The Development and Evaluation of Ventilator Weaning Protocol in Adult Critically Ill of Surgical Intensive Care Unit at Songklanagarind Hospital

Abstract

This study aimed to develop and evaluate the clinical nursing practice guideline (CNPG) for ventilator weaning in adult critically ill patients at the Surgical Intensive Care Unit (SICU). Two phases were sequentially conducted, 1) development of the CNPG, and 2) evaluation of the basic qualification of CNPG implementation. The research instruments included the CNPG, the Feasibility of utilizing CNPG and User’s Satisfaction Questionnaire, and the Weaning Protocol Outcome Assessment Form. The content validity of these instruments was examined by three experts. The CVI revealed 1.0 & 0.92 and Cronbach Alpha of the Weaning Protocol Assessment Form for Readiness to Wean of general critical surgery patients and cardiac surgery patients, Monitoring the Patients’ Weaning Abilities Form, and Readiness to Extubation Assessment Form were 0.95 0.96 0.97 and 0.81 respectively and the KR20 for Feasibility of utilizing CNPG was 0.80. The inter-rater reliability of the developed CNPG were 0.91 and 0.92. Data were analyzed by using descriptive statistics.

The results showed in the following: 1) The CNPG development consisted of the nursing intervention in three phases including: pre-weaning phase, weaning phase, and post-weaning phase. 2) The CNPG was implemented in 20 surgical critically ill patients by 36 SICU nurses to test the basic qualification. The results showed that all SICU nurses described the CNPG as being feasible for using at a high level, and 80.6 % of them reported their satisfaction at a high level. All patients met the weaning protocol . In general, duration of receiving mechanical ventilation was 23.13 hours (SD=16.66, median=17.83). Weaning duration of the subject patients was 5.25 hours (SD=6.08, median=3.00). None of patients needed reintubation within 48 hours after extubation.

The findings indicated that this CNPG could be applicable for implementation, especially knowledge related to assessment of the patient’s readiness and decision making to wean is very necessary for nurses in caring for critically ill patients.