Mechanical Ventilation Essay
A nurse-led approach to Mechanical Ventilation Weaning Protocol Mechanical ventilation (MV) was introduced to intensive care units (‘CU) nearly forty years ago. Patients are often placed on MV for various reasons and different lengths of time. It is the procedure where a patient receives ventilator support through a mock airway because his or her body cannot inhale oxygen or remove carbon dioxide through spontaneous breathing. Ventilation is therefore delivered through an artificial airway to meet the patient’s oxygen demands without harming the patient.
Although this ethod is one of the most common medical therapies used in a hospital setting today (Southern Medical Journal) and is a live-saving measure, prolonged MV is causing a problem of cost and health complications for patients (Crit Care Med 2009). Therefore, from the moment a patient is placed on MV, the goal is to wean him or her off it. Healthcare professionals are taking steps to wean patients off MV by promoting spontaneous breathing so they can heal, restore and recover quicker.
This happens though extubation – the process where the artificial airway is permanently removed (Crit Care Med 2009). Yet, there has not been any nationally agreed clinical guideline to wean a patient. This patient is solely dependent on the experience and judgment of the nurse or doctor on his or her case (Nursing Standard). The high mortality rate of MV patients only adds insult to injury; therefore, it is critical for an MV weaning protocol to be implemented. Several studies show that this responsibility falls upon the nurses close at hand.
According to Christine Newmarch, senior staff nurse at in the Intensive Therapy Unit of The Royal Liverpool University Hospital, nurses carry the weight of understanding various modes of ventilation and t is their responsibility to recognize the both potential and actual problems involved to wean patients successfully from MV. According to the Journal of Advanced Nursing, there are three distinct stages of weaning that healthcare professionals the reason the patient is on MV has not been resolved. Weaning begins once the patient’s condition has stabilized.
The final stage has several outcomes. Either the patient has been successfully weaned and can breathe spontaneously for at least 24 hours, or when he or she is still partially dependent on ventilator support, third, they are still wholly dependent on MV, or lastly, death. Although the physician is the initiator of the weaning process, the nurse is the team member who has to keep the ball rolling. The nurse takes the role of primary and direct caregiver and is therefore the one who will first detect any changes in the patient’s behavior.
The nurse also has essential knowledge of person-patient interactions, which is a therapeutic tool for the weaning process. Nurses are familiar with the use of MV in critical care patients (International Journal of Nursing Terminologies and Classifications). “Critical care nurses have a pivotal role in the management of mechanical ventilation and eaning,” Oournal of Advanced Nursing). They are the ones to apply the therapy, manage patient responses and prevent potential MV related complications. They are therefore also the ones to determine when weaning should occur.
Since most patients who receive MV are in the ‘CU, intervention cannot begin until the patient has recovered well enough to resume spontaneous breathing, at which point weaning begins. For some patients such as those who have had open-heart-surgery or who suffer from chronic obstructive pulmonary disease, weaning can start as soon as a few hours. Conversely, for patients such as premature babies or burn victims, the process may not start for a few days or even weeks (Nursing 2006). There are several different weaning approaches the nurse should consider, and without proper protocol, weaning could increase the mortality rate ofa patient.
In North America, where weaning teams are favored Oournal for Advanced Nursing 2006), the team members each play a significant role in the weaning process. There are multi- disciplinary team members who focus on the weaning of the patient as well as an outcome manager who documents the process. They construct a weaning plan with weaning board and flow sheets. A study conducted by Cohen et al, showed that without sufficient communication between protocol team members and without proper documentation, the weaning process tends to be less successful.
On the contrary, once effective communication and documentation were implemented, there was a significant reduction in ventilator time, and similarly a reduction in ICU stay. Most importantly, the importance of organized protocol was confirmed with no adverse effects on mortality. Protocol is extremely important as it creates compliance from all medical staff (Nursing in Critical Care 2010). It is vital that patient’s physical and psychological status should be assessed before weaning begins. There are generally three different groups of patients who are candidates for weaning (Crit Care Med 2009).
The first group is candidates for easy weaning and make up roughly 70% of patients on MV. They fall into this category because their first attempt at spontaneous breathing is a success. The second group makes up about 25% of MV patients. They are so categorized because their first attempt at spontaneous breathing failed, often due to weakened muscles, and they have to pend about seven more days on MV before another attempt at weaning can be made. The last group makes up about 5% of patients who are extremely hard to stage of weaning is the post-extubation period.
Muscle weakness can often be minimized through early mobilization of the patient, well-controlled use of sedation and early use of sedation, often called a “sedation vacation” (Nursing 2006). Rapid weaning, or short-term weaning, is typically reserved for patients who are expected to recover quickly and the goal is to wean them off MV within six to eight hours of being placed on MV. More often than not, these patients are extubated in the perating room as soon as anesthesia wears off and this is done under the care of anesthesia staff (Nursing 2006).
A well-designed, multi-disciplinary protocol is essential when evaluating and executing rapid weaning. This process, directed by nurses and respiratory therapists, has been found to be more effective than physician-directed weaning. The reason is that the nurses are at the patient’s bedside and can make immediate and effective changes while weaning. Long-term weaning is for patients who do not respond well to the transition from MV to spontaneous breathing (Nursing Standard 2009). Although no method of weaning has been proved more beneficial than another, these patients typically benefit from a tracheostomy.