الفهرس 
Factors affecting Weaning Success RateOnly 14 pages are availabe for public view
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Abstract
Although MV is often a lifesaver, it can lead to physiological, psychological, and lethal complications for the patients. Nurses can reduce quickly and properly the dangers of using MV through evaluation of weaning readiness & use of weaning indices for enhancing and promoting spontaneous breathing during weaning that can shorten the time of MV& ICU stay. Aim of the Study The purpose of this study was to a) to compare the Burns Weaning Assessment Program (BWAP) and the Integrative Weaning Index (IWI) in predicting successful weaning from mechanical ventilation and b) to examine the relationship between integrative weaning index and burns weaning assessment program scores & outcomes of weaning trials in mechanically ventilated patients. Setting and Population A descriptive comparitive study design was used. The study was conducted at neurosurgical ICU of the university hospital of Menoufia University, Menoufia Governorate. A convenient sample of 120 patients, both sexes, aged from 19 to 65 years old was used. To Achieve The Purpose of The Current Study The Following Tools Were Used: I) A Semi Structured Demographic Questionnaire: to collect data on age, gender, ICU length of stay, number of comorbidities, diagnosis on admission. Data were extracted from the patient’s medical records by the investigator at the initial data collection point. II) Cardiorespiratory Parameters Questionnaire: The questionnaire developed by (Holzheimer, Mannick, 2001) to assess oxygenation and hemodynamic parameters.: such as (pulse rate, respiratory rate, systolic blood pressure, diastolic blood pressure, CVP, mean arterial blood pressure (MAP) and arterial blood gases values (SaO2, PaO2and PaCo2). III) Respiratory Neuromuscular Function Questionnaire: which include Spontaneous respiratory rate (F), Spontaneous tidal volume (VT), Plateau pressure (P plat), Positive End Expiratory Pressure (PEEP) and respiratory mechanics which include Static Compliance (Cs), integrative weaning index (IWI) based on the equation = Cst × SaO2/ F/ VT. IV) Glasgow Coma Scale (GCS): was developed by Teasdale & Jennett, (1974) to give a reliable, objective way of monitoring level of consciousness for initial as well as subsequent assessment for patients. It gives the patient a score between 3 (indicating deep unconsciousness) and 15 (indicating full consciousness). V) Acute Physiology and chronic Health Evaluation II scale (APACHE II scale): developed by (Knaus et al., 1985) it is one of several ICU scoring systems that was designed to measure the severity of disease for adult patients admitted within 24 hours to intensive care units. VI) The charlson Comorbidity Index:The charlson Comorbidity Index was developed by (Charlson et al., 1987).It is a method of categorizing comorbidities of patients based on the International Classification of Diseases (ICD) diagnosis codes found in administrative data. <VII) Modified Nutrition Risk Assessment in Critically Ill (NUTRIC): developed by (Heyland et al., 2011). It was the first nutritional risk assessment tool developed specifically for the ICU population that can identify patients at risk for malnutrition with the following variables: age, number of comorbidities, days from hospital to ICU admission, and Acute Physiology and chronic Health Evaluation II (APACHEII)
and Sequential Organ Failure Assessment (SOFA) scores at admission. Later (Rahman et al., 2016) validated the modified NUTRIC, which allows the exclusion of the IL-6 levels, if not available, to assess nutritional risk at admission. VIII) Clinical Pulmonary Infection Score (CPIS): developed by (Pugin et al., 1991) to diagnosis VAP by using a combination of six clinical findings; body temperature, blood leukocyte count, volume and appearance of tracheal secretion, culture examination, Oxygenation (PaO2/ FiO2), and chest X-ray &progression of pulmonary Infiltrate. IX) Burns Weaning Assessment Program (BWAP) Checklist: was developed by (Burns et al., 1990) to assess and follow weaning progresses of the mechanically ventilated patients using a 26-factor scoring Checklist used to diminish variability in managing patients on MV. The checklist has three components: general assessment, respiratory assessment, and arterial blood gases results.
The study revealed the following findings: • The mean age of the studied sample in BWAP group and IWI group was (41.88 ±12.58; 42.25 ±12.17) respectively. Regarding gender more than one half of the participants in the BWAP group was female (53.3%), while in the IWI group (51.7%) was male. • The mean score of Glasgow Coma Scale (GCS) of the studied sample in BWAP& IWI group (13.88 ± 0.90 &14.07 ±0.89) respectively. About 26.7% of patients in BWAP group& 30.0 % of patient in IWI group were diagnosed with cardiogenic shock. • The mean APACHE score among studied sample in BWAP group and IWI group was (13.61±9.16, 10.96±8.05) respectively. The mean score of charlson comorbidity index score in BWAP &IWI group was (1.00 ±0.86 & 0.98 ±0.83) respectively which indicate that the patients have little comorbidities and lower risk to mortality. • The most of participant (95.1%) in IWI group and the majority of participant (88.4%) in BWAP group had low malnutrition risk. • The most of the participants in the IWI group had successful weaning rate of 93.30% while in the BWAP group it was 75% which indicate that the IWI is a more objective index of weaning success rate. • The mean duration of mechanical ventilator by days in BWAP and IWI group was (3.32 ±2.63& 2.33 ±1.32) respectively, also the mean ICU length of Stay by days in both BWAP & IWI groups was (7.08 ±3.25&5.85 ±1.91) respectively, which indicate that the IWI is a better predictor of weaning outcomes than the BWAP. • There was a negative correlation between weaning success rate and duration of mechanical ventilation, ICU length of Stay; also there was a highly statistically significant difference between weaning success rate, duration of mechanical ventilator by day and ICU length of Stay in both groups, P <0.000. • There was no significant correlation between weaning success rate and age, nutritional status, comorbid conditions among mechanically ventilated patients. However, there was a significant negative correlation between weaning success rate and severity of illness (APACHE II score) (P= 0.000). Also, there was highly statistical significant regarding weaning success rate & nutritional status in BWAP group only (P = 0.005). • The most of the participant (93.3%) in IWI group and the majority of participant in BWAP (75.0%) didn’t have VAP. Conclusion 1. Weaning success rate was significantly higher in the IWI group as compared with Burns Weaning Assessment Program group. Also, using the IWI shortens the duration of mechanical ventilation and the ICU length of stay. 2. There was no significant relationship between predictors of weaning such as age, nutritional status and co-morbid conditions while there was a significant negative correlation between severity of illness and weaning success rate among mechanically ventilated patients Recommendations Train the critical care nurse to use the integrative weaning index as weaning predictor beside the clinical data during weaning process of mechanically ventilated patient as a routine practice in the critically ill patients. Implications for Nursing Practice 3. Establish regular in-service education courses for critical care nurse to educate them about the most proper timing of weaning to avoid premature weaning, which expose patients to severe respiratory, cardiovascular, and psychological stress and accelerating the process of liberation from mechanical ventilation. 4. Train critical care nurses to screen mechanically ventilated patients to identify people at risk for weaning difficulty. Early prediction of factors influencing weaning process can improve the management of mechanically ventilated patients. Implications for Future Research Replication of the study is recommended using large sample size and random selection technique.