Homeworks academic service


Patient need during mechanical ventilation literature review

Pharmacological Interventions Five studies reported that pharmacological interventions can be addressed to promote comfort during receiving mechanical ventilation. The use of analgesics and sedative therapy have become the standard of care at the ICU to relieve discomfort and improve patient tolerance to MV in a humane manner 6 Analgesics combined with adequate sedation has been shown to increase patient comfort and reduce stress response as well as the duration of MV and ICU length of stay Another two studies also reported that analgesic and sedation therapy significantly reduced discomfort in patients with MV 4 In contrast, the use of sedative and analgesics did not significantly protect patients with complex-mixed discomfort Moreover, a study by Grap et al.

Patients with less movement were associated with greater levels of sedation, even though all patients spent the vast majority of their time with no arm movement or leg movement 6.

Services on Demand

Nursing Care Intervention Following patient assessment and safety checks, consideration of nursing care interventions to promote patient comfort and well-being needs to be addressed The management of nursing care of patients with MV was challenged on some levels, such as involving highly technical skills, and requiring advanced knowledge on invasive monitoring Effective nursing care that can promote comfort and reduce discomfort during ventilator treatment includes positioning, mouth care, and management of stressors, such as ineffective communication, sleep disturbance, and isolation Nurses deliver high quality care by using relevant technologies and psychosocial care measures Based on these evidences, the authors highlighted four nursing interventions that could be applied to promote comfort in patients receiving mechanical ventilation as described below: Positioning Positioning in patients with MV can improve patient comfort and also address physiological aims of optimizing oxygen transport and reducing the level of myocardial workload Two studies reported that positioning can promote comfort during MV 37 Similarly, Bonten reported that semi-recumbent positioning patient need during mechanical ventilation literature review a ventilated patient with the head of the bed elevated from 30 to 45 degrees significantly improved oxygenation and ventilation and also reduced VAP in patients with MV.

The improvement of oxygenation and ventilation may influence the reduction of discomfort and promotion of comfort in patients with MV Suctioning Endotracheal suctioning is a component of bronchial hygiene therapy in MV and involves mechanical aspiration of pulmonary secretions from a patient with an artificial airway in place Jones stated that suctioning may increase patient comfort during ventilator treatment.

  • Ross A, Crumpler J;
  • Adomat R, Killingworth A;
  • Communication about chronic critical illness.

This may be done through an endotracheal tube, tracheostomy tube or through the nose or mouth into the trachea. Although each procedure is slightly different, indications, supplies, procedures, and risks are similar Similarly, a study by Grap and Munro found that frequent mouth care has been reported to significantly increase patient comfort and suggested performing mouth care every two to four hours to improve oral hygiene 6.

Effective Communication Tracy and Chlan 41 mentioned that nurses commonly use positive body language, friendly facial expression, eye contact and touching to reduce patient distress during MV treatment. Two studies of communication methods described non-vocal communication techniques, including gesture and mimics, lip-reading, eye contact, and touching to communicate with the patients with MV 27 Similarly, Martensson and Fridlund 39 mentioned that another option, which can be used as a communication method in patients with MV is pen and paper.

This method is always a great strategy for the nurse and patient to be able to communicate with each other. However, most of the strategies used augmentative and alternative communication AAC strategy during MV treatment.

The American speech language hearing association defines augmentative and alternative communication as any method used as a means of communication when oral speech cannot be achieved These strategies can be categorized in three parts: Complementary and Alternative Interventions Complementary and alternative therapy has been used to promote comfort in patients with MV, such as relaxation massage, therapeutic touch and emphatic physical contacts 48and music therapy 23 Complementary therapies might be an important alternative or adjunct to pharmacological intervention to treat symptoms of discomfort in patients with MV Music therapy was commonly used in nursing practice as an effective intervention and an integral part of the plan for patient care As a non-pharmacologic intervention, music has been used to relieve pain and anxiety and also to promote comfort in patients with MV 162343 The effect of music can patient need during mechanical ventilation literature review emotions through pitch and rhythmic vibrations that have effects within the limbic system, where it can produce pleasant memories to sensory stimuli Conclusion It can be concluded that comfort needs can be associated with physical, psychospirirtual, sociocultural, or environmental detractor from comfort during MV treatment.

Interventions to promote comfort include pharmacological, nursing care, and complementary interventions that can be addressed to prevent the negative impacts of decreased comfort and promote comfort during MV. Nurses and other healthcare providers can use the knowledge of this literature review as guidance to develop a quality comfort care for patients receiving MV based on comfort needs. Observational pain scales in critically ill adults. Self-reported symptom experience of critically ill cancer patients receiving intensive care.

J Cardiothorac Vasc Anesth. How caregivers view patient comfort and what they do to improve it: A description of patients' report of endotracheal tube discomfort. Intensive Crit Care Nurs. Sedation in adults receiving mechanical ventilation: Am J Crit Patient need during mechanical ventilation literature review.

Issues in weaning from mechanical ventilation: literature review.

Springer Publishing Company, Inc; Malinowski A, Stamler LL. A framework for professional practice. United States of America: Discovery of unexpected pain in intubated and sedated patients. Adult intensive care patients' perception of endotracheal tube-related discomforts: Perceptions of registered and enrolled nurses on thirst in mechanically ventilated adult patients in intensive care units-a phenomenographic study. Tombes MB, Gallucci B.

The effects of hydrogen peroxide rinses on the normal oral mucosa. A survey of the oral care practices of intensive care nurses. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: Wilson L, Kolcaba K.

Practical application of comfort theory in the perianesthesia setting.

Critical Care Nursing

Anxiety and agitation in mechanically ventilated patients. Symptom identification in the chronically critically ill. Monitoring in mechanical ventilation.

  • The presence of functional decline is predictive of poor outcomes at hospital discharge and the strong correlation with prolonged hospitalization, increased mortality, increased costs and the need for home rehabilitation
  • Promoting effective communication for patients receiving mechanical ventilation;
  • Crit Care Nurs Q;
  • Am J Phys Med Rehabil.

Chang DWeditor. Clinical application of mechanical ventilation. Delmar Cengage Learning; The effect of music therapy on the level of anxiety in the patients undergoing coronary angiography. Improving communication in the ICU using daily goals. The effect of music therapy on comfort in mechanically vnetilated patient in the intensive care unit.

Montana State University; Promoting effective communication for patients receiving mechanical ventilation. Patients' reports of health care practitioner interventions that are related to communication during mechanical ventilation. Nursing care of the mechanically ventilated patient: Nurse and patient characteristics associated with duration of nurse talk during patient encounters in ICU. Communication about chronic critical illness.

Communication difficulties and psychoemotional distress in patients receiving mechanical ventilation. Communicating with conscious and mechanically ventilated critically ill patients: Creating a therapeutic environment: Int J Nurs Stud.

  1. United States of America.
  2. Analgesics combined with adequate sedation has been shown to increase patient comfort and reduce stress response as well as the duration of MV and ICU length of stay 34. In early , the literature was reviewed from to by accessing the following databases.
  3. Controversy exists in weaning practices about appropriate and efficacious weaning readiness assessment indicators, the best method of weaning and the use of weaning protocols. Exclusion criteria for the study were articles that did not cover the topic, such as those who were unable toprovide relevant results and studies that have maintained patients in mechanical ventilation.

Sleep deprivation in critical illness: J Intensive Care Med. Sleep disturbances and fatigue in critically ill patients.

Critical care nursing practice. Practice of sedation and the perception of discomfort during mechanical ventilation in Chinese intensive care units. Lateral positioning of ventilated intensive care patients: Prevention of hospital-acquired pneumonia: Infect Dis Clin North Am.

  1. Subsequent, the selected abstracts were analyzed and those who did not meet the inclusion criteria were excluded.
  2. The improvement of oxygenation and ventilation may influence the reduction of discomfort and promotion of comfort in patients with MV Patient comfort in the intensive care unit.
  3. Oral hygiene with chlorhexidine in preventing pneumonia associated with mechanical ventilation. Prevention of hospital-associated pneumonia and ventilator-associated pneumonia.
  4. Complementary and Alternative Interventions Complementary and alternative therapy has been used to promote comfort in patients with MV, such as relaxation massage, therapeutic touch and emphatic physical contacts 48 , and music therapy 23 , 49.
  5. In a study by Clavet et al.

Martensson IE, Fridlund B. Factors influencing the patient during weaning from mechanical ventilation: Oral care of the critically ill: Tracy MF, Chlan L. Nonpharmacological interventions to manage common symptoms in patients receiving mechanical ventilation. Otuzoglu M, Karahan A.

Determining the effectiveness of illustrated communication material for communication with intubated patients at an intensive care unit. Int J Nurs Pract. Almerud S, Petersson K. Music therapy--a complementary treatment for mechanically ventilated intensive care patients. Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: Patient comfort in the intensive care unit: Adomat R, Killingworth A.

Critical Care Nursing

Care of the critically ill patient: Ciftci H, Otzunc G.