An integrative review of evidence-based parameters utility in predicting patient success in maintiaining spontaneous ventilation post-extubation
Paulsen, Heather Dawn.
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The purpose of this integrative literature review is to identify the current standard of care in determining mechanically ventilated patients' readiness for extubation and evidence-based parameters utility in predicting the patients' maintenance of unassisted ventilation post-extubation. This topic was explored using an integrative literature review. Literature was gathered by searching databases with key search terms related to endotracheal intubation and mechanical intubation. A review of abstracts using the inclusion and exclusion criteria was conducted to determine which studies would be incorporated. Next, the literature selected was sorted into three categories, a) reviews of the current standard of care in determining a patients' readiness to wean from mechanical ventilation; b) measurement technique, validity, and use of the RSBI; and c) other parameters in predicting successful extubation. Results of this integrative literature review showed the current standard of care in extubation to be 1). Patient's underlying reason for intubation is resolving and patient is medically stable 2). A spontaneous breathing trial is attempted 3). If tolerated, patient continues to second spontaneous breathing trial that is longer in duration (30-120 minutes). 4). If the second spontaneous breathing trial is tolerated, the patient is extubated. The spontaneous breathing trial tolerance predicts approximately 86% of successful extubations. The next purpose was to identify evidence based parameters utility in predicating patients' maintenance of unassisted ventilation post-extubation. The rapid shallow breathing index was review along with the integrated weaning index, swallow study data, addition of dead space and involuntary cough peak flow. These parameters were shown to approximate the spontaneous breathing trial prediction data. In conclusion, determining the value of the rapid shallow breathing index would benefit patients being extubated and a shift in paradigm from indicators of failure to indicators of success may prove helpful in proceeding with determining a patient's ability to maintain spontaneous ventilation post-extubation.