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|Title:||SCAMP for non-invasive ventilation implementation by nurses in acute cardiogenic pulmonary edema||Authors:||Christofi, P.
|Keywords:||SCAMP protocol;Patients;Pulmonary edema||Category:||Clinical Medicine||Field:||Medical and Health Sciences||Issue Date:||2015||Publisher:||SAGE||Source:||European Journal of Cardiovascular Nursing, Volume 14, Pages S91-S91, 2015||Abstract:||Background: Non-Invasive Ventilation (NIV) is an important therapeutic tool in Acute Cardiogenic Pulmonary Edema (ACPE), whereas nursing knowledge adequacy is associated with successful implement Standardized Clinical Assessment & Management Plans (SCAMPs) are care pathways designed for standardization of care of heterogeneous patient population, such as of ACPE, for quality of care improvement and resource utilization reduction.Purpose:The development of an evidence based nurse led SCAMP protocol for NIV implementation in ACPE. Methods: Literature review, consensus of the research team, entry and exclusion criteria, clinical improvement or not, NIV outcomes and failure criteria were established.The protocol/algorithm consists of actions concerning initial patient assessment, ventilator checks, implementation, monitoring, parameters’ titration, corrective measures and NIV release. The targeted data collection elaborated in two ICUs in Cyprus, where trained nurses initiated and run NIV, according to the protocol/algorithm, under intensivists’ supervision. The researchers-observers were recording process, without interfere in treatment decisions and deviations. ACPE patients were recruited (n = 20), in two pilot applications (n = 10). Each application was followed by data processing and modification of the protocol/algorithm, based on deviation, observations and literature review.Results: The participants were presented with dyspnea,tachypnea, hypoxemia, acidosis, generalized crackles in all lung fields, and imaging documentation of ACPE.Non-Invasive Spontaneous Mode, PS 6-20cmH2O, PEEP 5-7cm H2O and FiO2 0,4-1,0 were implemented.Twelve patients were released of NIV in four hours,with a mean duration of 7.43±5.6hours. In four hours’recordings, improvement was shown in the rest study variables, compared with baseline, such as hypoxemia(PO2/FiO2:296±92.9mmHg, F29.89 p<0.0001), acidosis(pH:7.4±0.05, F14.8 p = 0.029), RR (19.3±3.7/1’, F7.513p<0.0001), heart rate (HR) (81.8±20.1, F92.3 p <0.049),blood pressure, systolic (SBP:119,5±11.3mmHg, F8.662p = 0.01) and diastolic (DBP:67±9,8mmHg, F7.253 p =0.131), and recovery in level of consciousness (100%). The mean ICU length of stay (37.9±24.9 hours) was shorter in patients without concomitant diseases (35%) (22.7±13.9 ώρες, p = 0.042). Lack of NIV tolerance (10%) and vomiting(5%) were managed by removing NIV.Conclusions: The present protocol/algorithm is demonstrated to be safe and feasible.||URI:||http://ktisis.cut.ac.cy/handle/10488/8729||ISSN:||Print ISSN: 1474-5151
Online ISSN: 1873-1953
|DOI:||10.1177/1474515115579615||Rights:||©The European Society of Cardiology||Type:||Article|
|Appears in Collections:||Άρθρα/Articles|
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