Acute Respiratory Distress Syndrome ARDS Developed Clinical Pathway

Acute Respiratory Distress Syndrome (ARDS) Developed Clinical Pathway: Suggested Protocol Maha Salah Abdullah Ismail 1, Hanaa Y. Hashem 2, Mahmoud M. Alsaghier 3, Mohamed Salah 4 1 - Assistant Lecturer of Critical Care and Emergency Nursing Faculty of Nursing, Cairo University, Egypt. (e-mail: metcy 2004@yahoo. com) 2 - Assistant Professor of Medical-Surgical Nursing & Director of the Quality Assurance Unit Faculty of nursing, Cairo University, Egypt. 3 - Lecturer of Anesthesia and Intensive Care, Faculty of Medicine - Al- Azhar University, Egypt 4 - Resident of Anesthesia and Intensive Care Assigned Doctor for Pain Management, Nizwa Hospital – Sultanate Oman. ABSTRACT Acute respiratory distress syndrome (ARDS) represents a complex clinical syndrome and carries a high risk for mortality. The severity of the clinical course, the uncertainty of the outcome, and the reliance on the full spectrum of critical care resources for treatment mean that the entire health care team is challenged. Researchers and clinicians have investigated the nature of the pathological process and explored treatment options with the goal of improving outcome. Through this application of research to practice, we know that some previous strategies have been ineffective, and innovations in mechanical ventilation, sedation, nutrition, and pharmacological intervention remain important research initiatives. Developed Clinical pathway is multidisciplinary plans of best clinical practice for this specified group of patients that aid in the coordination and delivery of high quality care. They are a documented sequence of clinical interventions that help a patient to move, progressively through a clinical experience to a desired outcome. Although there is a lot of heterogeneity in patients with ARDS, this suggested protocol for developed clinical pathway with alternatives was built depended on a lot of researches and evidence based medicine and nursing practices which may be helping these patients to improve outcomes, quality of life and decrease mortality. Aim: The aim of this study is to evaluate the effect of applying a suggested protocol from developed clinical pathway on patients with severe acute respiratory distress syndrome. Research Hypotheses: The following research hypotheses CONTACT was formulated: 1 - Applying a suggested protocol from developed clinical pathway will improve clinical outcomes of Email: Phone: patients with severe acute Website: respiratory distress syndrome. 2 -Applying a suggested protocol from developed clinical pathway will reduce mortality rate of patients with severe acute respiratory distress syndrome. Research design: This study will conducted using a quasiexperimental design. Setting: The study will be carried out at Critical Care Units, affiliated to Cairo University Hospitals which had patients diagnosed with ARDS. Sample: Convenience sample of all male and female adult patients had severe ARDS will be admitted to the selected critical care units within 1 year. Tool: (1) A mechanically ventilated patients characteristics questionnaire; consists of Socio-demographic data sheet & Medical data sheet. (2) Clinical outcomes sheet. Keywords— Clinical pathway - Acute respiratory distress syndrome (ARDS). INTRODUCTION Clinical pathways are multidisciplinary plans (or blueprint for a plan of care) of best clinical practice for specified groups of patients with a particular diagnosis that aid in the coordination and delivery of high quality care. They are a documented sequence of clinical interventions that help a patient with a specific condition or diagnosis move, progressively through a clinical experience to a desired outcome. Predominantly, they are management tools and clinical audit tool that are based on clinical information developed in other guidelines or parameters. They are specific to the institution using them. Originally, critical pathways began with admission and ended with discharge from the hospital. Today, they are usually interdisciplinary in focus, merging the medical and nursing plans of care with those of other disciplines, such as physical therapy, nutrition, or mental health. They provide opportunities for collaborative practice and team approaches that can maximize the expertise of multiple disciplines. Clinical pathways have four main components; a timeline, the categories of care or activities and their interventions, intermediate and long term outcome criteria, and the variance record (to allow deviations to be documented analyzed). They differ from practice guidelines, protocols and algorithms as they are utilized by a multidisciplinary team and have a focus on the quality and coordination of care (1). Acute respiratory distress syndrome (ARDS) represents a complex clinical syndrome and carries a high risk for mortality. The severity of the clinical course, the uncertainty of the outcome, and the reliance on the full spectrum of critical care resources for treatment mean that the entire health care team is challenged. Since the 1960 s, researchers and clinicians have investigated the nature of the pathological process and explored treatment options with the goal of improving outcome. Through this application of research to practice, we know that some previous strategies have been ineffective, and innovations in mechanical ventilation, sedation, nutrition, and pharmacological intervention remain important research initiatives (2). Acute Lung Injury (ALI)/ Acute Respiratory Distress Syndrome (ARDS) are affecting both medical and surgical patients. Despite great advances in understanding the pathogenesis of disease mortality rate is still high. Mortality rates ranges between (30 -50 %), although some trials had demonstrated lower mortality rates (25 -30 %). Prevention of long-term disabilities must be a priority of care. Even survivors of ARDS usually experience long ICU stay, hospital stay and several co-morbidities & require prolonged rehabilitation time until of full recovery. Restoration of normal activities ranges between 6 months to 12 months. Nearly half of survivors had neurocognitive impairment & decrease quality of life that persist at least 2 years. ALI/ARDS not only represent great impact on ICU but on nation's economics as well (3). A key role for the critical care nurse is early detection and prevention of ARDS. Therefore, with respect to ARDS, it is essential that critical care nurses be knowledgeable about risk factors, assessment tools and protocols, and prevention strategies. ARDS is at the extreme end of a continuum of hypoxic acute lung injury (ALI) that results in respiratory failure. In 1994, the American-European Consensus Conference members issued definitions of ALI and ARDS that are widely used by researchers today (2). REFERENCES Audimoolam, S. , Nair, M. , Gaikwad, R. , & Qing, C. (2005). The Role of Clinical Pathways in Improving Patient Outcomes. Knowledge Management for Medical Care. Morton, P. G. , & Fontaine, D. K. (2014). Critical Care Nursing A Holistic Approach (10 th ed. ). Philadelphia: Lippincott Williams & Wilkins. Sole, M. L. , Klein, D. G. , & Moseley, M. J. (2013). Introduction to critical care nursing (6 th ed. ). Amesterdam: Elsevier/Saunders. Siegel, M. , & Hyzy, R. (2010). Mechanical ventilation in acute respiratory distress syndrome. UP TO DATE, 1 -17. 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