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.
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.
Nurs Crit Care. 2019 Mar;24(2):89-96. doi: 10.1111/nicc.12404. Epub 2019 Jan 7.
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.
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.
Systematic review with meta-analysis.
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.
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.
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, I = 18%, and p = 0.00001); and hospital length of stay (mean differences = -2.9 days, 95% confidence interval = -4.24 to -1.56, I = 0%, and p = 0.00001).
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.
This review provides evidence supporting intensive care unit nurses' crucial role and abilities to lead weaning from mechanical ventilation.
本系统评价旨在综合目前有关护士主导的撤机方案与常规医师主导的护理相比有效性的最佳证据。
方案指导的撤机已被证明可缩短机械通气时间。研究报告称，由护士实施的撤机方案可缩短机械通气时间，并对撤机结局产生重大影响。这对危重症患者尤其具有积极意义。
系统评价与荟萃分析。
从各数据库尽可能回溯检索至文献库建立时间，包括 CINAHL、PubMed、Scopus 和 Cochrane 对照试验中心注册库，直至 2016 年 1 月。
检索以确定最佳现有证据，包括针对接受机械通气的成年患者的护士主导的撤机方案的定量研究。我们排除了所有非护士和非侵入性机械通气实施的撤机方案研究以及涉及 18 岁以下患者人群的研究。
数据库检索共检索到 369 篇文章。3 项纳入的研究共纳入 532 例患者，最终纳入综述。汇总数据显示，护士主导的撤机方案在缩短机械通气时间方面具有统计学意义（平均差异=-1.69 天，95%置信区间=-3.23 至 0.16）、重症监护病房住院时间（平均差异=-2.04 天，95%置信区间=-2.57 至-1.52，I²=18%，p=0.00001）和住院时间（平均差异=-2.9 天，95%置信区间=-4.24 至-1.56，I²=0%，p=0.00001）方面有统计学意义。
有证据表明，使用护士主导的撤机方案对接受机械通气的成年患者的撤机结局和患者安全有积极影响。
该综述提供了证据支持重症监护病房护士在领导机械通气撤机方面的关键作用和能力。
