadi, A. (2017). Success rate of weaning from mechanical ventilation in patients admitted to the intensive care unit with utilization burns wean assessment program. Archives of Anesthesiology and Critical Care, 3(2), 319-323.

Khalil, N. S., Mohamed, W. Y., & Sharkawy, M. A. M. (2018). Patients’ weaning from mechanical ventilation: Complete versus incomplete ventilator bundle implementation. international Journal of Africa Nursing Sciences, 8(2), 28-32. https://doi.org/10.1016/j.ijans.2018.02.003.

Khammas, A. H., & Dawood, M. R. (2018). Timing of tracheostomy in intensive care unit patients. International archives of otorhinolaryngology, 22(04), 437-442.

Khan, S. H., Wang, S., Harrawood, A., Martinez, S., Heiderscheit, A., Chlan, L., ... & Khan, B. (2017). Decreasing Delirium through Music (DDM) in critically ill, mechanically ventilated patients in the intensive care unit: study protocol for a pilot randomized controlled trial. Trials, 18(1), 1-8.

Klompas, M. (2019, August). Prevention of intensive care unit-acquired pneumonia. In Seminars in respiratory and critical care medicine, 40(04) 548-557.

Kotfis, K., Marra, A., & Ely, E. W. (2018). ICU delirium—A diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiology intensive therapy, 50(2).

Louzon, P., Jennings, H., Ali, M., & Kraisinger, M. (2017). Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds. American Journal of Health-System Pharmacy, 74(4), 253-262.

Mahmoodpoor, A., Hamishehkar, H., Asghari, R., Abri, R., Shadvar, K., & Sanaie, S. (2019). Effect of a probiotic preparation on ventilator‐associated pneumonia in critically ill patients admitted to the intensive care unit: a prospective double‐blind randomized controlled trial. Nutrition in Clinical Practice, 34(1), 156-162.

Mesa, P., Previgliano, I. J., Altez, S., Favretto, S., Orellano, M., Lecor, C., ... & Ely, E. (2017). Delirium in a Latin American intensive care unit. A prospective cohort study of mechanically ventilated patients. Revista Brasileira de terapia intensiva, 29, 337-345.

Mondardini, M. C., Sperotto, F., Daverio, M., Caramelli, F., Gregori, D., Caligiuri, M. F., ... & Amigoni, A. (2019). Efficacy and safety of dexmedetomidine for prevention of withdrawal syndrome in the pediatric intensive care unit: protocol for an adaptive, multicenter, randomized, double-blind, placebo-controlled, non-profit clinical trial. Trials, 20(1), 1-9. ‏

Perkins, G. D., Mistry, D., Gates, S., Gao, F., Snelson, C., Hart, N., ... & Breathe Collaborators. (2018). Effect of protocoled weaning with early extubation to noninvasive ventilation vs invasive weaning on time to liberation from mechanical ventilation among patients with respiratory failure: the breath randomized clinical trial. Jama, 320(18), 1881-1888.

Resar, R., Pronovost, P., Haraden, C., Simmonds, T., Rainey, T., Nolan, T. (2005). Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf ;31 (5):243–248.

Sepahyar, M., Molavynejad, S., Adineh, M., Savaie, M., & Maraghi, E. (2021). The effect of nursing interventions based on burns wean assessment program on successful weaning from mechanical ventilation: A randomized controlled clinical trial. Iranian Journal of Nursing and Midwifery Research, 26(1), 34.

Vetrugno, L., Guadagnin, G. M., Brussa, A., Orso, D., Garofalo, E., Bruni, A., . . . Bove, T. (2020). Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1. Ultrasound Journal, 12(9), 2- 10.

Thille, A. W., Reynaud, F., Marie, D., Barrau, S., Rousseau, L., Rault, C., ... & Drouot, X. (2018). Impact of sleep alterations on weaning duration in mechanically ventilated patients: a prospective study. European Respiratory Journal, 51(4).

Wang, H., Wang, C., Wang, Y., Tong, H., Feng, Y., Li, M., ... & Yu, K. (2019). Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis. Current medical research and opinion, 35(3), 435-446.

Zhang, Z., Chen, K., Ni, H., Zhang, X., & Fan, H. (2017). Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis. Scientific reports, 7(1), 1-9.