tolerance of the endotracheal tube: a systematic ... · tolerance of the endotracheal tube: a...
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Tolerance of the endotracheal tube: a systematic literature review
22.1
1.15
Nydahl, Nursing Research
Project of the German Early Mobilization Network Nydahl P, Hermes C, Dubb R, Kaltwasser A, Schuchhardt D (2015). Toleranz des endotrachealen Tubus bei beatmeten Intensivpatienten. Med Klin Intensivmed Notfmed 110(1):68-76.
Background & problem
Nydahl, Nursing Research
Background Clinicians have concerns about patient‘s tolerance of ETT, with consequences for more sedation, fixation and less mobilization1,2,3
Definition In favor of a higher value (health) a lesser competing value (ETT) is accepted. It is the "will to allow something“4
Question What factors have got an impact on patient‘s tolerance of an ETT?
1 Aitken 2011, 2 Grossbach 2011, 3 Needham 2011, 4 Moore 2011
Method
Nydahl, Nursing Research
• Data bases: Pubmed, CINAHL, hand search
• Time frame: till Aug. 2014 • Terms: patient experience, ventilator,
tube, endotracheal tube, tolerance, acceptance, compliance, comfort, discomfort
• Design: quantiative & qualitative studies • Excluded: ETT during operation & short-
term procedures, children, unclear ETT vs trach.
Results
Nydahl, Nursing Research
• 8 quantitative studies5-12, incl. 2 RCT8,12
• 4 qualitative studies13-16
• 2 mixed design17,18
• High risk of bias: not able to remember, suggestions instead of questions • ETT vs trach9,12: no difference in tolerance or outcome
• Is tolerance measurable by choking, swallowing, breathing, removal?
5 Rotondi 2002, 6 Machata 2007, 7 Samuelson 2007, 8 Samuelson 2008, 9 Saur 2009, 10 Samuelson 2010, 11 Khalaila 2011, 12 Trouillet 2011, 13 Johnson 2006, 14 Schou 2008, 15 Karlsson 2012, 16 Clukey 2014, 17 Grap 2002, 18 Van der Leur 2004
Results
Nydahl, Nursing Research
• 8 quantitative studies5-12, incl. 2 RCT8,12
• 4 qualitative studies13-16
• 2 mixed design17,18
• High risk of bias: not able to remember, suggestions instead of questions • ETT vs trach8,12: no difference in tolerance or outcome
• Is tolerance a measurable by choking, swallowing, breathing, removal?
5 Rotondi 2002, 6 Machata 2007, 7 Samuelson 2007, 8 Samuelson 2008, 9 Saur 2009, 10 Samuelson 2010, 11 Khalaila 2011, 12 Trouillet 2011, 13 Johnson 2006, 14 Schou 2008, 15 Karlsson 2012, 16 Clukey 2014, 17 Grap 2002, 18 Van der Leur 2004
Incidence of unplanned removals per 1,000 days Central venous lines 12.4 ETT 24.7 Arterial lines 46.5 Stomach tubes 73.9 Carrion 2000
Related factors
Nydahl, Nursing Research
Decrease tolerance
Endotracheal suctioning
Getting insufficient air
Being speechless
Pain
Anxiety Dependence
Constriction
Swallowing
Fixation of ETT
Movements of ETT
Related factors
Nydahl, Nursing Research
Increase tolerance Able to survive
Able to breath
Being patient
Needs were considered
Depth of sedation Drugs
Distraction
Family presence
Nurses
Mobilization and
rehabilitation
Related factors
Nydahl, Nursing Research
Decrease tolerance
Endotracheal suctioning
Getting insufficient air
Being speechless
Pain
Anxiety Dependence
Constriction
Swallowing
Fixation of ETT
Movements of ETT
Competence, analgesia
Adaption ventilator
Tablets, comm. aids
Screening, analgesia
Information, family, drugs
Empower-ment
Control cuff
Control cuff, drugs
Replace fixation, diff
type
Re-move ETT, fixation
Delirium screening &
management
ETT tolerance
Nydahl, Nursing Research
• Is a complexe phaenomenon • Requieres specific observation and evaluation • Nurses may have a lower ETT tolerance than patients (high value:
well-being & comfort) • Deeper sedation seems to be an insufficiant strategy, but may be
required due to staff problems (competence, workforce shortages) • Most useful strategies:
• Empowerment of the patient‘s understanding • Ask patient what strategy may be most useful • Family presence • Early mobilization