Clinical Application Of Best Evidence For Airway Management In Adult Critically Ill Patients

ObjectiveThrough systematic literature search,quality evaluation and integration of evidence related to airway management of adult critically ill patients,and summarizing the best evidence,it provides a basis for clinical practice management.Guided by evidence-based nursing methods and theories,the clinical application of the best evidence of airway management in critically ill adult patients is carried out to improve the clinical outcomes of critically ill patients,improve the compliance of clinical nursing staff to the best evidence of airway management,shorten the gap between evidence and reality,and promote the continuous improvement of nursing quality.Methods1.Guided by evidence-based nursing methods and following the clinical evidence practice and application mode of Joanna Briggs Institute(JBI),this study summarized domestic and foreign evidences related to airway management in adult critically ill patients by identifying clinical problems,building a team,literature retrieval,quality evaluation,and evidence synthesis.2.Stakeholders are invited to conduct FAME evaluation on the best evidence summarized and screen the evidence.Based on the final best evidence,the evidence-based team will develop the quality audit indicators and the audit methodology.Based on the results of baseline review,the analysis of obstacle factors and promotion factors is carried out,and the corresponding action strategies are formulated.3.A non-contemporaneous controlled study was used to implement evidence-based nursing interventions in the extraneous intensive care unit of a tertiary hospital in Jingzhou City,and to evaluate the changes at the patient level,nurse level,and system level before and after the evidence was applied.Results1.This study included a total of 25 articles,including 1 advanced clinical decision support,7 guidelines,8 systematic reviews,5 evidence summaries,and 4 expert consensus.The best evidence was summarized from 7 aspects:airway evaluation,airway attraction timing,cuff pressure management,airway humidification,airway suctioning,tracheostomy stoma care,and oral care,a total of 44 best evidences were integrated.2.After FAME evaluation of the best evidence,a total of 27 pieces of evidence were included.The evidence-based team developed 20 review indicators based on the best evidence,among which the clinical implementation rate of 12 review indicators ranged from 0 to 71.43%,and the clinical implementation rate of 8 review indicators were all 0.The results of questionnaire survey showed that the qualified rate of airway management knowledge test was 44%.The main obstacle factors are the lack of nurse training at the practitioner level,the lack of relevant evidence-based knowledge,the lack of standardized procedures of airway management and the lack of materials at the system level.3.Results after application of evidence:(1)Patient level:①Comparison of the incidence of pulmonary infection in patients before and after the application of the evidence:After the application of the evidence,the incidence of pulmonary infection in the airway management of critically ill patients decreased from 42.31%to 21.74%,the difference was statistically significant(P<0.05).②Comparison of NICU hospitalization days before and after the application of evidence:After the application of the evidence,the NICU hospitalization days of patients have been shortened,but the results of the two groups were not statistically significant(P>0.05).③Evidence before and after the application in patients with sputum character comparison:evidence before application of sputum properties I degree of 4 cases,accounted for 7.69%,II degrees for 28 cases,accounted for 53.85%,Ⅲ degrees for 20 cases,accounted for 38.46%;Evidence I degrees after the application of 33 cases,accounting for 71.74%;II degrees of 13 cases,accounting for 28.26%,0 cases Ⅲdegrees.The sputum characteristics of patients were significantly improved compared with those before the application of evidence(P<0.05).(2)Nurse level:①The implementation of nurse review indicators:after the application of evidence,the implementation rate of nurse review indicators was significantly increased,and the implementation rate was generally around 90%or above,except for the low implementation rate of indicator 19(75%).②Comparison of nurses’ knowledge,behavior and attitude scores before and after the application of evidence:After evidence-based training and the application of evidence,the scores of nurses’ knowledge,behavior and attitude have been significantly improved,and the difference is statistically significant(P<0.05).(3)System level:the department formulated routine airway management nursing and airway management related flow charts for adult patients with critical illness,shot standardized operation videos,formed Manual of Artificial Airway Management in Extractive Care Units,and improved the airway management training plan and other relevant contents.Conclusions1.There is a large gap between airway management evidence and clinical practice in adult critically ill patients.Obstacle factors should be analyzed according to the gap,and feasible countermeasures should be developed according to the specific practice of the hospital,and targeted application of evidence should be applied.2.The clinical application of evidence-based best evidence of airway management in adult critically ill patients can reduce the incidence of airway complications in critically ill patients,improve the clinical outcome of patients to a certain extent,improve the compliance and cognitive level of evidence-based evidence implementation of nurses,and standardize the behavior of nurses.