Nursing Strategies for Effective Weaning of the Critically Ill Mechanically Ventilated Patient

Ward, Darian A.; Fulbrook, Paul

doi:10.1016/j.cnc.2016.07.008

Cited by 15 publications

(14 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although mechanical ventilation is often a life-giving treatment, its usage can result in unwanted side effects, including ventilator-associated lung injury, ventilator-associated pneumonia, sinusitis, gastrointestinal bleeding, and venous thromboembolism. [ 21 , 22 ] It has been well recognized that the optimal use of the sedating agent may influence the duration of mechanical ventilation. Benzodiazepines and opiates are the most frequent drugs used for sedation and analgesia in the ICU.…”

Section: Discussionmentioning

confidence: 99%

The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

Soltani

Salari

Javaherforooshzadeh

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose This study aimed to determine the effect of exogenous melatonin on the number of sedative drugs and the duration of mechanical ventilation in traumatic intracranial hemorrhage patients in ICU. Methods This double-blind randomized clinical trial study was conducted in the ICU wards of Golestan Hospital, Ahvaz, Iran, from September 2017 to March 2018. In this study, 52 patients with intracerebral hemorrhage were selected by convenient sampling (26 patients in each group) and were randomly assigned to two groups of melatonin and control. Sedation and pain management package was applied to both groups. Outcomes: Amount of the sedative and opioid drug; mechanical ventilation time; ICU staying time; Glasgow Coma Score; hemodynamic parameters. Results There was no significant difference between them in terms of demographic characteristics. Cumulative doses of morphine and mechanical ventilation time were significant in two groups. ( P < 0.05) The mean length of ICU staying was not significant. Glasgow Coma Score on the 6th day was significant in two groups ( P < 0.05). Diastolic blood pressure was significant between groups ( P < 0.001). Conclusion This study presented that morphine consumption and mechanical ventilation time were significantly lower in the melatonin group than in the control. Also, rise in GCS in the melatonin group was faster in the melatonin group than in the control. The use of melatonin can be recommended for patients with ICH in the ICU for better outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

Soltani

Salari

Javaherforooshzadeh

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…In this sense, the role of nurses is of fundamental importance for the early and accurate performance of weaning from MV, as well as in the implementation of various care for mechanically ventilated patients, which precede the weaning process ( 13 ) .…”

Section: Discussionmentioning

confidence: 99%

“…In this context, it is essential to reduce the time in which the patient is under invasive artificial ventilation, restoring spontaneous ventilation as soon as possible, a process called ventilatory weaning ( 9 , 11 - 12 ) . The performance of the nurse in this context aims to minimize the adverse events caused by MV and potential risks to which the patient on artificial ventilation is exposed, such as self-extubation, the occurrence of VAP and other nosocomial infections, in addition to extubation failure ( 13 ) .…”

Section: Introductionmentioning

confidence: 99%

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Silva

Tonelli²,

Costa³

et al. 2020

Rev. Latino-Am. Enfermagem

View full text Add to dashboard Cite

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.

show abstract

“…Although mechanical ventilation is frequently a life-saving therapy, its use can result in unwanted side effects, including ventilator associated lung injury, ventilator associated pneumonia, sinusitis, gastrointestinal bleeding, and venous thromboembolism. [181920] Moreover, investigations have shown that the duration of mechanical ventilation is associated with short and long term mortality. [21]…”

Section: Discussionmentioning

confidence: 99%

Melatonin supplementation may improve the outcome of patients with hemorrhagic stroke in the intensive care unit

et al. 2017

View full text Add to dashboard Cite

Objective:Although mechanical ventilation is frequently a life-saving therapy, its use can result in unwanted side effects. It has been well documented that the choice of sedating agent may influence the duration of mechanical ventilation. Melatonin is a sedative and analgesic agent without any respiratory depressant effect which makes it an attractive adjuvant for sedation in the intubated patients. The aim of this study is to evaluate the effect of melatonin on the duration of mechanical ventilation in patients with hemorrhagic stroke.Methods:Forty adult intubated patients with hemorrhagic stroke, who were admitted to the Intensive Care Unit (ICU) within 24 h of onset, were enrolled in this randomized double-blind study. Subjects in the melatonin group received 30 mg of melatonin every night throughout the nasogastric tube. Length of ICU stay, mortality, and duration of mechanical ventilation were recorded for all patients.Findings:The duration of mechanical ventilation and length of ICU stay were shorter in patients who received melatonin in comparison with the control group, and this difference was statistically significant for the length of ICU stay and marginally significant for the duration of mechanical ventilation. Although not statistically significant, the mortality rate of the control group was 30%, almost double that of the study group (15%).Conclusion:Melatonin possesses hypnotic, analgesic, anti-inflammatory, and anti-oxidative properties that distinguish it as an attractive adjuvant in patients under mechanical ventilation. In conclusion, the administration of melatonin may facilitate the weaning process through decreasing the consumption of sedatives with respiratory depressant properties as well as preventing ventilator-associated lung injury.

show abstract

Nursing Strategies for Effective Weaning of the Critically Ill Mechanically Ventilated Patient

Cited by 15 publications

References 66 publications

The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Melatonin supplementation may improve the outcome of patients with hemorrhagic stroke in the intensive care unit

Contact Info

Product

Resources

About