| Objectives:We systematically searched,evaluated,and summarized the best evidence on artificial airway cuff management for patients in intensive care units(ICU)at home and abroad;constructed an evidence-based practice plan for artificial airway cuff management for ICU patients based on the best evidence and clinical scenarios;to apply evidence-based practice protocols to clinical practice and evaluate their effectiveness.Methods:This study uses the Joanna Briggs Institute(JBI)evidence-based health care model updated in 2016 as the theoretical framework and is divided into four parts of the study:1.Systematic search of domestic and international artificial airway cuff management for ICU patients from January 2012 to January 2022 on clinical practice guidelines,expert consensus,and systematic evaluation,etc.,and conducted a rigorous quality evaluation and literature analysis to screen and integrate the best evidence on the management of artificial airway cuffs in ICU patients.2.Introduce evidence into clinical scenarios,convene stakeholder meetings to collect the opinions of evidence-based expert panels based on the criteria of feasibility,appropriateness,effectiveness,and clinical meaning,and screen out the best evidence that is appropriate for clinical scenarios.Based on the best evidence and clinical scenarios,quality review indicators were developed,and a baseline review of the evidence before the application was conducted in the neurosurgery ICU of a tertiary hospital.3.Analyze potential facilitators and barriers from 3 perspectives:practice environment,potential practice staff,and evidence-based change.Based on the results of the baseline review and the facilitators and barriers,the multi-disciplinary team(MDT)constructs an evidence-based practice plan for the management of artificial airway cuffs in ICU patients,taking into account site-specific scenarios.4.Evidence-based practice changes in the department were carried out through various means,including education and training and improvement of quality control management mechanisms,and the effectiveness of the application of the program was evaluated at the patient level,nurse level,and system level.Results:1.The best evidence summary of artificial airway cuff management in ICU patients included 22 publications,including 3 clinical decisions,7 guidelines,3expert consensus,and 9 systematic reviews.Twenty-nine best pieces of evidence were summarized,including eight aspects of artificial airway assessment,cuff selection,cuff inflation method,cuff inflation timing,cuff pressure regulation,cuff leakage assessment,removal of retained material on the cuff,and cuff leakage test.2.After discussion among relevant interest groups and adjudication by the evidence-based expert panel,21 pieces of best evidence with feasibility,clinically meaningful,and appropriate clinical scenarios were screened out.Based on the best evidence and scenario analysis,the review panel members constructed 16 review indicators and determined the corresponding review methods.The baseline review of ICU patient cuff pressure pass rate was 69.19%,the incidence of ventilator-associated pneumonia was 5.69‰,and the nurse artificial airway cuff management perception questionnaire score was(35.33±12.22),with a pass rate of 50%.At the baseline review,the implementation rates of review indicators 2,4,9,13,14,and 15 were<60%and the implementation rates of the remaining review indicators were>60%.3.Combined with potential promotion and obstacle factors in evidence-based practice,the evidence-based practice plan for artificial airway cuff management of ICU patients was discussed and developed by MDT.After the application of the evidence-based practice plan,certain effects were achieved in three aspects:(1)At the patient level,the qualified rate of cuff pressure in ICU patients increased from 69.19%to 91.86%,and there were statistically significant differences(χ~2=28.192,P<0.001);the incidence of ventilator-associated pneumonia decreased from 5.69‰to 2.00‰.(2)At the nurse level,the knowledge questionnaire score of nurses’artificial airway cuff management improved from(35.33±12.22)to(42.47±9.67),and there were statistically significant differences(t=-2.748,P=0.008);and the pass rate of nurses’artificial airway cuff management knowledge questionnaire improved from50%to 86.11%,and there were statistically significant differences(χ2=10.797,P=0.001);in baseline review,the implementation rate of review indicators with implementation rate<60%increased significantly,with statistical significance(P<0.05).(3)At the system level,the department has carried out innovation from the aspects of hardware facilities improvement,process reengineering,quality control mechanism improvement,adding cuff manometer,popularizing artificial airway containing subglottic suction,developing improved ICU cuff manometer pressure measurement operation process and operation scoring criteria,and designing nursing checklist for ICU patients with artificial airway cuff management.To standardize the behavior of nurses to ICU patients’artificial airway cuff management.Conclusions:Based on the best evidence and combined with the clinical scenario of the department,this study developed an evidence-based practice protocol for the management of artificial airway cuffs in ICU patients and was clinically applied to improve the rate of cuff pressure compliance in ICU patients,reduce the incidence of ventilator-associated pneumonia in ICU patients,improve nurses’knowledge of artificial airway cuff management in ICU patients and the rate of nurses’implementation of the reviewed indicators,and improve the standard and monitoring process for the management of artificial airway cuff in ICU patients. |
