Extubation Failure Open Chest Cardiac Surgery Routinely Collected Data Research

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Health Medical

Description

PICOT question: in patients post cardiac surgery, how does early extubation, compared to ventilation therapy affect respiratory complications 6 hours post operatively?

* I included one of the articles that needs to be used*

Assignment Criteria:

1. Describe the clinical or administrative problem related to the PICOT question formulated

• Formulate the PICOT question in the intervention format

• Discuss why the problem is important to nursing practice

• Discuss the chosen intervention

• Elaborate on how the intervention may impact the stated outcome

2. Discuss two (2) barriers that a master’s prepared nurse might encounter before implementing the intervention.

3. Explore two (2) possible actions that can be used for handling those barriers.

4. Identify two (2) inclusion criteria and two (2) exclusion criteria to be used in the

analysis of the evidence.

5. Identify the databases (e.g., CINAHL, Medline) and key terms used in initiating the

search.

6. The scholarly paper should be in narrative format, four (4) to five (5) pages

excluding the title and reference pages.

7. Include an introductory paragraph, purpose statement, and a conclusion.

8. Include level 1 and 2 headings to organize the paper.

Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used.

10. Include a minimum of three (3) references from professional peer-reviewed nursing journals to support the paper. References should be from scholarly peer-reviewed journals (review in Ulrich Periodical Directory) and be less than five (5) years old.

11. APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).

Unformatted Attachment Preview

782103 research-article2018 CNU0010.1177/1474515118782103European Journal of Cardiovascular NursingSanson et al. Original Article Predictors of extubation failure after open-chest cardiac surgery based on routinely collected data. The importance of a shared interprofessional clinical assessment European Journal of Cardiovascular Nursing 2018, Vol. 17(8) 751­–759 © The European Society of Cardiology 2018 Article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/1474515118782103 DOI: 10.1177/1474515118782103 journals.sagepub.com/home/cnu Gianfranco Sanson1,2, Massimiliano Sartori1, Lorella Dreas3, Roberta Ciraolo4 and Adam Fabiani3 Abstract Background: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. Aim: To identify variables that are predictive of ExtF and related outcomes. Method: Prospective observational longitudinal study. Consecutively presenting patients (n=205) undergoing openheart cardiac surgery and admitted to the Cardiosurgical Intensive Care Unit (CICU) were recruited. The clinical data were collected at CICU admission and immediately prior to extubation. ExtF was defined as the need to restart invasive or non-invasive mechanical ventilation while the patient was in the CICU. Results: The ExtF incidence was 13%. ExtF related significantly to hospital mortality, CICU length of stay and total hospital length of stay. The risk of ExtF decreased significantly, by 93% in patients with good neurological function and by 83% in those with a Rapid Shallow Breathing Index of ≥57 breaths/min per litre. Conversely, ExtF risk increased 27 times when the PaO2/FiO2 was
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Explanation & Answer

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Running Head: PICOT QUESTION ON EARLY EXTUBATION

PICOT Question on Early Extubation
Name
Institution
Course
Date

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PICOT QUESTION ON EARLY EXTUBATION

2

Introduction
Extubation failure (ExtF) is associated with prolonged hospital length of stay and a high
mortality rate among adults who have undergone cardiac surgery patients. The clinical question
is how early extubation affects respiratory complications 6 hours postoperatively compared to
ventilation therapy in patients post cardiac surgery.
Purpose Statement
Extubation failure (ExtF) is a major clinical problem in nursing practice because it is
postoperatively associated with prolonged hospital length of stay and mortality among adult
patients who have undergone cardiac surgery. The purpose of this PICOT study is to identify
predictive variables for ExtF and related outcomes (Lopes et al., 2018). The PICOT question is,
therefore;
PICOT Question: In post-cardiac surgery patients, how does early extubation, compared to
ventilation therapy, affect respiratory complications 6 hours postoperatively?
The Clinical Problem Related to the PICOT Question Formulated
The clinical problem related to the formulated PICOT question is extubation failure
(ExtF) associated with prolonged hospital length of stay and a high rate of mortality among adult
who has undergone cardiac surgery patients. Further, the mortality and increased length of stay
are observed postoperatively due to the variables related to ExtF such as the (PaO2/FiO2) ratio,
which illustrates the proportion of partial oxygen pressure in the arteries and fraction of inspired
oxygen (Sanson, et al., 2018). Other related factors attributed to this clinical problem are rapid
shallow breathing index, endotracheal secretions, cough strength, and neurological function.
The PICOT Question in the Intervention Format

PICOT QUESTION ON EARLY EXTUBATION

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PICOT question: in patients post-cardiac surgery, how does early extubation, compared to
ventilation therapy, affect respiratory complications 6 hours postoperatively?
Population: post-cardiac surgery patients
Intervention: Early extubation
Comparison: Ventilation therapy
Outcome: Affect respiratory complications
Time: 6 hours postoperatively
Why the Problem is Important to Nursing Practice
The problem is important to nursing practice because it is postoperatively associated with
prolonged hospital length of stay and mortality among adult patients who have undergone
cardiac surgery. This clinical problem is also a significant problem in nursing practice due to its
contribution to the increased cost of providing healthcare and reduced patient outcomes (Nguyen
et al., 2020). Extubation failure has thus been a major barrier to achieving quality patient
outcomes, providing quality care, and promoting efficient and effective nursing care delivery.
Identifying variables that can be used to predict the Extubation failure (ExtF) and its related
outcome will thus help a nursing practice overcome this clinical problem.
Chosen Intervention
The chosen intervention is early Extubation. According to the authors, the decision to
extubate adult patients who have undergone cardiac surgery should be taken after gathering
sufficient evidence from evidence-based practice. Such evidence must be gathered from a
combination of the data derived from clinical assessments in nursing and medical practice
(Nguyen et al., 2020). The authors also suggest that extubation should be delayed until a point

PICOT QUESTION ON EARLY EXTUBATION

4

when it is ascertained that the patient has achieved safe oxygenation, hemodynamic conditions,
respiratory, and good neurocognitive function following successful cardiac surgery.
Elaborate on how the Intervention may Impact the Stated Outcome
Early Extubation is the removal of the endotracheal tube within the elapse of six hours
following cardiac surgery. The removal of the en...


Anonymous
Excellent resource! Really helped me get the gist of things.

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