Nursing sensitive process and outcome measures in patients with adult respiratory distress syndrome (ARDS) receiving mechanical ventilation.

摘要

Acute Respiratory Distress Syndrome, or ARDS, causes a rapid and severe deterioration in pulmonary function resulting in respiratory failure, and requires mechanical ventilation in a critical care setting. The current evidenced-based approach to the intermittent manipulation of ventilator settings is known as the "lung protective philosophy" and incorporates lower lung volumes and pressures than have historically been used. The nursing contribution to the process of mechanical ventilation involves monitoring both the patient and the ventilator to identify responses to therapy and initiate further intervention as indicated. The contribution of this monitoring activity to patient outcomes in ARDS care has not been adequately quantified.;In this study, monitoring intensity, therapeutic intervention intensity, compliance with lung protective parameters, and adverse events were explored as potential nursing sensitive indicators using a retrospective, descriptive study design. The sample consisted of 67 ARDS patients (45 men and 22 women) between the ages of 18 and 79 having received mechanical ventilation. Study variables were measured during the first 72 hours of treatment following diagnosis with ARDS based on nursing documentation in the medical record. Compliance with lung protective parameters for peak alveolar pressure and tidal volume were found to be lower than in previous clinical trials. The high prevalence of subjects (n = 29) with risk factors for abdominal compartment hypertension in the sample was thought to contribute to this finding. The exclusion of these subjects with such risk factors did not result in significant increase in compliance with these parameters.;Monitoring intensity was positively correlated with both severity of illness (r = 0.500) and therapeutic intervention intensity (r = 0.313), and was inversely related to compliance with lung protective parameters (r = 0.392). The model including monitoring intensity, severity of illness, and compliance with lung protective parameters did not adequately fit the data (p = 0.082), and explained little of the variation in compliance with lung protective parameters. Only two adverse events (self-extubation and medication error) were reported during the study period.;The heterogeneity of the ARDS population, the process of integrating research into practice, the interdependent nature of the interventions of interest, and retrospective nature of the study were identified as issues that affected the sensitivity of the selected study variables to the unique contribution of nursing to the care of patients with ARDS receiving mechanical ventilation in this study. Further exploration of the sensitivity of these variables to the unique contribution of nursing, as well as the identification of other nursing sensitive variables is needed.