Fatima Mohammad Hirzallah1, Aidah Alkaissi2, Maria do Céu Barbieri-Figueiredo3. 1. University of Porto, ICBAS -Instituto de Ciências Biomédicas Abel Salazar, Universityof Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Faculty of Medicine and Health Sciences, Nursing and Midwifery Department, An-Najah National University, Nablus P. O. Box 7, Palestine. 2. Anesthesiology and Intensive Care Nursing, Dean of Nursing College, Faculty of Medicine and Health Sciences, Nursing and Midwifery Department, An-Najah National University, Nablus P. O. Box 7, Palestine. 3. ESEP and integrated researcher of CINTESIS, Escola Superior de Enfermagem do Porto (ESEP), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; ICBAS -Instituto de Ciências Biomédicas Abel Salazar, Universityof Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal.
Abstract
OBJECTIVES: The aim of this systematic review is to synthesize the current best evidence for the effectiveness of weaning protocols led by nurses compared with usual physician-led care. BACKGROUND: Protocol-directed weaning has been shown to reduce the duration of mechanical ventilation. Studies have reported that a weaning protocol administered by nurses leads to a reduction in the duration of mechanical ventilation and has a major effect on weaning outcomes. This can have especially positive consequences for critically ill patients. STUDY DESIGN: Systematic review with meta-analysis. SEARCH STRATEGY: The databases CINAHL, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from as far back as the database allowed until January 2016. INCLUSION AND EXCLUSION CRITERIA: Searches were performed to identify the best available evidence including quantitative studies of nurse-led weaning protocols for mechanically ventilated adult patients. We excluded all studies of weaning protocols implemented by non-nurses and non-invasive mechanical ventilation and studies that addressed patient populations younger than 18 years of age. RESULTS: The database searches resulted in retrieving 369 articles. Three eligible studies with a total of 532 patients were included in the final review. Pooled data showed a statistically significant difference in favour of the nurse-led weaning protocol for reducing the duration of mechanical ventilation (mean differences = -1.69 days, 95% confidence interval = -3.23 to 0.16), intensive care unit length of stay (mean differences = -2.04 days, 95% confidence interval = -2.57 to -1.52, I2 = 18%, and p = 0.00001); and hospital length of stay (mean differences = -2.9 days, 95% confidence interval = -4.24 to -1.56, I2 = 0%, and p = 0.00001). CONCLUSION: There is evidence that the use of nurse-led weaning protocols for mechanically ventilated adult patients has a positive impact on weaning outcomes and patient safety. RELEVANCE TO CLINICAL PRACTICE: This review provides evidence supporting intensive care unit nurses' crucial role and abilities to lead weaning from mechanical ventilation.
OBJECTIVES: The aim of this systematic review is to synthesize the current best evidence for the effectiveness of weaning protocols led by nurses compared with usual physician-led care. BACKGROUND: Protocol-directed weaning has been shown to reduce the duration of mechanical ventilation. Studies have reported that a weaning protocol administered by nurses leads to a reduction in the duration of mechanical ventilation and has a major effect on weaning outcomes. This can have especially positive consequences for critically illpatients. STUDY DESIGN: Systematic review with meta-analysis. SEARCH STRATEGY: The databases CINAHL, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from as far back as the database allowed until January 2016. INCLUSION AND EXCLUSION CRITERIA: Searches were performed to identify the best available evidence including quantitative studies of nurse-led weaning protocols for mechanically ventilated adult patients. We excluded all studies of weaning protocols implemented by non-nurses and non-invasive mechanical ventilation and studies that addressed patient populations younger than 18 years of age. RESULTS: The database searches resulted in retrieving 369 articles. Three eligible studies with a total of 532 patients were included in the final review. Pooled data showed a statistically significant difference in favour of the nurse-led weaning protocol for reducing the duration of mechanical ventilation (mean differences = -1.69 days, 95% confidence interval = -3.23 to 0.16), intensive care unit length of stay (mean differences = -2.04 days, 95% confidence interval = -2.57 to -1.52, I2 = 18%, and p = 0.00001); and hospital length of stay (mean differences = -2.9 days, 95% confidence interval = -4.24 to -1.56, I2 = 0%, and p = 0.00001). CONCLUSION: There is evidence that the use of nurse-led weaning protocols for mechanically ventilated adult patients has a positive impact on weaning outcomes and patient safety. RELEVANCE TO CLINICAL PRACTICE: This review provides evidence supporting intensive care unit nurses' crucial role and abilities to lead weaning from mechanical ventilation.
Authors: Fernando G Zampieri; Jorge I F Salluh; Luciano C P Azevedo; Jeremy M Kahn; Lucas P Damiani; Lunna P Borges; William N Viana; Roberto Costa; Thiago D Corrêa; Dieter E S Araya; Marcelo O Maia; Marcus A Ferez; Alexandre G R Carvalho; Marcos F Knibel; Ulisses O Melo; Marcelo S Santino; Thiago Lisboa; Eliana B Caser; Bruno A M P Besen; Fernando A Bozza; Derek C Angus; Marcio Soares Journal: Intensive Care Med Date: 2019-10-08 Impact factor: 17.440