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1.
Webster J 《Nursing in critical care》2000,5(3):116-124
An idea involving the expansion of the role of the paediatric intensive care nurse and the promotion of enhanced quality patient care is presented. A point prevalence study was conducted to investigate practices in weaning from ventilation in children after cardiac surgery. The development of a clinical protocol, audit of practice, education and training and implementation of a change in practice are discussed. Recommendations for future research are made. 相似文献
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Frazier SK Moser DK Schlanger R Widener J Pender L Stone KS 《Biological research for nursing》2008,9(4):301-310
Mechanical ventilator support and the resumption of spontaneous ventilation or weaning create significant alterations in alveolar and intrathoracic pressure that influence thoracic blood volume and flow. Compensatory autonomic tone alterations occur to ensure adequate tissue oxygen delivery, but autonomic responses may produce cardiovascular dysfunction with subsequent weaning failure. The authors describe autonomic responses of critically ill patients (n = 43) during a 24-hr period of mechanical ventilatory support and during the 24 hr that included their initial spontaneous breathing trial using continuous positive airway pressure. Nearly two thirds of these patients demonstrated abnormal autonomic function and this dysfunction was more severe in those patients who were unable to sustain spontaneous ventilation (n = 15). With further systematic study, autonomic responses may be useful in the identification of patients who are likely to develop cardiac dysfunction with the resumption of spontaneous breathing. 相似文献
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Fifty-eight long-term survivors of mechanical ventilation have been traced and examined for evidence of auditory, visual, behavioural, developmental and central nervous system abnormalities. There were four children with serious neurological or intellectual handicaps, the causes of which did not seem to be related to deficiencies of their ventilator treatment but rather to events preceding ventilation or to the disease which had necessitated ventilation. There were an additional eight children who may have some intellectual damage. The occurrence of convulsions or hypoxic episodes during or preceding the period of treatment was significantly more common among the 12 children with a poor outcome, than those with a good outcome. 相似文献
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Louise Rose Sioban Nelson Linda Johnston Jeffrey J Presneill 《American journal of critical care》2007,16(5):434-43; quiz 444
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. 相似文献
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A Bowling J Formby 《Nursing standard (Royal College of Nursing (Great Britain) : 1987)》1992,6(29):28-30
This paper reports the data on accidents from a randomised controlled trial evaluating health authority-funded nursing home and long stay care of the elderly ward care in one inner London health district. Respondents randomised to NHS nursing homes experienced a higher accident rate than respondents randomised to conventional long stay hospital wards for elderly people. Respondents in the homes also experienced an earlier decline in functional and mental ability than those in hospital. These disadvantages have to be balanced against the previously published observational data from the evaluation, which clearly indicated that quality of life in the homes was superior to that in the wards. The conclusion from this study is that earlier decline in functional and mental ability and increased accident risk in the more flexible environments of the nursing homes have to be balanced against an inferior quality of life in the large hospital long stay wards. 相似文献
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A Bowling J Formby K Grant 《Nursing standard (Royal College of Nursing (Great Britain) : 1987)》1992,6(31):25-27
This paper reports the data on accidents from a randomised controlled trial evaluating health authority-funded nursing home and long stay care of the elderly ward care in one inner London health district. Respondents randomised to NHS nursing homes experienced a higher accident rate than respondents randomised to conventional long stay hospital wards for elderly people. Respondents in the homes also experienced an earlier decline in functional and mental ability than those in hospital. These disadvantages have to be balanced against the previously published observational data from the evaluation, which clearly indicated that quality of life in the homes was superior to that in the wards. The conclusion from this study is that earlier decline in functional and mental ability and increased accident risk in the more flexible environments of the nursing homes have to be balanced against an inferior quality of life in the large traditional hospital wards; such assessments are not easy to make on behalf of other people. This final part of the report details the authors' conclusions. 相似文献
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OBJECTIVE: To standardise the paediatric intensive care unit (PICU) team's approach to weaning paediatric patients from mechanical ventilation. METHOD: The study employed a time series design over 2 years. A total of 220 patients (pre-intervention n=107 and post-intervention n=113) were studied. Independent variables measured in both the pre- and post-intervention groups included total ventilation time (TVT), weaning duration (WD), and length of stay (LOS), as well as quality indicators (weaning failure and reintubation rates). RESULTS: The pre-intervention analysis demonstrated an existing fluctuation between outcome variables. When outcome indicators were compared between the pre- and post-intervention groups, both TVT and LOS were longer post-intervention (median difference: TVT -15.8 hours, P<0.068; and LOS -23.75 hours, P<0.088). WD was comparable between groups (median difference: WD -1.5 hours, P<0.427). Quality indicators were better post-intervention. Kaplan-Meier survival analysis demonstrated that long-term ventilated patients post-intervention had a reduced probability of remaining ventilated. CONCLUSION: Weaning children from mechanical ventilation can be performed safely and effectively with the aid of collaborative guidelines. Although times were prolonged, the quality indicators were slightly improved, indicating that quicker was not always better. Long-term ventilated patients, in particular, would appear to benefit from weaning guidelines. 相似文献
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Decisions to withdraw life-sustaining therapy are being made more often as patients and healthcare providers increase their awareness of patient rights. The process of withdrawal of mechanical ventilation must be conducted in a humane fashion. An understanding of the ethical, legal and practical considerations for patient management during this type of intervention will enhance the ability of the healthcare provider to participate. 相似文献
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J. A. Farias I. Alía A. Esteban A. N. Golubicki F. A. Olazarri 《Intensive care medicine》1998,24(10):1070-1075
Objective: The development of weaning predictors in mechanically ventilated children has not been sufficiently investigated. The purpose
of this study was to evaluate the accuracy of some weaning indices in predicting weaning failure. Design: Prospective, interventional study. Setting: University-affiliated children's hospital with a 19-bed intensive care unit. Patients: 84 consecutive infants and children requiring mechanical ventilation for at least 48 h and judged ready to wean by their
primary physicians. Interventions: Patients who met the criteria to start weaning underwent a trial of spontaneous breathing lasting up to 2 h. Bedside measurements
of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5
min of spontaneous breathing. The primary physicians were blinded to those measurements, and the decision to extubate a patient
at the end of the spontaneous breathing trial or reinstitute mechanical ventilation was made by them. Failure to wean was
defined as the requirement for mechanical ventilation at any time during the trial of spontaneous breathing (trial failure)
or needing reintubation within 48 h of extubation (extubation failure). Measurements and main results: Seventy-five patients had neither signs of respiratory distress nor deterioration in gas exchange during the trial and were
extubated. Twelve patients required reintubation within 48 h. In 9 patients, mechanical ventilation was reinstituted after
a median duration of the spontaneous breathing trial of 35 min. The only independent predictor of trial failure was tidal
volume indexed to body weight [odds ratio 2.60, 95 % confidence interval (CI) 1.40 to 24.9]. The only independent predictor
of extubation failure was frequency-to-tidal volume ratio indexed to body weight (odds ratio 1.23, 95 % CI 1.11 to 1.36).
The sensitivity, specificity, and positive and negative predictive values to predict weaning failure were calculated for each
of the above variables. These values were 0.48, 0.86, 0.53, and 0.83, respectively, for a frequency-to-tidal volume ratio
higher than 11 breaths/min per ml per kg and 0.43, 0.94, 0.69, and 0.83, respectively, for a tidal volume lower than 4 ml/kg.
Conclusions: Three-quarters of ventilated children can be successfully weaned after a trial of spontaneous breathing lasting 2 h. Both
tidal volume and frequency-to-tidal volume ratio indexed to body weight were poor predictors of weaning failure in the study
population.
Received: 20 February 1998 Accepted: 10 June 1998 相似文献
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Jae Hyung RohAra Synn RN Chae-Man LimHee Jung Suh RN Sang-Bum HongJin Won Huh MD Younsuck Koh 《Journal of critical care》2012
Purpose
The primary objective of this clinical trial of patients on mechanical ventilation was to determine if a weaning protocol implemented solely by nurses could reduce the weaning time relative to usual care (UC).Materials and Methods
This study is a prospective, randomized, controlled trial conducted from January 2007 to January 2009 that compared protocol-based weaning (PBW) with UC. A total of 122 patients who received invasive ventilation in the medical ICU of the Asan Medical Center were examined. Nurses operated the mechanical ventilators according to a predesigned ventilator-weaning protocol for the PBW group (n = 61), and intensive care unit (ICU) physicians managed weaning in the UC group (n = 61).Results
There were no significant differences in the 2 groups at baseline. The number of patients who successfully discontinued mechanical ventilation was similar in the 2 groups (PBW, 46 patients, 75.4%; UC, 47 patients, 77.0%; P = .832). The weaning time was 47 hours (interquartile range, 24-168 hours) in the UC group and 25 hours (interquartile range, 5.75-134 hours) in the PBW group (P = .010).Conclusions
The weaning protocol administered by the nurses was safe and reduced the weaning time from mechanical ventilation in patients who were recovering from respiratory failure. 相似文献14.
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Randomised controlled trial comparing cisatracurium and vecuronium infusions in a paediatric intensive care unit 总被引:2,自引:1,他引:2
Objective To evaluate and compare the efficacy, infusion rate and recovery profile of vecuronium and cisatracurium continuous infusion in critically ill children requiring mechanical ventilation.Design and setting Prospective, randomised, double-blind, single-centre study in critically ill children in a paediatric intensive care unit in a tertiary childrens hospital.Methods Thirty-seven children from 3 months to 16 years old (median 4.1 year) were randomised to receive either drug; those already receiving more than 6 h of neuromuscular blocking drugs were excluded. The Train-of-Four (TOF) Watch maintained neuromuscular blockade to at least one twitch in the TOF response. Recovery time was measured from cessation of infusion until spontaneous TOF ratio recovery of 70%.Results The cisatracurium infusion rate in nineteen children averaged 3.9±1.3 µg kg–1 min–1 with a median duration of 63 h (IQR 23–88). The vecuronium infusion rate in 18 children averaged mean 2.6±1.3 µg kg–1 min–1 with a median duration of 40 h (IQR 27–72). Median time to recovery was significantly shorter with cisatracurium (52 min, 35–73) than with vecuronium (123 min, 80–480). Prolonged recovery of neuromuscular function (>24 h) occurred in one child (6%) on vecuronium.Conclusions Recovery of neuromuscular function after discontinuation of neuromuscular blocking drug infusion in children is significantly faster with cisatracurium than vecuronium. Neuromuscular monitoring was not sufficient to eliminate prolonged recovery in children on vecuronium infusions. 相似文献
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目的 对应用自主呼吸试验(SBT)撤机方式与逐渐降低机械通气支持水平撤机方式成功拔管的患者进行比较,以寻找最佳撤机方式.方法 选择57例机械通气患者,病情稳定后通过撤机试验前评估,然后准备撤机.采用前后对照的方法将患者分为两组,2004年6月-2005年12月的21例患者作为对照组,采用逐渐降低机械通气支持水平的撤机方式拔管;2006年1月-2007年3月的36例患者作用为试验组,采用SBT的撤机方式拔管.分别观察两组患者的机械通气时间、住重症监护病房(ICU)时间、呼吸机相关性肺炎(VAP)发生率、48 h内再插管率、ICU病死率.结果 试验组与对照组的机械通气时间分别为(59.45±37.1)h和(111.4±59.8)h(P=0.001),住ICU时间分别为(8.0±5.5)d和(15.3±14.3)d(P=0.034),VAP发生率分别为16.7%和38.0%(P=0.070),48 h内再插管率分别为19.4%和5.0%(P=0.253),ICU病死率分别为25.0%和24.0%(P=0.920).结论 SBT的撤机方式比逐渐降低机械通气支持水平的撤机方式具有机械通气时间和住ICU时间短的优点,而两组VAP发生率、48 h内再插管率、ICU病死率基本相同. 相似文献
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Chang MY 《Hu li za zhi The journal of nursing》2006,53(5):69-75
The process of being weaned from mechanical ventilation is a stressful transition for critically ill patients who are taken off ventilation assistance and regain spontaneous breathing. Degree of weaning success is being increasingly used as an outcome indicator in clinical practice and lay literature. However, "successful weaning" remains a largely undefined concept in nursing practice. Following the concept analysis framework of Walker and Avant (1995), any such analysis that targets development of an operational definition of successful weaning should focus on two distinct sets of indicators, namely objective physiological and subjective psychological. Listing defining attributes and developing a model case will accurately reflect underlying relationships between weaning concepts. 相似文献
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Mauricio DanckersHoriana Grosu MD Raymonde JeanRaul B. Cruz MD Amelita FidellagaQifa Han PhD Elizabeth AwerbuchNagesh Jadhav MD Keith RoseHassan Khouli MD 《Journal of critical care》2013