Mekanik ventilasyondan ayırma ve hemşirelik

Demirkılıç, Ufuk; Yava, Ayla; KÜRKLÜOĞLU, Mustafa; KOYUNCU, Aynur; GÜLER, Adem

Mekanik ventilasyondan ayırma ve hemşirelik

Aynur KOYUNCU, (Gülhane Askeri Tıp Akademisi Kalp Damar Cerrahisi Anabilim Dalı, Ankara, Türkiye)

Ayla YAVA, (Gülhane Askeri Tıp Akademisi, Cerrahi Hastalıkları Hemşireliği Bilim Dalı, Ankara, Türkiye)

Mustafa KÜRKLÜOĞLU, (Gülhane Askeri Tıp Akademisi Kalp Damar Cerrahisi Anabilim Dalı, Ankara, Türkiye)

Adem GÜLER, (Gülhane Askeri Tıp Akademisi Kalp Damar Cerrahisi Anabilim Dalı, Ankara, Türkiye)

Ufuk DEMİRKILIÇ (Gülhane Askeri Tıp Akademisi Kalp Damar Cerrahisi Anabilim Dalı, Ankara, Türkiye)

Türk Göğüs Kalp Damar Cerrahisi Dergisi

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Yıl: 2011 Cilt: 19 Sayı: 4 Sayfa Aralığı: 671 - 681 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Mekanik ventilasyondan ayırma ve hemşirelik

Öz:

Mekanik ventilatörden ayırma, hastanın mekanik destek ve endotrakeal tüpten ayrılmasına ilişkin tüm süreci kapsar. Mekanik ventilatörden ayırmak için hastanın fizyolojik ve psikolojik durumu ile tıbbi personel mevcudiyetine göre uygun zaman belirlenmelidir. Ayırmanın her aşaması ileri hemşirelik bilgisi ve becerisi gerektirmektedir. Hemşirelik gözlemi ve hastadaki gelişmelerin sürekli izlenmesi; mekanik ventilatörden ayırmanın gecikmesini engelleyebilir ve oluşabilecek sorunların erken dönemde fark edilmesini sağlayabilir. Hemşirelik bakımının kalitesi ayırma başarısını belirleyen önemli faktörlerden biridir. Ayırma sürecinin takip prosedürleri ve uygulamaları önceden belirlenmelidir. Ayırma sürecine yönelik kurumsal protokoller başarı oranını etkileyen diğer faktörlerdir. Bu makalede, ayırma aşamaları ve yöntemleri, kararın verilmesi, ayırma parametreleri ve hemşirelik bakımı derlenmiştir.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi

Weaning from mechanical ventilation and nursing

Öz:

Weaning from a mechanical ventilator covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. The appropriate time for weaning should be determined according to the physical and emotional condition of the patient together with the presence of medical staff. Each phase of weaning requires advanced nursing knowledge and skill. Nursing observations and continuous monitoring of the patient’s progress may prevent the delay of weaning and help notice problems that might be encountered during the process in the early phases. The quality of nursing care is one of the important factors that determines the success of weaning. The follow-up procedures and applications of the weaning process should be determined beforehand. Institutional protocols for the weaning process are the other factors affecting the success rate of weaning. In this article the weaning phases and methods, decision making, weaning parameters, and nursing care are reviewed.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık

1. Rose L, Nelson S. Issues in weaning from mechanical ventilation: literature review. J Adv Nurs 2006;54:73-85.
2. MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001;120:375S-95S.
3. Marini JJ, Wheeler AP. Weaning from mechanical ventilation, In: Marini JJ, Wheeler AP, editors. Critical care medicine: the essentials. 2nd ed. Pennsylvania: Willams & Wilkins; 1997. p. 173-95.
4. Mancebo J. Weaning from mechanical ventilation. Eur Respir J 1996;9:1923-31.
5. Calfee CS, Matthay MA. Recent advances in mechanical ventilation. Am J Med 2005;118:584-91.
6. Pingleton SK. Complications of acute respiratory failure. Am Rev Respir Dis 1988;137:1463-93.
7. Crocker C. Nurse led weaning from ventilatory and respiratory support. Intensive Crit Care Nurs 2002;18:272-9.
8. Gelsthorpe T, Crocker C. A study exploring factors which influence the decision to commence nurse-led weaning. Nurs Crit Care 2004;9:213-21.
9. Jenny J, Logan J. Promoting ventilator independence: a grounded theory perspective. Dimens Crit Care Nurs 1994;13:29-37.
10. Logan J, Jenny J. Qualitative analysis of patients’ work during mechanical ventilation and weaning. Heart Lung 1997;26:140-7.
11. Blackwood B. Can protocolised-weaning developed in the United States transfer to the United Kingdom context: a discussion. Intensive Crit Care Nurs 2003;19:215-25.
12. Blackwood B, Wilson-Barnett J, Trinder J. Protocolized weaning from mechanical ventilation: ICU physicians’ views. J Adv Nurs 2004;48:26-34.
13. Burns SM, Burns JE, Truwit JD. Comparison of five clinical weaning indices. Am J Crit Care 1994;3:342-52.
14. Cull C, Inwood H. Weaning patients from mechanical ventilation. Prof Nurse 1999;14:535-8.
15. Norton L. The role of the specialist nurse in weaning patients form mechanical ventilation and the development of nurseled approach. Nurs Crit Care 2000;5:220-7.
16. Price AM. Nurse-led weaning from mechanical ventilation: where’s the evidence? Intensive Crit Care Nurs 2001;17:167-76.
17. Haris J. Weaning from mechanical ventilation: relating the literature to nursing practice. Nurs Crit Care 2001;6:226-31.
18. Goodman S. Implementing a protocol for weaning patients off mechanical ventilation. Nurs Crit Care 2006;11:23-32.
19. Blackwood B, Wilson-Barnett J, Patterson CC, Trinder TJ, Lavery GG. An evaluation of protocolised weaning on the duration of mechanical ventilation. Anaesthesia 2006; 61:1079-86.
20. Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C, et al. Predicting success in weaning from mechanical ventilation. Chest 2001;120:400S-24S.
21. MacIntyre NR. Psychological factors in weaning from mechanical ventilatory support. Respir Care 1995;40:277-81.
22. Çelik S. Mekanik ventilasyonda hemşirelik yaklaşımları. Yoğun Bakım Hemşireleri Dergisi 2001;5:92-7.
23. Herrera M, Blasco J, Venegas J, Barba R, Doblas A, Marquez E. Mouth occlusion pressure (P0.1) in acute respiratory failure. Intensive Care Med 1985;11:134-9.
24. Gandia F, Blanco J. Evaluation of indexes predicting the outcome of ventilator weaning and value of adding supplemental inspiratory load. Intensive Care Med 1992; 18:327-33.
25. MacIntyre NR. Respiratory mechanics in the patient who is weaning from the ventilator. Respir Care 2005;50:275-86.
26. Capdevila XJ, Perrigault PF, Perey PJ, Roustan JP, d’Athis F. Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest 1995;108:482-9.
27. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324:1445-50.
28. Pierson DJ. Nonrespiratory aspects of weaning from mechanical ventilation. Respir Care 1995;40:263-7.
29. Pilbeam SP, editor. Mechanical ventilation: physiological and clinical applications. Philadelphia: Mosby; 1998. Çeviri editörleri: Çelik M, Besler MP, Helvacı A, Yalman A, Orhon ZN, Yaycı F. Mekanik ventilasyon fizyolojik ve klinik uygulamalar. İstanbul: Logos Tıp Yayıncılık; 1998. s. 52-68.
30. Pierson DJ. Weaning from mechanical ventilation in acute respiratory failure; concepts indications and techniques. Respir Care 1983;28:646-62.
31. Tahvanainen J, Salmenperä M, Nikki P. Extubation criteria after weaning from intermittent mandatory ventilation and continuous positive airway pressure. Crit Care Med 1983;11:702-7.
32. Millbern SM, Downs JB, Jumper LC, Modell JH. Evaluation of criteria for discontinuing mechanical ventilatory support. Arch Surg 1978;113:1441-3.
33. Sahn SA, Lakshminarayan S. Bedside criteria for discontinuation of mechanical ventilation. Chest 1973; 63:1002-5.
34. Sahn SA, Lakshminarayan S, Petty TL. Weaning from mechanical ventilation. JAMA 1976;235:2208-12.
35. Marini JJ, Smith TC, Lamb V. Estimation of inspiratory muscle strenght in mechanically ventilated patients:the measurement of maximal inspiratory pressure. J Crit Care 1986;1:32-6.
36. Esteban A, Alía I, Ibañez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest 1994;106:1188-93.
37. Burgess GE 3rd, Cooper JR Jr, Marino RJ, Peuler MJ, Warriner RA 3rd. Laryngeal competence after tracheal extubation. Anesthesiology 1979;51:73-7.
38. Levis SM, Heitkemper MM, Dirksen SR, Mechanical ventilation. In: Levis SM, Heitkemper MM, Dirksen SR, editors. Medical surgical nursing: assessment and management of clinical prolems. Vol. 2. Philadelphia: Mosby; 2004. p. 1781-5.
39. Miller RL, Cole RP. Association between reduced cuff leak volume and postextubation stridor. Chest 1996;110:1035-40.
40. Tobin MJ, Perez W, Guenther SM, Lodato RF, Dantzker DR. Does rib cage-abdominal paradox signify respiratory muscle fatigue? J Appl Physiol 1987;63:851-60.
41. Marino PL, Sutin KM, editor. The ICU book. 3rd ed. New York: Lippincott Williams & Wilkins; 2006. Çeviri editörleri: Yorgancı K, Topeli-İskit A. Mekanik ventilasyonun sonlandırılması. Ankara: Palme Yayıncılık; 2009. p. 511-27.
42. White EH. Management of client with acute pulmoner disorders. In: Black JM, Hawks JH, editors. Medical surgical nursing: clinical management for positive outcome. 7th ed. Vol 2. Philadelphia: Elsevier Saunder Comp; 2005. p. 1880-6.
43. Olgun N, Eti-Aslan F, Sert H. Solunum fonksiyonlarının değerlendirilmesi: Mekanik ventilasyondaki hastanın hemşirelik bakımı. In: Karadakovan A, Eti-Aslan F, editörler. Dahili ve cerrahi hastalıklarda bakım. Adana: Nobel Kitabevi; 2010. p. 451-3.
44 Hewlett AM, Platt AS, Terry VG. Mandatory minute volume. A new concept in weaning from mechanical ventilation. Anaesthesia 1977;32:163-9.
45. Quan SF, Parides GC, Knoper SR. Mandatory minute ventillation (MMV): An overview. Respir care 1990;35:898- 905.
46. Koyuncu A. Noninvaziv mekanik ventilasyonda hemşirelik bakımı. III. Göğüs Hastalıkları Hemşireliği Kursu’nda sunulmuştur; 18-19 Aralık 2008, Ankara, Türkiye: Kurs Kitabı, Türk Toraks Derneği Basımı; 2008. s. 122-7.
47. Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med 2003;138:861-70.
48. Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, et al. Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 2003;168:70-6.
49. Luce JM. The cardiovascular effects of mechanical ventilation and positive end-expiratory pressure. JAMA 1984;252:807-11.
50. Naughton MT, Rahman MA, Hara K, Floras JS, Bradley TD. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 1995;91:1725-31.
51. Bojar R, editor. Manual of perioperative care in adult cardiac surgery. Boston: Blackwell Publishing; 2005.
52. Mathru M, Rao TL, El-Etr AA, Pifarre R. Hemodynamic response to changes in ventilatory patterns in patients with normal and poor left ventricular reserve. Crit Care Med 1982;10:423-6.
53. Pinsky MR, Summer WR, Wise RA, Permutt S, Bromberger- Barnea B. Augmentation of cardiac function by elevation of intrathoracic pressure. J Appl Physiol 1983;54:950-5.
54. Hemsley B, Sigafoos J, Balandin S, Forbes R, Taylor C, Green VA, et al. Nursing the patient with severe communication impairment. J Adv Nurs 2001;35:827-35.
55 Cornock MA. Stress and the intensive care patient: perceptions of patients and nurses. J Adv Nurs 1998;27:518-27.
56. Thomas LA. Clinical management of stressors perceived by patients on mechanical ventilation. AACN Clin Issues 2003;14:73-81.
57. Driver AG, LeBrun M. Iatrogenic malnutrition in patients receiving ventilatory support. JAMA 1980;244:2195-6.

APA	KOYUNCU A, Yava A, KÜRKLÜOĞLU M, GÜLER A, Demirkılıç U (2011). Mekanik ventilasyondan ayırma ve hemşirelik. , 671 - 681.
Chicago	KOYUNCU Aynur,Yava Ayla,KÜRKLÜOĞLU Mustafa,GÜLER Adem,Demirkılıç Ufuk Mekanik ventilasyondan ayırma ve hemşirelik. (2011): 671 - 681.
MLA	KOYUNCU Aynur,Yava Ayla,KÜRKLÜOĞLU Mustafa,GÜLER Adem,Demirkılıç Ufuk Mekanik ventilasyondan ayırma ve hemşirelik. , 2011, ss.671 - 681.
AMA	KOYUNCU A,Yava A,KÜRKLÜOĞLU M,GÜLER A,Demirkılıç U Mekanik ventilasyondan ayırma ve hemşirelik. . 2011; 671 - 681.
Vancouver	KOYUNCU A,Yava A,KÜRKLÜOĞLU M,GÜLER A,Demirkılıç U Mekanik ventilasyondan ayırma ve hemşirelik. . 2011; 671 - 681.
IEEE	KOYUNCU A,Yava A,KÜRKLÜOĞLU M,GÜLER A,Demirkılıç U "Mekanik ventilasyondan ayırma ve hemşirelik." , ss.671 - 681, 2011.
ISNAD	KOYUNCU, Aynur vd. "Mekanik ventilasyondan ayırma ve hemşirelik". (2011), 671-681.

APA	KOYUNCU A, Yava A, KÜRKLÜOĞLU M, GÜLER A, Demirkılıç U (2011). Mekanik ventilasyondan ayırma ve hemşirelik. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 19(4), 671 - 681.
Chicago	KOYUNCU Aynur,Yava Ayla,KÜRKLÜOĞLU Mustafa,GÜLER Adem,Demirkılıç Ufuk Mekanik ventilasyondan ayırma ve hemşirelik. Türk Göğüs Kalp Damar Cerrahisi Dergisi 19, no.4 (2011): 671 - 681.
MLA	KOYUNCU Aynur,Yava Ayla,KÜRKLÜOĞLU Mustafa,GÜLER Adem,Demirkılıç Ufuk Mekanik ventilasyondan ayırma ve hemşirelik. Türk Göğüs Kalp Damar Cerrahisi Dergisi, vol.19, no.4, 2011, ss.671 - 681.
AMA	KOYUNCU A,Yava A,KÜRKLÜOĞLU M,GÜLER A,Demirkılıç U Mekanik ventilasyondan ayırma ve hemşirelik. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2011; 19(4): 671 - 681.
Vancouver	KOYUNCU A,Yava A,KÜRKLÜOĞLU M,GÜLER A,Demirkılıç U Mekanik ventilasyondan ayırma ve hemşirelik. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2011; 19(4): 671 - 681.
IEEE	KOYUNCU A,Yava A,KÜRKLÜOĞLU M,GÜLER A,Demirkılıç U "Mekanik ventilasyondan ayırma ve hemşirelik." Türk Göğüs Kalp Damar Cerrahisi Dergisi, 19, ss.671 - 681, 2011.
ISNAD	KOYUNCU, Aynur vd. "Mekanik ventilasyondan ayırma ve hemşirelik". Türk Göğüs Kalp Damar Cerrahisi Dergisi 19/4 (2011), 671-681.