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Critical Thinking: Research Paper
Zainab Albaher
Colorado State University – Global Campus
HCM-505: Research Methodology in Healthcare Management – 14982
Dr. Mary Moore
November 27, 2021
Introduction
Mechanical ventilation (MV) is one of the most prevalent interventions in critical care units (ICUs), with an anticipated increase in occurrence over the next decade and is one of the main reasons why patients need an ICU bed (Guilhermino et al., 2018). In contrast to non-invasive ventilation, which uses a face mask as the interface, invasive mechanical ventilation includes an endotracheal tube (ETT) and a mechanical ventilator. The ETT protects the airway and delivers artificial breaths to the critically ill patients.
According to (Saritas et al., 2019), MV is a lifesaving for patients with hypoxic and hypercapnic respiratory failure, invasive mechanical ventilation stabilizes them by decreasing the work of breathing, disbursing blood flow to other tissues in patients with shock, and allowing for the implementation of low tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS). Accurate and timely decision-making is critical to provide safe, best-practice care and to reduce the occurrence of problems associated with MV management. To establish and maintain clinical reasoning and evaluation abilities, as well as to encourage self-reflection and the provision of safe and high-quality care, continuing education is essential (Roberts et al., 2021).
(Lin-Li Sang et al., 2021) stated that longer duration of mechanical ventilation is related with different problems, which leads to increase rates of in-hospital mortality, longer hospitalization, and higher expenses. Longer ICU stays and in-hospital mortality are associated with patients who fail at least three MV weaning attempts or require more than seven days of weaning after the first spontaneous breathing trial, compared to patients who successfully weaned on the first attempt.
Weaning from mechanical ventilation is an important element of ventilator support. Prolonged mechanical ventilation can induce complications such ventilator associated pneumonia; the ventilator should be removed when the underlying cause of respiratory failure has been eliminated to minimize these issues. Early extubation can lead to recurrence or worsening of respiratory failure as well as an increase in costs, reintubation, and mortality. It’s still considered as a serious challenge for clinicians (Lin-Li Sang et al., 2021).
In October 2021, an experimental study was carried out among adult mechanically ventilated patients prior to weaning criteria and discontinuation of mechanical ventilator in King Fahad Specialist Hospital ICUs in Dammam, Saudi Arabia. A study aimed to investigate the association between early mobilization of the intubated patients in ICUs and successful weaning process (Fontela et al., 2018). Ethical approval was obtained from the Ethics Committee, participation in the study was voluntary. Furthermore, the participants’ family were informed about the confidentiality of the responses, the study aims, risks and benefits were explained and provided informed consent by agreeing to complete the study (Refaee & Shehri, 2021). The inclusion criteria were: (1) the age of patients was between 18 and 40 from both genders and (2) mechanically ventilated patients via an endotracheal tube in the ICU that are intubated within 24 hours. The exclusion criteria were: (1) death before discontinuation of MV; (2) children less than 18 years and pregnant women; (3) patients with neurological injury and residual deficit such as acute cerebrovascular accident and sudden cardiac arrest and (4) patients transferred to another hospital. A total number of qualified patients included in the study was 50 patients (Pappal et al., 2019).
Data collected through respiratory therapists working in the ICU using a survey that includes some of patients’ demographic data such as age and gender, weight, hight, days on mechanical ventilator, vital signs, monitored weaning values during spontaneous breathing trial, sedative and neuromuscular blocking agent received during the period of requiring mechanical ventilator until disconnecting the artificial airways and patients’ mobilization. The survey was written in English and Arabic, and it takes around 20 minutes to complete (Pappal et al., 2019) .
Statistical Analysis System (SAS) was used in mechanical ventilation data analysis; the reason behind this because, SAS is friendly to SPSS, JMP, IBM, Excel files, and additional extensions. It hence permits importation and exportation of data easily without the need for manual procedures which results in errors. Additionally, SAS has a decent interactive Graphic interface. Medical information is always complex not only in terms of denoting the capacity but also the assortment of data and structure as well. Health information derives from diverse bases such as diagnostics and therapeutic information. Medical data is extremely subtle, comprising treasured information for medical tests and private conditions of patients; therefore, while handling health information establishments need analytic platforms which safeguard data (Ali & Bhaskar, 2016). In, addition, A chi-square test was used to compare the relationship between two variables since method investigated the association between early mobilization of the intubated patients in ICUs and successful weaning process (Kim, 2017).
Body: Main and subtopics
Mechanical ventilation is essential inside ICUs to manage patients during treatment plan. A mechanical ventilator is used to assist the patient in breathing when a patient is undergoing surgery or is unable to breathe and needs assistance because of a critical disease. Patients are connected to ventilators via an artificial airway which is a hollow tube that passes in the mouth and down into the trachea and placed in their windpipe. The device is able to save the lives of patients with respiratory failure or hypoxemia through ensuring that the body receives enough oxygen and removes carbon dioxide.
Gaps requiring future study
The research study has several limitations such as the participation of the ICUs was voluntary that could lead to include only ICUs that have enough staffing or have an interest in early mobilization studies. The study was conducted 3 ICUs in the same hospital and region, therefore the number of patients included was small. In addition, data was collected through a survey which might lead to missing some important data due to limited number of highly experienced respiratory therapists. Also, the interpretation of collected data using SAS was limited because not all functions could be used without a license, and it is costly (Fontela et al., 2018).
Future study suggests that increasing the number of participated ICUs in different cities in within Saudi Arabia which involve large study population. The survey could be collected electronically with the assistant from nurses to make sure all data is complete.
Conclusion
References
Ali, Z., & Bhaskar, S. B. (2016). Basic statistical tools in research and data analysis. Indian Journal of Anaesthesia, 60(9), 662. https://doi.org/10.4103/0019-5049.190623
Fontela, P. C., Lisboa, T. C., Forgiarini-Júnior, L. A., & Friedman, G. (2018). Early mobilization practices of mechanically ventilated patients: A 1-day point-prevalence study in southern Brazil. Clinics, 73. https://doi.org/10.6061/clinics/2018/e241
Guilhermino, M. C., Inder, K. J., & Sundin, D. (2018). Education on invasive mechanical ventilation involving intensive care nurses: A systematic review. Nursing in Critical Care, 23(5), 245–255. https://doi.org/10.1111/nicc.12346
Kim, H.-Y. (2017). Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restorative Dentistry & Endodontics, 42(2), 152. https://doi.org/10.5395/rde.2017.42.2.152
Lin-Li Sang, Wei-Yun Teng, Jie Yang, & Liu-Zhao Cao. (2021). Predictive value of diaphragmatic rapid shallow breathing index in mechanical ventilation weaning: A systematic review and meta-analysis. Signa Vitae, 17(4), 34–41. https://doi.org/10.22514/sv.2020.16.0119
Pappal, R. D., Roberts, B. W., Mohr, N. M., Ablordeppey, E., Wessman, B. T., Drewry, A. M., Yan, Y., Kollef, M. H., Avidan, M. S., & Fuller, B. M. (2019). Protocol for a prospective, observational cohort study of awareness in mechanically ventilated patients admitted from the emergency department: The ED-AWARENESS study. BMJ Open, 9(10). https://doi.org/10.1136/bmjopen-2019-033379
Refaee, H., & Shehri, M. (2021). Readiness of respiratory therapists in Saudi Arabia to manage patients with COVID-19: A cross-sectional study. Saudi Critical Care Journal, 5, 24. https://doi.org/10.4103/sccj.sccj_7_21
Roberts, K. J., Johnson, B., Morgan, H. M., Vrontisis, J. M., Young, K. M., Czerpak, E., Fuchs, B. D., & Pierce, M. (2021). Evaluation of Respiratory Therapist Extender Comfort With Mechanical Ventilation During COVID-19 Pandemic. Respiratory Care, 66(2), 199–204. https://doi.org/10.4187/respcare.08459
Saritas, S., Kaya, A., & Dolanbay, N. (2019). Knowledge and Practices of Intensive Care Nurses on Mechanical Ventilation. International Journal of Caring Sciences, 12(1), 30–39.
Critical Thinking Assignment: Research Paper (130 points)
This final Critical Thinking assignment builds on the assignments from Modules 4, 6, and 10.
You will now write a formal paper on the topic you selected in Module 4. The paper must include the following elements:
Title page
Introduction—this should be revised based on feedback you received for the version you developed in Module 10.
Body of the paper that covers the main and subtopics.
Identify any gaps in the research that you think could be a research topic in the future.
Conclusion
References
Your paper should meet the following requirements:
Be six to seven pages in length, including the introduction, but not including the title or reference pages.
Be formatted according to Saudi Electronic University and APA writing guidelines.
Provide support for your statements with in-text citations from the ten scholarly articles you have gathered.
The following resources will help you with this assignment:
Purdue Online Writing Lab – General Format – scroll down to see the information writing and formatting Abstracts
Purdue Online Writing Lab – APA Sample Paper
Review the grading rubric to see how you will be graded for this assignment.
You are strongly encouraged to submit all assignments to the TurnItIn Originality Check prior to submitting them to your instructor for grading.