Evidence Based Practice for Breathing: A Literature Review

This literature review explores the latest evidence based practices for breathing and their implementation in critically ill patients. It discusses the effectiveness of oxygen therapy, tracheostomy, non-invasive ventilation, and other methods. The review also highlights the importance of evidence based practice in healthcare.

BREATHING

Table of Contents
INTRODUCTION...........................................................................................................................1
KEYWORDS...................................................................................................................................1
LITERATURE REVIEW................................................................................................................1
IMPLEMENTATION OF REVIEW OVER CRITICALLY ILL PATIENT..................................5
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Evidence Based Practice refers to all the medical processes and procedures that hold
effective scientific evidence, which undertaken by healthcare professionals towards dealing with
a medical issue (Portney, 2020)). In the contemporary industrial scenario, this type of practice
holds maximum value which requires professionals and organisations to include the same within
their clinical practice. Moreover, there are various problems upon which evidence-based practice
could be implemented within health and social care. One such area of focus is related to
Breathing.
Therefore, the report below is based on a detailed literature review over this element,
which would be using a range of sources to analyse latest evidence based practice in this area of
expertise. Alongside this, the report would also be implementing all the analytical knowledge to
a critically ill patient, which would be very much contributing towards their current state of
health.
KEYWORDS
Breathing, Evidence-Based Practice, Respiratory Treatment, COPD, Cystic Fibrosis, Respiratory
Health
LITERATURE REVIEW
Breathing is considered to be the most imperative function in a human body, which is
necessary to be regulated to ensure that all the other body functions and organs are effectively
supported towards keeping a person healthy. It is mandatory to be regulated to ensure that other
functions of the body, as well as mind are appropriately and effectively working towards
enhancing the health benefits for individuals (Townsend & Morgan, 2017). Moreover, there are a
number of treatments, clinical guidance and exercises which allows an individual towards
regulating their breathing and staying healthy. However, currently with advances in practice,
clinical patterns and technologies, it is very crucial to determine the latest evidence based
practices which are supportive towards dealing with critically ill patients in relation to their
breathing. Hence, the essay below is completely based on these practices towards breathing,
along with their critical analysis which would be allowing them to be further implemented to
support a critically ill patient in an effective manner.
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According to Johnson & Smith, (2016), the current evidence based practice followed by
various healthcare organisations has various clinical guidelines towards evidence based
practices. Moreover, these evidence based guidance provides opportunities to these professionals
towards gaining effective knowledge about the technical, as well as non-technical competencies
which is very necessary for dealing with breathing regulations and patterns of individuals
admitted in the care facility. The study has been very contributing towards determining several
attributes which are very well required by the healthcare professionals and nurses during dealing
with patients that have been facing problems in their breathing. These attributes are very
important to be taken into account to determine which ones are the most required and necessary
within the nursing practice in order to deal with patients who are critically ill. Therefore, the
technical skills which these evidence based guidelines cover are assessment of physiological
status of patients with methods like respiratory rate, oximetry and heart rate. Along with this,
another skill is assessment of lung function through usage of several peak flow tools, along with
spirometry, as well as administration of drug, as well as intravenous therapies.
As for non-technical skills, the guidance weighs upon appropriate care planning, as well
as educational support. For this purpose, the focus of this study is counselling of patients in terms
of bringing behavioural change, along with a core understanding of the learning and teaching
techniques. Moreover, the study also appropriately emphasises on provision and acquisition of
training related to several latest and technologically advanced respiratory monitoring
technologies and equipments.
Therefore, in order to critically discuss the same, the current evidence based practice
related to breathing and the overall framework that has been developed in relation to the same
enhances the need for nurses to possess these skills and attributes and apply the same each day
within clinical practice. The reason for the same is that having these skills would allow them to
be adaptable towards the latest innovation within the processes and the techniques that are in
relation with the dealing with breathing problems. However, one particular limitation of these
skills is that the study did not appropriately focus upon various co morbid conditions which
patients might face and which would require the nurses to indulge within a more comprehensive
approach towards dealing with such situations.
However, before moving over several evidence based practice in relation to breathing, it
is very important that a brief pathophysiology is performed over determination of several
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problems and issues associated with the same. As per the study performed by Barker & et. al.,
(2018), dysfunctional breathing is one of the most several respiratory disorder which is
commonly found in children but is also very much evident in case of adults. This issue is very
severe as it causes severe alterations within the biochemical patterns within an individual
associated with breathing that could create a chronic symptom. Moreover, the study explores
several causes which are related towards development of such issues in individuals. For this
purpose, the pathophysiology provides details such as issues like Asthma and Sinusitis, which
are illnesses that disrupt the regular functionality in relation to breathing. Along with this, there
might be several allergies which enhances problems like cold and cough which is also very much
inappropriate when it comes to breathing. Another effective emphasis which the study puts on is
related to the lifestyle of individuals. For example, people who often indulge in acts such as
smoking faces a lot of breathing problems due to blockage in their naval passage.
Another very prominent and contemporary cause which has been presented in various
latest studies is related to Covid-19 virus. According to the viewpoints of Ali & Alharbi, (2020),
this disease is related to the Severe Acute Respiratory Syndrome Coronavirus 2, which causes
heavy breathing problems and currently has become a global pandemic. Therefore, with such
inappropriate and lethal elements causing several breathing problems within the individuals, it is
imperative that several evidence-based practices are adopted towards addressing the same in an
effective manner.
One particular evidence-based practice that has been widely used in clinical and nursing
practice towards supporting individuals within breathing related issue, as well as ensuring proper
breathing regulation is Oxygen Therapy. As per the views of Sepehrvand & et. al., (2018), it is
important that the safety and efficacy of the this therapy as well as supplemental oxygen is
examined and determined which would be appropriately and effectively contribute towards
identifying the effectiveness of this evidence based practice. For this purpose, their study took
several Randomised Controlled Trials (RCTs) in a manner which is very effective towards
monitor the impact of several treatments on a range of patients. Therefore, the study
appropriately summarised that while there are various uses related to this therapy in particular, it
does not hold essential benefits of healthcare when it comes to certain group of individuals such
as normoxaemic patients.
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Another practice in regards to this is tracheostomy, which is a procedure where the
opening within the neck is created through placing a tube within the windpipe of a person. For
this purpose, a cut is made below the vocal cord of a person, where the tube is further inserted,
which allows the air to flow within the lungs and make breathing easier for the patient. However,
this procedure is very much older in discovery. However, with evidence based practice, there
have been a lot of improvements and evidence based research on this treatment in recent years.
As per the views of Bolsega & Sole, (2018), tracheostomy is a very viable process which
is very important to be given to patients that are critically ill. Moreover, their study was
conducted upon a group of professionals who were given a simulated setting to determine
effectiveness of this method of dealing with breathing issues, along with their effectiveness
towards performing this surgical practice appropriately. The results of their study determined
that while this method is clinically important, it is yet to be transformed and performed in a
better manner for which, better evidence based approach would be required to be adopted.
In addition to the above medical procedures, it is also imperative that monitoring
processes related to breathing are also critically discussed which also have transformed due to an
application of evidence based practice within the same. Therefore, in regards to this, Gargiulo,
O’Loughlin, & Breen, (2015), have presented a feasibility study towards electro-resistive bands
for monitoring of respiration within an individual. According to their study, this input is quite
accurate and its readings in relation to the tidal volume are precise to about ±10%. However,
their study reflected that there is yet a better and a highly reliable evidence based alternative yet
to be developed towards monitoring the cardiac and respiratory functions such as breathing.
There is yet another major evidence based practice which could be used towards dealing
with breathing issues within patients. This approach is Non-Invasive Ventilation, which refers to
usage of breathing support that is administered through breathing mask. It is one of the widely
used methods towards supporting individuals in dealing with breathing problems. One of the
studies in recent times by Hess, (2015), focuses on adopting an evidence-based approach that
non-invasive ventilation is highly effective when it comes to save lives. According to the
viewpoints presented by them, this evidence based practice is highly imperative when COPD, as
well as CPE are considered, which are two of the most severe illnesses that disrupts the breathing
within an individual. However, this method seems to be improving the chances of survival as
well as regulation in breathing. Moreover, it allows professionals to ensure that the care provided
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to patient in acute care is highly effective in settings where this method is implemented and is
used widely.
Yancey & Chaffee III, (2014), presented a literature where the focus has been given on
the exercising and physical activities as an evidence-based practice over treating individuals who
suffer from breathing problems, particularly COPD. Their study paid attention on Pulmonary
Rehabilitation, which is a multidisciplinary method that has an active inclusion of physical
fitness within treatment of patients. According to their viewpoint, the intervention of activities
like exercising and training supports, as well as improvise dyspnea, as well as the functional
capacity of lungs, which does contribute towards ensuring better and effective breathing of an
individual. Moreover, breathing exercises which involves a variety of movements that facilitates
the breathing in a person are usually implemented towards reversing the COPD’s typical pattern
in a human body, which ensure enhanced accessory muscles, as well as use of rib cage. This
ultimately allows individuals to be benefitted by this procedure which is a major contributor
towards healing their illnesses such as COPD.
IMPLEMENTATION OF REVIEW OVER CRITICALLY ILL PATIENT
It is highly imperative for the above analysis to be implemented over an individual who is
critically ill in order to determine the actual effectiveness of all these practices which have been
critically evaluated above. Moreover, it would also be appropriate towards ensuring major
contribution of these evidence based practices upon a person that is critically ill.
Hence, taking the Oxygen Therapy into consideration, it could be claimed from the above
analysis that it is not the best practice to rely on, depending upon the illness and physical
condition which the person is currently facing. However, there are ways in which the same could
be applied to someone who is critically ill. According to Siemieniuk & et. al., (2018), there are
ways in which the oxygen therapy must be given to individuals who is in an acute condition and
their study presented several recommendations of how best the professionals and the nurses
within the clinical practice could apply the same towards the patients. For example, the very first
recommendation which they have provided in their study was related to the fact that the oxygen
therapy must be stopped not higher than at 96% saturation. Along with this, another
recommendation which has been provided by their study is to appropriately start the therapy
between the range of 90% to 92% saturation. Along with this, the maximum limit which their
study has explored till which the oxygen therapy could commence is 93%. Moreover, this
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practice could be best applied with patients who suffer from Cystic Fibrosis, which yet again
could be a very severe health condition for an individual.
Another approach that was discussed above was related to tracheostomy, where the study
concluded that a better and effective evidence based approach is necessary to perform the same.
According to the study performed by Raimondi & et. al., (2017), it is imperative to ensure that
proper evidence based guidelines are provided in context of treating critically ill individual.
Moreover, their study resulted in a total of 19 recommendations that are required to be followed
within clinical and nursing practices in order to adopt this procedure and effectively place the
same towards dealing with a critically ill patient. Moreover, another evidence-based practice
which their study implied is that the medical professionals must use Percutaneous techniques
which are very less risky and decreases the rate of having any infectious outcome as compared to
the standard surgical tracheostomy. In this manner, it could be applied very well within nursing
and medical practice towards a critically ill patient within the facility.
In relation to the electro resistive bands, the above study and analysis denoted that there
are yet to be developments made in order to make it more reliable and accurate even during
physical movements or during sleep. Therefore, the same could just be used to get an idea about
the regulation of breathing of a critically ill patient. However, a more effective application of
these bands would not be able to function in an appropriate manner and hence, their reliability
towards the case of critically ill patient must be kept to a minimum.
As per the above analysis, non-invasive ventilation seems to be a very effective practice
to be adopted in nursing practices where the patient would appropriately be supported towards
giving them a very effective and essential support towards their breathing related problems.
However, even if this is a form of oxygen therapy, still there must be an appropriate way and
instance to implement this method, which means that this method must not be applied in every
condition involving a critically ill patient.
As per the points of view presented in the literature by Frat, Coudroy, & Thille, (2019),
High-flow Oxygen Therapy (HFOT) is one of the best therapies which the doctors and nurses
must give to patients who are critically ill and are admitted in the Intensive Care Unit. Moreover,
in terms of critical illness this must be the first line strategy which must be adopted by
individuals in the clinic if the patient suffers from Acute Respiratory Failure or ARF. On the
other hand, their study also explored in a very appropriate manner that Non-invasive Ventilation
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is very effectively recommended to be used in case of critically ill patient when the post-
extubation respiratory failure is to be avoided after within the ICU. Moreover, it could also be
used in case of post-operative patients. However, this study could be concluded effectively by
stating that both these evidence based practices and approaches are highly effective and
equivalent to one another, however, it is very important to gain appropriate knowledge of their
accurate implementation within the health and social care practice.
As per Doiron, Hoffmann & Beller, (2018), several critically ill individuals who have
been to ICU for their treatments suffer major issues in breathing and other physical aspects post
their discharge, such as problems in physical movements due to muscle weaknesses, reduction in
physical functions, as well as several breathing problems. However, early intervention in the
form of exercising has been an appropriate and proven way out towards ensuring that these
problems are eradicated and the person could reach to a better and effective state. Therefore,
physical exercise could be a very appropriate and effective evidence-based practice to be adopted
by professionals or nurses to be applied to critically ill patients to reach a desired level of
functionality in relation to breathing.
CONCLUSION
Thus, it is concluded that Evidence Based Practice is highly necessary in order to ensure
that several health related problems are being taken care of in a manner which is scientifically
proven and effective. Moreover, it is imperative to be involved in every clinical practice as it has
various benefits towards betterment in outcomes, accountability, along with satisfaction to the
patient and their peers. In addition to this, an importance of involvement of this sort of practice
could very well be enhanced by conducting appropriate literature review upon the same. As
witnessed above, the outcomes of such a review which is critically analysed helped in
determining the scope of various latest practices towards dealing with the issues related to
breathing as well as improvising the same in the current practice that is adopted within the health
and social care organisations. Lastly, it is very important that the solutions from the evidence
based practice are applied to critically ill patients in a manner which supports their life
conditions and provide them with better option towards managing their breathing and other
related respiratory systems in a proper and effective manner.
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REFERENCES
Books and Journals
Ali, I., & Alharbi, O. M. (2020). COVID-19: Disease, management, treatment, and social
impact. Science of the Total Environment, 138861.
Barker, N., & et. al. (2018). Practical guide to the management of dysfunctional
breathing. Paediatrics and Child Health. 28(3). 149-151.
Bolsega, T. J., & Sole, M. L. (2018). Tracheostomy Care Practices in a Simulated Setting: An
Exploratory Study. Clinical Nurse Specialist. 32(4). 182-188.
Doiron, K. A., Hoffmann, T. C., & Beller, E. M. (2018). Early intervention (mobilization or
active exercise) for critically ill adults in the intensive care unit. Cochrane Database of
Systematic Reviews. (3).
Frat, J. P., Coudroy, R., & Thille, A. W. (2019). Non‐invasive ventilation or high‐flow oxygen
therapy: When to choose one over the other?. Respirology. 24(8). 724-731.
Gargiulo, G. D., O’Loughlin, A., & Breen, P. P. (2015). Electro-resistive bands for non-invasive
cardiac and respiration monitoring, a feasibility study. Physiological measurement. 36(2).
N35.
Hess, D. R. (2015). The evidence is in: noninvasive ventilation saves lives. Critical care
medicine. 43(4). 927.
Johnson, A. M., & Smith, S. M. (2016). Respiratory clinical guidelines inform ward-based
nurses’ clinical skills and knowledge required for evidence-based care. Breathe. 12(3).
257-266.
Portney, L. G. (2020). Foundations of Clinical Research: Applications to Evidence-Based
Practice. FA Davis.
Raimondi, N., & et. al. (2017). Evidence-based guidelines for the use of tracheostomy in
critically ill patients. Journal of critical care. 38. 304-318.
Sepehrvand, N., & et. al. (2018). Effects of supplemental oxygen therapy in patients with
suspected acute myocardial infarction: a meta-analysis of randomised clinical
trials. Heart. 104(20). 1691-1698.
Siemieniuk, R. A., & et. al. (2018). Oxygen therapy for acutely ill medical patients: a clinical
practice guideline. Bmj. 363.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care
in evidence-based practice. FA Davis.
Yancey, J. R., & Chaffee III, D. (2014). Role of Breathing Exercises in the Treatment of
COPD. American family physician. 89(1). 15-16.
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