DEVELOPMENT OF CLINICAL NURSING PRACTICE GUIDELINES FOR PREVENTION OF REINTUBATION IN PEDIATRIC PATIENTS WITH SEVERE PNEUMONIA IN CHIANGRAI PRACHANUKROH HOSPITAL
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Abstract
BACKGROUND: Extubation in pediatric patients with severe pneumonia is complicated. Extubation failure leads to increased morbidity, cost and mortality. Developing and implementing clinical nursing practice guidelines to prevent reintubation will keep patients safety.
OBJECTIVE: To develop and study the outcomes of Implementing clinical nursing practice guidelines to prevent reintubation in pediatric patients with severe pneumonia in Chiangrai Prachanukroh hospital.
METHODS: This participatory action research was studied in pediatric patients who admitted to the pediatric intensive care unit in Chiangrai Prachanukroh hospital. The sample was selected by purposive sampling with divided into two groups. The first group was the 13 pediatric intensive care unit nurses The second group was 154 pediatric patients with severe pneumonia. This studied was divided into two periods, before and after using the nursing practice guideline (April 2018 to March 2019 and April 2020 to March 2021, respectively). The research instruments consisted of: 1) Clinical nursing practice guidelines for preventing re-intubation in pediatric patients with severe pneumonia 2) The assessment form of difficulty-easy to use and feasibility for implementing the guidelines 3) The observation record form of compliance of practice guidelines 4) The assessment form of registration nurse satisfaction 5) The outcomes record form of clinical nursing clinical practice guidelines for prevention of reintubation in pediatric patients with severe pneumonia. The data were analyzed using descriptive statistics and t-test statistics.
RESULTS: 1. The developed clinical nursing practice guidelines had 5 components which (1) Daily assessment of readiness weaning ventilator (2) Weaning the ventilator (3) Pre extubation assessment CALMS criteria, air leak test (4) Nursing care while extubation and (5) Nursing care after extubation. 2.The results of using the clinical nursing practice guidelines were found very easy to practice (mean 3.89, SD+0.25). The possibility of implementing the guidelines was at the level that could all be implemented (mean 3.88, SD+0.25). The registered nurses had the highest level of overall satisfaction with the implementation (mean 4.69, SD+0.63). Compare treatment outcomes before and after using the developed clinical nursing practice guidelines found the significantly difference in the duration of intubation (p=0.001) and length of stays (p=0.050). But, the reintubation rate (p=0.070), the acute upper airway obstruction rate (p=0.604 and the average cost were decreased (p=0.089) was not significantly different.
CONCLUSIONS AND RECOMMENDATIONS: The clinical nursing clinical practice guidelines which developed were effective for preventing re-intubation in pediatric patients with severe pneumonia and increased an effective nursing care. Therefore, it is recommended that the results be extended to all pediatric patients with severe pneumonia.
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References
Nascimento MS, Prado C, Troster EJ, Valério N, Alith MB, Lourenco de Almeida JF. Risk factors for post-extubation stridor in children: the role of orotracheal cannula. Einstein (Sao Paulo). 2015;13(2):226-31.
Valenzuela J, Araneda P, Cruces P. Weaning from mechanical ventilation in paediatrics. State of the art. Arch Bronconeumol. 2014;50(3):105-12.
Laham J, Breheny P. Extubations in the PICU – Where are we now?. J Intensive Crit Care. 2017;3(3):1-2.
Bunburaphong T. Respiratory care in clinical practice. 6th ed.Bangkok: Faculty of Medicine Ramathibodi Hospital, Mahidol University; 2016.
Li W, An X, Fu M, Li C. Emergency treatment and nursing of children with severe pneumonia complicated by heart failure and respiratory failure: 10 case reports. Exp Ther Med. 2016;12(4):2145-9.
The Thai Society of Pediatric Respiratory and Critical Care Medicine, The Royal College Pediatricians of Thailand and Pediatric Society of Thailand. Clinical guidelines for acute respiratory infection in children 2019. Bangkok: Beyond Enterprise; 2019.
Araya S, Lovera D, Zarate C, Apodaca S, Acuña J, Sanabria G, et al. Application of a prognostic scale to estimate the mortality of children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2016;35(4):369-73.
Kemmis S, McTaggart R. The action research planner. 3rd ed. Geelong: Deakin University Press; 1988.
Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare:a guide to best practice.4th ed. Philadelphia: Wolters Kluwer;2019.
Kneyber MCJ, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J, et al. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med. 2017;43(12):1764-80.
Newth CJ, Venkataraman S, Willson DF, Meert KL, Harrison R, Dean JM, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009;10(1):1-11.
Mikalsen IB, Davis P, Qymar K. High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med. 2016;24:93.
Satcha T, Nakarit K. The development of nursing service system for tuberculosis patients in Ranong hospital. Journal of Nursing Division 2012;39(2):22-36.
Sricharoenchai T. High flow nasal cannula uses. In: Staworn D, Piyavechviratana K, Poonyathawon S, editors. ICU everywhere. Bangkok: The Thai Society of Critical Care Medicine; 2018.p.18-41.
Hernández G, Vaquero C, González P, Subira C, Frutos-Vivar F, Rialp G, et al. Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA. 2016;315(13):1354-61.
Yurtseven A, Saz EU. The effectiveness of heated humidified high-flow nasal cannula in children with severe bacterial pneumonia in the emergency department. J Pediatr Res. 2020;7(1):71-6.
Khemani RG, Hotz J, Morzov R, Flink R, Kamerkar A, Ross PA, et al. Evaluating risk factors for pediatric post-extubation upper airway obstruction using a physiology-based tool. Am J Respir Crit Care Med. 2016;193(2):198-209.
Khemani RG, Hotz J, Morzov R, Flink RC, Kamerkar A, LaFortune M, et al. Pediatric extubation readiness tests should not use pressure support. Intensive Care Med. 2016;42(8):1214-22.
Artime CA, Hagberg CA. Tracheal extubation. Respir Care. 2014;59(6):991-1005.
Nickson C. Extubation assessment in the ICU. 2020 Nov 3. In: Life in the fastlane [Internet]. Cadogan M, Nickson C, editors. [cited 2022 Apr 27]. [about 2 screens]. Available from: https://litfl.com/extubation-assessment-in-the-i
Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294-302.
Kerdpitak S, Thampanichawat W, Nookong A. Factors related to success of weaning from mechanical ventilation in pediatric patients: a preliminary study. J Nurs Sci. 2014;32(2):32-40.
