Are nursing led protocols evolving with new automated mechanical ventilation weaning strategies: A systematic review

Brad Chesham
2018 Nursing and Palliative Care  
It is known that serious physiological and psychological consequences can arise when prolonged ventilation impacts patients. New automated weaning systems may decrease the duration of mechanical ventilation and ICU length of stay. This is a new introduction to ICU weaning plans which only relatively recently have aligned with specific weaning protocols to improve outcomes. The aim of this systematic review was to compare automated weaning against protocol based weaning. The second objective was
more » ... econd objective was to discover how nurses are getting involved and what is their application to the new technology? A systematic literature search was carried out using electronic databases as well as other sources including Google scholar. A detailed inclusion and exclusion criteria was constructed and applied for screening and the quality of the included studies was thoroughly assessed. 3 studies met the associated criteria for analysis totalling a patient population of 284. Automated ventilator weaning proved to be beneficial over protocol based weaning. The results showed an improved outcome towards a decrease in mechanical ventilation and in ICU length of stay. No immediate impact was noted on hospital length of stay or ICU mortality. Cultural and organisational variables were noted throughout the data, generating notable heterogeneity. The decision-making process related to extubation, staffing, compliance with the delivery of the protocols and medical cover and structure across the ICU were revealed to impact data. In no study did nursing play a primary role. In conclusion automated ventilation is beneficial over protocol based weaning. This benefit is limited and the lack of strength within the evidence results in minimal external validity. It was determined that nursing has a role to play within the process of weaning but has not yet thoroughly investigated the new technology and its possible applications. Electronic searches: One researcher developed, conducted and refined the search strategy to collate eligible studies. Database specific searches were undertaken, and the following sources were assessed: Cochrane Central Register of controlled trails (Central); MEDLINE; EMBASE; CINAHL; Wiley Interface. The databases were searched in November 2015. Once the databases were selected they were investigated for the subject topic. Focused MeSh terms were included: Automated Weaning; Automatic weaning Mechanical ventilation; Weaning; Nursing; Protocol directed weaning; Protocol. Searching other resources: A manual search of reference lists was also conducted of eligible studies to identify additional potential studies. Google scholar was also utilised as a search engine for prospective study inclusion. Although Google Scholar was helpful and introduced new content for analysis many articles listed were not relevant to the listed keywords. Secondarily many of the articles retrieved were simply duplicates of those found through the primary database search. Citations were downloaded into an endnote library.
doi:10.15761/npc.1000173 fatcat:dg4gtfbtjnef3lew436yshxt4q