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Nursing interventions in the extubation process: a scoping review


International Physical Medicine & Rehabilitation Journal
Maria Beatriz Rocha,1 Ana Filipa Poeira,2 Raquel Flamino,1 Neuza Santos1

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Abstract

Background: One of the main reasons why people need to be in an intensive care unit is due to the need of invasive mechanical ventilation. Mechanical ventilation allows for assisting or replacing spontaneous breathing. Weaning is a critical phase of mechanical ventilation and it represents about 40 % of it. Ventilatory extubation is essential, not only because it is an indicator of recovery of the person´s ventilatory autonomy, but also because of the risks that prolonged invasive mechanical ventilation causes.
Objectives: This research report was made due to the need of scientific evidence for the extubation process. We aim to get further insight into the nursing cares in people submitted to invasive mechanical ventilation, in intensive care units, in order to optimize this process.
Design: It was made a scoping review, based on the recommended methodology of Joanna Briggs Institute. It was used a five-step process that included: Identifying the research question; Identifying relevant studies; Study selection; Charting the data and collating, Summarizing and reporting the results.
Data sources: A literature search was performed in the following databases: Cochrane, CINAHL, Nursing Reference Center,Medline, ISI, Scielo and RCAAP.
Methods: Two independent reviewers assessed eligibility based on the article´s titles, abstracts and full text. Data extraction was conducted based on a table developed by the reviewers.
Results: Nine studies were included in this review. Circadian cycle, nurse-patient relationship, criteria, sedation, spontaneous breathing trial, secretions, level of consciousness, anxiety, vital signs, risk factors, oxygenation, general assessment of the patient, stridor, oral hygiene, position, extubation and food interruption were the relevant topics that emerged from each article.
Conclusion: It is shown that the vision and the holistic intervention during the extubation process is essential for the improvement of the quality of the ventilatory weaning and consequent extubation. This study allows for gathering the best existing scientific evidence to provide nursing cares of quality and excellence, minimizing the associated risks, by informing the reader in a schematic form, of the nursing care in the various stages of the extubation process.

Keywords

Airway extubation, Intensive care units, Nurses, Respiration, Artificial, Mechanical ventilation requires, Cardiac output, Respiratory muscle dysfunction

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