| ObjectiveThe aim is to develop and implement a clinical program for airway extubation in adult ICU patients.In order to provide theoretical guidance and a basis for standardizing the practice of airway extubation nursing and improving the quality and safety of tracheal extubation clinical care in China.Methods1.Literature research: We searched for international guidelines and relevant literature on airway extubation from various sources,such as websites,databases,and journals.We screened and appraised the quality of the literature,extracted and synthesized the recommendations,and formulated a preliminary program for airway extubation in adult ICU patients based on the evidence and the context analysis.We also graded the strength of the recommendations.2.Expert consultation: We invited 15 experts to review and revise the preliminary program,and to define the levels of recommendation,using a modified Delphi method.The aim was to enhance the scientific validity and feasibility of the program.3.Quasi-experimental study: We recruited 104 ICU patients who underwent airway intubation and met the inclusion and exclusion criteria from a tertiary hospital in Gansu province.We assigned 52 patients from May to October 2021 to the control group,who received conventional care,and 52 patients from May to October 2022 to the intervention group,who received care according to the program.We compared the incidence of abnormal changes in vital signs within 30 minutes after extubation,the incidence of adverse complications,and the rate of reintubation within 48 hours after extubation between the two groups,to assess the clinical effectiveness of the program.Results1.The preliminary construction of the program airway extubation in adult ICU patients:We included a total of 8 guidelines,all developed and published with funding from professional societies,and of high overall quality.Four of them were rated level A and the rest were rated level B.According to the focus issues,we extracted and integrated the recommendations in the guidelines based on content analysis,performed quality grading on the included recommendations,and built the preliminary program for airway extubation in adult ICU patients,involved 7 aspects of evaluation,plan,preparation,implementation,post-extubation treatment,adverse reaction reduction,and the treatment of special groups.2.The construction of a clinical program of airway extubation in adult ICU patients: We organized an expert meeting of 15 experts,who reviewed,revised,and defined the recommendation levels for the evidence-based airway extubation preliminary program.According to expert opinions,one item was deleted,one item was divided into two items for elaboration,and four items were added.We confirmed the final draft of the program for airway extubation in adult ICU patients,including 7 themes and 37 recommendations,of which 25 were strong recommendations and 7 were weak recommendations..The aim was to improve the scientific validity and feasibility of the program.3.The implementation and evaluation of the program for airway extubation in adult ICU patients: There was no significant difference between the two groups in terms of demographic data,type of disease diagnosis,intubation-related data,and vital signs before extubation(P > 0.05).The results of the comparison of outcome indicators of evidence implementation showed that the patients in the intervention group had more stable heart rate and blood pressure in the initial period after extubation than the control group,and lower incidence of respiratory distress,coughing,and sore throat(P < 0.05).ConclusionThe program for airway extubation in adult ICU patients based on the guidelines provides theoretical and practical support and a basis for the clinical nursing practice of tracheal extubation in critically ill patients.After clinical application,it is feasible and effective as it facilitates the stabilization of patients’ vital signs at the early stage of extubation and reduces the incidence of adverse complications. |
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