Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians

Danckers, Mauricio; Grosu, Horiana B.; Jean, Raymonde; Cruz, Raul B.; Fidellaga, Amelita; Han, Qifa; Awerbuch, Elizabeth; Jadhav, Narendra; Rose, Keith; Khouli, Hassan

doi:10.1016/j.jcrc.2012.10.012

Cited by 61 publications

(65 citation statements)

References 20 publications

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“…device with trans-renal fixation), the suprarenal stent and/or iliac limbs were sometimes left in place. Postoperative care occurred in a dedicated cardiovascular intensive care unit (ICU), and standardized ICU protocols were used for all patients 16 .…”

Section: Methodsmentioning

confidence: 99%

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

Scali

McNally

Feezor

et al. 2014

Journal of Vascular Surgery

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Objectives Type 1a endoleak after endovascular aortic repair (EVAR) can be a challenging complication to manage, and due to concerns regarding morbidity and mortality of open surgical conversion (OSC), reports of complex endoluminal salvage techniques are increasing. Despite development of these endovascular remedial strategies, many patients ultimately require OSC. The purpose of this analysis was to determine outcomes of elective open conversion for type 1a endoleak and compare them to elective primary open juxtarenal aortic repair (OJAR) to determine if these concerns are warranted. Methods From 2000–12, 54 patients underwent EVAR conversion at median time of 27 months [interquartile range (IQR): 9, 55]. Indications included: endograft thrombosis (N=2, 4%), intraoperative EVAR failure (N=3, 6%), rupture (N=5, 9%), graft infection (N=6, 11%), and endoleak (All: N=38, 70%; type 1a: N=25). Because many open conversions are performed for emergent indications without endovascular options, we chose elective type 1a endoleak patients as our study group. These 25 patients were compared to an elective open juxtarenal aneurysm repair cohort matched by anatomy and comorbidities. Primary end-points were 30-day and 1-year mortality. Secondary end-points included early complications, cross-clamp time, procedure time, blood loss, and length of stay (LOS). Results Demographic and comorbidity data in the OSC and OJAR groups did not differ with the exception that OJAR patients presented with smaller aneurysm diameter and a higher rate of chronic obstructive pulmonary disease (P = .03). OSC patients more frequently underwent a non-tube graft repair [OSC, N=6 (24%) vs. OJAR, N=20 (80%); P=.0002], required longer procedure times (P=.03), and received more plasma transfusion (P=.03). The 30-day mortality was 4% in both groups (observed difference in rates = 0%, 95% CI for difference in mortality rates = [−14.0%, 14.0%], P=1). A similar rate of major complications occurred [OSC (N = 9) 36% vs. OJAR (N = 8) 32%; P = 1]. One-year survival was 83% in OSC and 91% in OJAR (observed difference = 7%, 95% CI [−15%, 29%], P=.65). Conclusions Despite many advances in EVAR technology, the need for OSC persists, and will likely become more common as older generation devices fail or providers attempt EVAR in more anatomically complex patients. Elective OSC for type 1a endoleak can be technically challenging, but is not associated with increased morbidity or mortality when compared to OJAR in appropriately selected patients. These results should be considered before pursuing complex endovascular remediation of EVAR failures.

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Section: Methodsmentioning

confidence: 99%

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

Scali

McNally

Feezor

et al. 2014

Journal of Vascular Surgery

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“…The development of protocols and guidelines for NIV/CPAP management is recommended in order to clarify the roles of each professional and to increase greater efficiency during NIV application (20). An example of how adequate risk assessment tools/protocols may help nurses considerably in enhancing patient safety is The Burns Wean Assessment Program checklist, developed to assist clinicians in the systematic evaluation of 26 clinical factors important to weaning (23). Good inter-professional communication influences quality of care and patient safety.…”

Section: Ventilation Team Trainingmentioning

confidence: 99%

How to enhance experience and skill of non invasive ventilation: suggestions from the literature

Nicolini¹

2015

sob

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SummaryThe literature relevant to non invasive ventilation (NIV) synthesizes the most recent trends in enhancing experience and skill of NIV team care. Studies concerning ventilation team-based practices but also single respiratory health professional education and training were included in our research. Critical care education and training and inter-professional education should start in medical and post graduated school. Curriculum design, implementation, and assessment of clinical skills completed by the trained medical expert are essential components of competency-based education. Nurses, respiratory therapists and physiotherapists have different roles in ventilation team care around the world. Delivering effective training for NIV is challenging. Team-based care using patient simulation education as an adjunct to traditional clinical training (patient care, didactics, small group teaching and protocols) is superior to traditional clinical training alone and can affect positively patient and provider outcomes.

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“…25 Tracheostomy has also been proposed as a method of reducing duration of mechanical ventilation. Once weaning protocols are in place, they may be nurse driven, which may decrease duration of mechanical ventilation compared with physician-driven protocols.…”

Section: Fever Leukopenia or Leukocytosismentioning

confidence: 99%

Ventilator-Associated Pneumonia

Epstein

2015

Small Animal Critical Care Medicine

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Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians

Cited by 61 publications

References 20 publications

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

How to enhance experience and skill of non invasive ventilation: suggestions from the literature

Ventilator-Associated Pneumonia

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