Development a Caring Model of Critically Ill Surgical Patients with Difficult Weaning Using ABCDEF-R Bundle
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Abstract: This research and development aimed to develop and evaluate a model for critically ill surgical patients with difficult weaning by using ABCDEF-R bundle in a surgical intensive care unit of Maharaj Nakhon Si Thammarat Hospital. Participants in the project were divided into 2 groups: 21 nurses caring for critically ill patients and 85 critically ill surgical patients, 40 people were in the pre-implementing group and 45 were in the post-implementing group. The research instruments were: 1) demographic and illness data records, 2) assessment of knowledge about weaning from a ventilator, 3) the assessment of practical feasibility and easily/difficulty in using model, 4) the risk assessment of difficult weaning, 5) the assessment of clinical and organization’s outcomes and 6) procedure manual based on ABCDEF-R bundle activities. Data were analyzed using descriptive and comparative statistics. Results showed that nurses’ knowledge after model implementation and two-month follow-up was significantly higher than before model implementation (p < .05). The model was feasible and easy to implement in practice for all 7 categories at high and very high level (> 80%). The clinical outcomes after model implementing were better than before regarding the significantly decrease of weaning time (p= .021), the number of mechanical ventilation days (p= .04), the incidence of ventilator associated pneumonia (p= .025) and the length of stay in ICU (p= .036). It is concluded that caring for critically ill surgical patients with difficult weaning by using the ABCDEF-R bundle can improve the care quality and some clinical outcomes. However, it should be followed up in long term.
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References
Information center. Surgical critical care statistics of Maharaj Nakhon Si Thammarat Hospital. Nakhon Si Thammarat: Maharaj Nakhon Si Thammarat Hospital; 2020. (In Thai)
Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from mechanical ventilation in critically ill adults. Am J Respir Crit Care Med 2017;195:120-33.
Tonnelier A, Tonnelier JM, Nowak E, Gut GC, Prat G, Renault A, et al. Clinical relevance of classification according to weaning difficulty. Respir Care 2011;56(5):583-90.
Chu YF, Jiang Y, Meng M, Jiang JJ, Zhang JC, Ren HS, et al. Incidence and risk factors of gastrointestinal bleeding in mechanically ventilated patients. World J Emerg Med 2010;1(1): 32-6.
Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in Humans. Am J Respir Crit Care Med 2011;183:364-71.
Edriss H, Whiting J, Nugent K. A ventilator associated event in an intensive care unit patient with multiple comorbidities and prolonged mechanical ventilation. Gaziantep Med J 2014;20(3):277-80.
Pukkham K, Khuwatsamrit K, Wisettharn T. Evaluating the feasibility and clinical outcome for assessment prevention and management of acute delirium in a surgical intensive care unit. Thai Journal of Nursing and Midwifery Practice 2019;6(1):68-86. (In Thai).
Darayon R. Experience of patients encountering difficulty weaning from mechanical ventilation. [Master Thesis of Nursing Science]. Prince of Songkla University;2007. (In Thai)
Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Euro Respir J 2007;29:1033-56.
Wisettharn T, Pukkham K, Yodrabum, S. The development of ventilator weaning model in critically ill surgical patients in Maharaj Nakhon Si Thammarat Hospital. Thai Journal of Cardio-Thoracic Nursing 2019;30(2):176-92. (In Thai)
Barr J, Gilles LF, Kathleen PE, Wesley E, Celine G, Joseph FD. et al. Clinical practice guidelines for the management of pain agitation and delirium in adult patients in the intensive care unit: Executive summary. Am J Health-Syst Pharm 2013;70:53-8.
Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandhari pande PP, et al., Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018;46:e825–e73.
Chanques G, Constantin JM, Devlin JW, Ely EW, Frase GL, Gelinas C, et al., Analgesia and sedation in patients with ARDS. Intensive Care Med. https://doi.org/10.1007/s00134-020-06307-9.
Boocha P, Seangduang N. Research and Development: Process and Application. Journal of Phrae Public Health for Development 2021;1(1):77-89. (In Thai)
Nantachipan P. The CPGs quality evaluation questionnaire. Chiang Mai: Faculty of Nursing; 2006. (in Thai)
Naopiriyawat U, Puttapitakpol S, Srisurin W. Development of a nursing care model for caring patients on ventilator controlling by volume and pressure at the medical intensive care unit of a tertiary care hospital. Journal of nurses’ association Thailand, North-eastern division 2011;29(3):25-34.
Pu L, Zhu B, Jiang L, Du B, Zhu X, Li A, et al. Weaning critically ill patients from mechanical ventilation: A prospective cohort study. J Crit care 2015;30:862.e7-862.e13.
Wasee P, Thongchai C, Phongmunjit P, Chuajedton P, Sukkasem S. Effectiveness of evidence based ventilator weaning protocol implementation among patients in surgical critical care unit at Chiangrai Prachanukrau Hospital. Journal of Thailand Nursing and Midwifery Council 2006;21(3):75-86. (In Thai)
Wannakul A. Development of clinical practice guideline for weaning protocol from mechanical ventilator in SICU Phatthalung hospital. Krabi Medical Journal 2018;1(2):1-11. (In Thai)
Sornsomnuk S, Khuwatsamrit K, Monkong S. Effects of using nursing practice guidelines for ventilator associated pneumonia prevention on the incidence of ventilator associated pneumonia. Rama Nurs J 2017;23(3):284-97. (In Thai)