Nurse-led study finds combination protocol shortens ventilation time

Intensive care unit staff at a U.S. hospital reported average ventilation time fell by nearly 50%, or almost two days, when they used a specific protocol.

The protocol combined three tools proven to shorten ventilation time, according to a study in the Spring issue of AACN Advanced Critical Care.

Staff at CHRISTUS Good Shepherd Medical Center, Longview, Texas, helped develop and study the protocol combining use of the awakening and breathing coordination, delirium monitoring/management and early mobility (ABCDE) bundle, along with the Critical-Care Pain Observation Tool (CPOT) to assess a patient’s pain levels and the Richmond Agitation-Sedation Scale (RASS), which measures sedation quality and depth.

They implemented the protocol in the medical center’s 34-bed ICU and found a 76.5% compliance rate among nursing staff.

ABCDE bundle implementation resulted in a significant decrease in ventilation time in all patients. Sedation time was also less than without ABCDE bundle implementation, but that finding was not significant.

“Of the 34 patients included in the post-intervention phase of the study, one required reintubation within 24 hours,” the authors wrote. “None of the remaining 33 patients were readmitted within 30 days of hospital discharge or re-intubated within 30 days of extubation.”

A nurse-driven protocol

Wesley Davis, DNP

Nurses are the most likely providers to care for ventilated patients, according to the study’s senior author Wesley Davis, DNP, ENP-C, FNP-C, AGACNP-BC, CEN, assistant professor, University of South Alabama College of Nursing, Mobile, Ala. “At this particular facility and at most facilities, the nurse is with the vented patient 24-7,” he said.

Respiratory therapists also help to manage these patients’ breathing, but there might be one respiratory therapist assigned to several floors. “Therefore, it’s primarily the nurse’s responsibility to maintain the patient’s breathing and respiration by the vent and by being the stand-in person until the respiratory therapist is able to arrive,” Davis said.

Nurses not only manage patients’ breathing by the vent but also manage the sedation that helps patients to breath, tolerate the vent and manage anxiety.

Reducing ventilation time is key

Optimal ventilation is clearly associated with reduced ventilator-induced lung injury. And proper management of the vent allows nurses and respiratory therapists to work together to ween patients off the vents early, according to Davis.

“We know that the longer patients stay on the vent, the more likely they are to get things like nosocomial sepsis or ventilator-associated infections, such as ventilator-associated pneumonia,” he said. “There’s also lung injury that comes from the pressure that’s being applied to the lungs from the vent.”

The goal for the nurse and ICU team is to understand how to best manage the ventilator, have protocols in place to ween patients as early as possible and prevent further harm, according to Davis.

“The vents are like a drug,” he said. “They’re not without side effects if they’re used incorrectly.”

The protocol

The three tools in the bundle have been proven to work individually on vented ICU patients, according to Davis.

“Our particular study looked at what would happen if we combined some of our most common tools and combined the results …read more

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