Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Abstract

Objective: to clinically validate the nursing diagnosis of Dysfunctional Ventilatory Weaning Response in adult patients admitted to Intensive Care Units. Method: a concurrent cohort performed with 93 patients admitted to Intensive Care Units. The incidence and incidence density of the diagnosis were estimated, its related factors were identified based on bivariate analysis and clinical indicators for determining its occurrence, according to the global and temporal presentation. Results: the overall incidence of the diagnosis was 44.09% and the incidence density was 14.49 occurrences for every 100 extubations/day. The factors related to the diagnosis were the following: age, clinical severity, fluid balance, oliguria, hemodialysis, edema in upper/lower limbs, anasarca, number of antibiotics, hypothermia, hyperthermia, amount of secretion, muscle retraction, anxiety score, heart rate, use of vasopressors and non-invasive ventilation after extubation. The clinical indicators most frequently identified for determining the diagnosis were the following: tachypnea, drop of saturation and tachycardia. Temporal progression in the severity of these manifestations was found. Conclusion: the Dysfunctional Ventilatory Weaning Response is a common finding in critically ill patients. Some components of the diagnosis of the NANDA-International (2018) version could be clinically validated. It is noteworthy that there are variables not yet described in the taxonomy, demonstrating the need to review this nursing diagnosis.

Neurocritical Patients: Review of the Scope of Nursing Diagnoses and Care in the Intensive Care Unit

“…The results of da Silva et al. (2020 ), corroborate the most recent findings identified in this research, such as the risk of decreased cardiac output, anxiety related to the threat of death, stress factors, and fear associated with separation from the support system.…”

“…Fluid control of critically ill patients; assessment of congestive signs such as the presence of edema and anasarca; evaluation of eliminations; assessment of pulmonary crackles; patient care on mechanical ventilatory support; monitoring of ventilatory parameters; adequate positioning for gas exchange optimization; performance of specific oral hygiene in patients with orotracheal tube and tracheostomy; continuous assessment of the level of sedation and consciousness; monitoring for weaning from ventilation and removal of the artificial airway ( da Silva et al, 2020 ).…”

“…Given these assumptions, it is observed that there is a greater need for intensive care for patients with severe neurological impairment, 2 with the ICU being the most appropriate environment for patient handling together with the multidisciplinary team, as it offers care intensive care and continuous monitoring, through technological parameters, attributing to health professionals a greater control of intercurrences, speed in decision-making and precise actions to improve the prognosis ( da Silva et al, 2020 ).…”

Nursing diagnoses, results, and interventions in the care for Covid-19 patients in critical condition

“…The phase of weaning from mechanical ventilation support is seen as progressive and subject to failures, which causes the later withdrawal of this support; thus, the development and adoption of preventive measures and shared care with the health team is relevant, which justifies the indication of nursing diagnoses, results and interventions related to this situation (21) .…”