Nurse led weaning from ventilatory and respiratory support.
Weaning from mechanical ventilation is challenging and requires expert knowledge and skill. Weaning can be defined as the process of assisting patients to breathe spontaneously without mechanical ventilatory support [Am. J. Crit. Care 7 (1998) 1491. Weaning from mechanical ventilation is not about the method used but more about how that method is employed [Crit. Care Med. 27 (1999) 2331]. A review of the literature revealed that there was no one method of weaning that was superior, furthermore evidence suggests that the use of a protocol was more effective in reducing the duration of weaning [Dimensions Crit. Care Nurs. 2 (1991) 398; Respir. Care Clin. North Am. 2 (1996) 105; AACN Clin. Issues Crit. Care 7 (1996) 550; Crit. Care Med. 25 (1997) 567; Arch. Surg. 133 (1998) 483; Chest 118 (2000) 459]. A retrospective audit of all patients who were ventilated for 7 or more days in one intensive care over a 1-year period, revealed 94 (of 500) patients were ventilated for an average of 16.8 days. There were no weaning guidelines or protocols in place at this time and weaning from mechanical ventilation was inconsistent and uncoordinated. A process mapping exercise revealed there was a delay in initiating the decision to wean of 96 h. Weaning protocols were put in place and nurse led weaning was initiated and supported by the nurse consultant. Monthly statistics were collated and this revealed the average ventilator time had reduced. Protocol led weaning has been effective in reducing the duration of ventilation. Problems still occur in initiating the decision to wean early. An audit of patient notes has revealed many reasons for this. These reasons include, over sedation, the use of morphine and midazolam, particularly in the elderly and those with renal impairment, is delaying weaning. Other reasons include, delay in tracheostomy placement. Staff are not initiating weaning guidelines early this may be due to lack of knowledge, lack of support or failure of the guidelines. Mechanisms are in place to support nurses at the bedside.
Crocker
Cheryl
C
Critical Care Directorate, Nottingham City NHS Hospital, Hucknall Road, Nottingham NG5 1PB, UK. ccrocker@ncht.trent.nhs.uk
D003422:Critical Care / Q000379:methods*; D006801:Humans; D009720:Nurse Clinicians; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000451:nursing* / Q000592:standards; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D015300:Ventilator Weaning / Q000451:nursing* / Q000592:standards