Starnes Elizabeth, Palokas Michelle, Hinton Elizabeth
School of Nursing, University of Mississippi Medical Center, Jackson, USA.
Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence.
JBI Database System Rev Implement Rep. 2019 Nov;17(11):2248-2264. doi: 10.11124/JBISRIR-2017-004025.
The objective of this scoping review was to explore existing literature on protocols initiated by nurses for a spontaneous breathing trial in adult intensive care unit (ICU) patients in order to examine and conceptually map the evidence, and identify gaps in the literature.
Nurses are vital in the care of the critically ill mechanically ventilated patient. By involving the nurse in the weaning process through implementing the final stage of the weaning process, the spontaneous breathing trial, patients may liberate from mechanical ventilation more readily, thereby reducing the cost of care and number of complications associated with prolonged ventilation.
This review considered experimental and quasi-experimental study designs, analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational studies, qualitative studies, and text and opinion papers. Adult ICU patients, aged 18 and over who were mechanically ventilated and candidates for weaning to spontaneous breathing trials, were included in the review. Adult ICUs included but were not limited to burn ICUs, cardiovascular ICUs, medical ICUs, neurological ICUs, surgical ICUs and trauma ICUs in all geographic locations. This scoping review considered studies that examined the use of nurse-initiated protocols for a spontaneous breathing trial.
The Joanna Briggs Institute scoping review methodology was used. Key information sources searched were Cochrane Database of Systematic Reviews, PubMed, PROSPERO, DARE, CINAHL, Embase, Scopus, Academic Search Premier, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, MedNar, ProQuest Dissertations and Theses, Papers First and societal websites with information relevant to the scoping review. Only studies published in English were included, and no date limits were applied. The data extraction tool was developed by the authors to examine information retrieved from the studies.
Four studies, with 430 participants, were included in this review. One study was a non-randomized controlled trial, two were randomized controlled studies, and one was a text and opinion paper. The four studies included in the review identified both eligibility criteria for spontaneous breathing trial initiation, detailed elements of a spontaneous breathing trial, and criteria for success. Three of the four studies reported outcomes with the use of protocols for spontaneous breathing trials initiated by nurses.
All included studies support the utilization of protocols and allowing the nurse to initiate the protocol, however variations in the eligibility criteria, details of the spontaneous breathing trial and success criteria create ambiguity in practice.
本范围综述的目的是探索关于护士发起的成人重症监护病房（ICU）患者自主呼吸试验方案的现有文献，以便审查和从概念上梳理证据，并识别文献中的空白。
护士在重症机械通气患者的护理中至关重要。通过让护士参与撤机过程的最后阶段，即自主呼吸试验，患者可能更容易脱离机械通气，从而降低护理成本以及与长时间通气相关的并发症数量。
本综述纳入实验性和半实验性研究设计、分析性观察性研究、病例对照研究、分析性横断面研究、描述性观察性研究、定性研究以及文本和观点论文。年龄在18岁及以上、接受机械通气且为自主呼吸试验撤机候选者的成年ICU患者纳入本综述。成人ICU包括但不限于所有地理位置的烧伤ICU、心血管ICU、内科ICU、神经科ICU、外科ICU和创伤ICU。本范围综述纳入了研究护士发起的自主呼吸试验方案使用情况的研究。
采用乔安娜·布里格斯研究所范围综述方法。检索的关键信息来源包括Cochrane系统评价数据库、PubMed、PROSPERO、DARE、CINAHL、Embase、Scopus、学术搜索高级版、Cochrane对照试验中心注册库、ClinicalTrials.gov、MedNar、ProQuest学位论文数据库以及与范围综述相关的论文第一手资料和社会网站。仅纳入以英文发表的研究，且不设日期限制。作者开发了数据提取工具来审查从研究中检索到的信息。
本综述纳入了4项研究，共430名参与者。1项研究为非随机对照试验，2项为随机对照研究，1项为文本和观点论文。综述纳入的4项研究确定了自主呼吸试验启动的资格标准、自主呼吸试验的详细要素以及成功标准。4项研究中的3项报告了使用护士发起的自主呼吸试验方案的结果。
所有纳入研究均支持使用方案并允许护士启动方案，然而资格标准、自主呼吸试验细节和成功标准的差异在实践中造成了模糊性。
