Mechanical Ventilation Weaning Protocol
A Gold Standard Nurse-Led Approach in the ICU
This paper explores fifteen different medical and academic journals to show the importance of nurse-led Mechanical Weaning (MV) protocol. Based on studies conducted in the United States, Taiwan, Australia and New Zealand, the paper will show that without an effective weaning plan, the job of an intensive care unit (ICU) nurse becomes difficult and ineffective. Different weaning approaches will be discussed as well as different outcomes of successful weaning.
A nurse-led approach to Mechanical Ventilation Weaning Protocol Mechanical ventilation (MV) was introduced to intensive care units (ICU) nearly forty years ago. Patients are often placed on MV for various reasons and different lengths of time. It is the procedure where a patient receives ventilator support through a mock airway because his or her body cannot inhale oxygen or remove carbon dioxide through spontaneous breathing. Ventilation is therefore delivered through an artificial airway to meet the patient’s oxygen demands without harming the patient. Although this method is one of the most common medical therapies used in a hospital setting today (Southern Medical Journal) and is a live-saving measure, prolonged MV is causing a problem of cost and health complications for patients (Crit Care Med 2009). Therefore, from the moment a patient is placed on MV, the goal is to wean him or her off it. Healthcare professionals are taking steps to wean patients off MV by promoting spontaneous breathing so they can heal, restore and recover quicker. This happens though extubation – the process where the artificial airway is permanently removed (Crit Care Med 2009). Yet, there has not been any nationally agreed clinical guideline to wean a patient. This patient is solely dependent on the experience and judgment of the nurse or doctor on his or her case (Nursing Standard). The high mortality rate of MV patients only adds insult to injury; therefore, it is critical for an MV weaning protocol to be implemented. Several studies show that this responsibility falls upon the nurses close at hand. According to Christine Newmarch, senior staff nurse at in the Intensive Therapy Unit of The Royal Liverpool University Hospital, nurses carry the weight of understanding various modes of ventilation and it is their responsibility to recognize the both potential and actual problems involved to wean patients successfully from MV. According to the Journal of Advanced Nursing, there are three distinct stages of weaning that healthcare professionals should adhere to. During the pre-weaning stage, weaning has not begun because the reason the patient is on MV has not been resolved. Weaning begins once the patient’s condition has stabilized. The final stage has several outcomes. Either the patient has been successfully weaned and can breathe spontaneously for at least 24 hours, or when he or she is still partially dependent on ventilator support, third, they are still wholly dependent on MV, or lastly, death. Although the physician is the initiator of the weaning process, the nurse is the team member who has to keep the ball rolling. The nurse takes the role of primary and direct caregiver and is therefore the one who will first detect any changes in the patient’s behavior. The nurse also has essential knowledge of person-patient interactions, which is a therapeutic tool for the weaning process. Nurses are familiar with the use of MV in critical care patients (International Journal of Nursing Terminologies and Classifications). “Critical care nurses have a pivotal role in the management of mechanical ventilation and weaning,” (Journal of Advanced Nursing). They are the ones to apply the therapy, manage patient responses and prevent potential MV related complications. They are therefore also the ones to determine when...
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