NS instillation in patients and Harmful effects

The Assignment (Evidence-Based Project)

Part 4A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:

· An evaluation table

· A levels of evidence table

· An outcomes synthesis table

 

Part 4B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

By Day 7 of Week 7

Submit Part 4A and 4B of your Evidence-Based Project.

 

 

Name

Fall 2018

Evidence-Based Project, Part 4: Critical Appraisal of Research

Dr. Instructor

 

 

Walden University

 

 

 

 

1. Evaluation table

2. Level of Evidence Table

3. Outcome Synthesis Table

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author (Year)   Conceptual framework Design/

Method

Sample/

Setting

Major Variables Measurement Data

analysis

Findings Appraisal
Schultz et al, (2018)

BMJ open8(1), e019789

  None Randomized

Controlled

Trial (RCT)

Purpose: effectiveness of Normal Saline instillation (NSI) to determine its feasibility for full efficacy trial.

Searched 4 databases from 2014-2019.

Focussed only on studies with a control group.

Excluded those without controlled trials

N- 825 studies

Setting-respiratory care hospital

Age-(0-16 years) intubated

 

IV- NSI, Lung Recruitment

 

DV 1- Oxygen concentration

DV2- Secretion Efficieny

 

 

NSI –

0.1 ml/kg of NaCl with ETS event/

Lung Recruitment-increasing PEEP by a factor of two

Oxygen

Concentration

Feasibility for full efficacy.

Feasibility of the entire study through examination of recruitment,

Eligibility,

Protocol,

adherence and missing data

Normal Saline has no potential benefit to tracheostomy process

Weaknesses

· Does not

Contain full

Body of research

Potential missed

Evidence with

Restriction to

Only controlled

Trials.

Strengths

A large sample

Of study hence

Reliable

Identified the

Exact impact of

NS during

Suctioning of

Respiratory

Patients

Conclusion

Use of NS in tracheostomy is

Feasible with no

Supported

Benefit in

Suctioning.

Feasibility

Benefits

Outweigh

Potential risks

Eliminating NSI

Is cost effective

And EBP

Friendly

Wang et al.,( 2017 )Australian Critical Care30(5), 260-265   NSI has

Adverse

Effects on

Respiratory

Patients such

As increased

Hear rate, dyspenia and reduced oxygen

SR-systematic

Review

Purpose:

To evaluate the necessity of NSI to ICU patients.

Data sources.

Cochrane,

Embase and scienceDirect.

Focussed only on studies with a control group

Limited search

To RCT

N-337

Study setting- ICU in respiratory care.

Intubated patients.

IV-NSI

DV-oxygen saturation

DV2-Heart rate

 

Was a similar amount of NSI involved?

Heart rate- pulses

Blood pressure-

examination

Oxygen saturation-pool mean difference using the random

effect model.

NS

instillation reduces oxygen concentration but has little effect on heart rate and blood pressure

The pooled mean difference between was -1.14%

Weakness

Low

methodology

quality

Missing data

Strengths

Large body

of sources

identified the

pooled mean

difference in

the saturation

of oxygen

as -1.14

 

conclusion

NSI is harmful

To the health,

By reducing

Oxygen

saturation

 

Leddy &

Wilkinson

(2015) RCTR51(3), 60

  Current Evidence does not support the routine NS instilatilation for ETS Survey, Expert opinion.

Purpose: to determine the practises of therapists and registered nurses in six Hospitals in Ontario

Survey admission to 180 participants

Setting six hospitals in Ontario

IV-NSI

DV-oxygen saturation

DV2-Heart rate

 

DV3-expert application opinion

Survey administration and response analysis using descriptive statistical analysis, comparative statistics on RN and RRT opinions Report, statistical analysis using

SPSS software and

Pearson rule

38.6 % of RN’s frequently used NS

42% Rarely used NS for Suctioning.

51.4 % observed patient adverse effects of NS

NS reduces oxygen saturation

NS increases

Patient

agitation

Weakness

Does not

contain full

body of

evidence

Full of bias

because it

mainly

consists of

opinions.

Strengths

Compares,

opinions from

different

professionals

Analyses

literature on

subject

Caparros & Forbes (2014) 33(4), 246-253   None SR

Qualitative Review of literature.

Purpose: -to ascertain if the routine method is harmful or beneficial and provide

evidence based

advice

Searched 3 databases from 2014-2019.

Focussed only on studies without any exclusions

Review of literature.

NS instillation in patients and Harmful effects

N/A Qualitative analysis

of relevant journal sources from relevant databases

Compared literature

From scholarly sources

NS is not beneficial to the human secretion suctioning hence should

Stopped

Strengths

Large body

of sources

identified the

pooled mean

difference in

the saturation

of oxygen

as -1.14

 

conclusion

NSI is harmful

To the health

 

 

 

 

 

 

 

 

 

References

Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review. Dimensions of Critical Care Nursing33(4), 246-253.

Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory therapists: how well do they align with clinical practice guidelines? Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR51(3), 60.

Schults, J. A., Cooke, M., Long, D. A., Schibler, A., Ware, R. S., & Mitchell, M. L. (2018). Normal saline instillation versus no normal saline instillation and lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction: the NARES trial. A study protocol for a pilot, factorial randomized controlled trial. BMJ open8(1), e019789. https:// bmjopen.bmj.com/content/8/1/e019789.abstract

Wang, C. H., Tsai, J. C., Chen, S. F., Su, C. L., Chen, L., Lin, C. C., & Tam, K. W. (2017). Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials. Australian Critical Care30(5), 260-265. https:// www.sciencedirect.com/science/article/pii/S1036731416301369

 

 

 

Peer Reviewed Article

 

Level

 

Level

 

Wang et al., (2017) Normal saline instillation before suctioning

 

Level I Provides a meta-analysis from randomized controlled trials involving normal saline use

 

Schultz et al., (2018) Normal saline instillation versus no normal saline instillation and lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction

 

Level II It entails a randomized experiment in which all the members of group are subjected to a particular treatment with normal saline. All the members of the particular group had results recorded then evaluated
Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review. Level V A critical analysis of the qualitative studies surrounding the use of Normal saline in suctioning
Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory therapists: how well do they align with clinical practice guidelines?. Level VII Involves a thorough analysis of the opinions of RN’s and respiratory theorists on the overall use of NS and observed effects

 

Levels of evidence in the Peer Reviewed Articles

 

 

 

 

 

 

 

 

 

 

Author Year Sample/setting Key Findings Appraisal and study Quality General Comments
Schultz et al, (2018)

BMJ open8(1), e019789

N- 825 patients

studies

Setting-respiratory care hospital

Age-(0-16 years) intubated patients

 

Feasibility of the entire study through examination of recruitment,

Eligibility,

Protocol,

adherence and missing data

 

Normal Saline has no potential benefit to tracheostomy process

Weaknesses

Does not

contain full body of research

Potential missed evidence with restriction to only controlled

trials.

Strengths

A large sample of study hence reliable

Identified the exact impact of NS during

Suctioning of respiratory

patients

Conclusion

Use of NS in tracheostomy is

feasible with no supported benefit in suctioning.

Feasibility

Benefits outweigh potential risks

Eliminating NSI is cost effective and EBP friendly

Very relevant to the study with a large sample setting.

The results effectively answer the clinical question of inquiry.

Provides level one evidence which offers best outcomes for professional practise amendments

Leddy &

Wilkinson

(2015) RCTR51(3), 60

Survey admission to 180 participants

Setting six hospitals in Ontario.

Private, public and institutional hospitals

Registered nurses and

respiratory

therapists

38.6 % of RN’s frequently used NS

42% Rarely used NS for Suctioning.

51.4 % observed patient adverse effects of NS

NS reduces oxygen saturation

NS increases

Patient

agitation

Weakness

Does not contain full body of

evidence

Full of bias because it mainly consists of opinions.

Strengths

Compares, opinions from different professionals

Analyses literature on

Subject

Conclusion- moderately reliable since it is level VII but accurate resource on NS application

 

Provides expert opinion on the application of NS.

Relevant for analysing impact of NS from nursing professionals.

However, being in the levels VII of evidence, must be supported by other stronger sources.

It also

comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue.

Generally ineffective unless supported by other sources

Caparros & Forbes (2014) 33(4), 246-253 Review of literature.

NS instillation in patients and Harmful effects

Review of quantitative and qualitative literature.

NS instillation in patients and Harmful effects

Strengths

Large body of sources

Different EBP scholarly sources.

Weaknesses

Does not provide full body evidence since little or efficacy trial employed

 

conclusion

NSI is harmful to the health

Feasibility

Moderately applicable

Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue.

Generally ineffective unless supported by other sources

Wang et al.,( 2017 )Australian Critical Care30(5), 260-265 N-337 patients

Study setting- ICU in respiratory care.

Intubated patients.

18 -30years

NS

instillation reduces oxygen concentration but has little effect on heart rate and blood pressure

The pooled mean difference between was oxygen concentration was -1.14%

NSI is a common practise in ICU Respiratory care

Weakness

Low methodology quality

Missing data

Strengths

Large body of sources identified the pooled mean difference in

the saturation of oxygen

as -1.14

conclusion

NSI is harmful to the health, by reducing Oxygen

Saturation in tracheostomy patients.

Feasibility.

Benefits of the entire study outweigh the potential risks.

Research results are reliable and pooled from large resources.

 

 

This is one of the most relevant sources to this study with a large population and sample setting.

Being a level two evidence with favourable outcomes, it helps to solve the clinical question and provides a comprehensive answer to the study question

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