Weaning Patterns in Mechanically Ventilated Patients with Acute Myocardial Infarction

2.50
Hdl Handle:
http://hdl.handle.net/10755/150219
Type:
Presentation
Title:
Weaning Patterns in Mechanically Ventilated Patients with Acute Myocardial Infarction
Abstract:
Weaning Patterns in Mechanically Ventilated Patients with Acute Myocardial Infarction
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Mylott, Laura
P.I. Institution Name:Massachusetts General Hospital
The use of mechanical ventilation has increased dramatically in the past 10 years. Mechanical ventilation is associated with pneumonia and consumes a disproportionate amount of health care resources. Weaning occupies nearly 40% of the time spent on mechanical ventilation, yet weaning readiness and the weaning process have not been well described. Determining weaning readiness and predicting the weaning trajectory will enable clinicians to expedite the weaning process and hasten the termination of mechanical ventilation. Research questions are: (1) what are the weaning patterns of adults with acute myocardial infarction (AMI) who were successfully weaned after 24 hours of mechanical ventilation and, (2) what are the clinical indicators of weaning readiness in adults with AMI who have been successfully weaned after 24 hours of mechanical ventilation? The Weaning Continuum Model (Knebel, Shekleton, Clochesy, Hanneman, 1998) was used as the guiding framework. A retrospective chart review was conducted of patients who met the study criteria during 1997 and 1998. Curley’s (1998) decision-making rules for progressive weaning guided pattern recognition and description. Indicators for weaning readiness were identified by using paired samples t-test for continuous variables and Wilcoxon-matched pairs signed ranked analyses for categorical variables to compare pre and post weaning variables. This sample of 66 patients generated 488 clinical days of data from initiation of mechanical ventilation to extubation. The mean age of the sample was 67 years and 65% were male. Patients’ severe cardiac dysfunction was indicated by a median serum creatinine phosphokinase of 1579 mg/dl, a median left ventricular ejection fraction of 38% and an incidence of 29% of cardiogenic shock. Three patterns of weaning were identified: 1) sprint – weaning process spanned several hours and was completed within one day; 2) consistent – characterized by an average of 2 days of progressive weaning; 3) inconsistent – characterized by an average of 3 days of non-progressive weaning. Clinical indicators of weaning readiness identified were: hemodynamic stability, enhanced afterload reduction, negative fluid balance, absence of infection and improving pulmonary oxygenation. Patients in the sprint and consistent groups weaned progressively over a brief time period, even after a long period of intubation. This pattern suggests that weaning is more of an event in this population than a process. The clinical picture of weaning readiness is largely one of cardiovascular stability. This knowledge can be used by nurses to intervene and expedite the weaning process, curtailing the physiological, emotional and financial burden associated with mechanical ventilation.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleWeaning Patterns in Mechanically Ventilated Patients with Acute Myocardial Infarctionen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150219-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Weaning Patterns in Mechanically Ventilated Patients with Acute Myocardial Infarction</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Mylott, Laura</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Massachusetts General Hospital</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">lmylott@partners.org</td></tr><tr><td colspan="2" class="item-abstract">The use of mechanical ventilation has increased dramatically in the past 10 years. Mechanical ventilation is associated with pneumonia and consumes a disproportionate amount of health care resources. Weaning occupies nearly 40% of the time spent on mechanical ventilation, yet weaning readiness and the weaning process have not been well described. Determining weaning readiness and predicting the weaning trajectory will enable clinicians to expedite the weaning process and hasten the termination of mechanical ventilation. Research questions are: (1) what are the weaning patterns of adults with acute myocardial infarction (AMI) who were successfully weaned after 24 hours of mechanical ventilation and, (2) what are the clinical indicators of weaning readiness in adults with AMI who have been successfully weaned after 24 hours of mechanical ventilation? The Weaning Continuum Model (Knebel, Shekleton, Clochesy, Hanneman, 1998) was used as the guiding framework. A retrospective chart review was conducted of patients who met the study criteria during 1997 and 1998. Curley&rsquo;s (1998) decision-making rules for progressive weaning guided pattern recognition and description. Indicators for weaning readiness were identified by using paired samples t-test for continuous variables and Wilcoxon-matched pairs signed ranked analyses for categorical variables to compare pre and post weaning variables. This sample of 66 patients generated 488 clinical days of data from initiation of mechanical ventilation to extubation. The mean age of the sample was 67 years and 65% were male. Patients&rsquo; severe cardiac dysfunction was indicated by a median serum creatinine phosphokinase of 1579 mg/dl, a median left ventricular ejection fraction of 38% and an incidence of 29% of cardiogenic shock. Three patterns of weaning were identified: 1) sprint &ndash; weaning process spanned several hours and was completed within one day; 2) consistent &ndash; characterized by an average of 2 days of progressive weaning; 3) inconsistent &ndash; characterized by an average of 3 days of non-progressive weaning. Clinical indicators of weaning readiness identified were: hemodynamic stability, enhanced afterload reduction, negative fluid balance, absence of infection and improving pulmonary oxygenation. Patients in the sprint and consistent groups weaned progressively over a brief time period, even after a long period of intubation. This pattern suggests that weaning is more of an event in this population than a process. The clinical picture of weaning readiness is largely one of cardiovascular stability. This knowledge can be used by nurses to intervene and expedite the weaning process, curtailing the physiological, emotional and financial burden associated with mechanical ventilation.</td></tr></table>en_GB
dc.date.available2011-10-26T10:19:15Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T10:19:15Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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