Evidence Based Nursing Research on Early Tracheostomy for Severe Burn Patients

This research investigates the effectiveness of early tracheostomy for severe burn patients in reducing rates of pneumonia, ICU delirium, and length of stay in the ICU. The study includes populations with severe burns who require mechanical ventilation and compares early tracheostomy to long-term intubation with oral care. The study will exclude randomized trials and diagnostic studies. Databases searched include Cochrane, PUBMED, and CINAHL.

Running head: EVIDENCE BASED NURSING RESEARCH
EVIDENCE BASED NURSING RESEARCH
Name of the Student:
Name of the University:
Author Note:

1EVIDENCE BASED NURSING RESEARCH
1. a.
The research question involves the severely burned patients for whom the
early tracheotomies are conducted within seven days in comparison to 28 days result
in case of earlier weaning from the ventilator. Does this decrease rates of pneumonia,
ICU delirium and shorter length of stay in the intensive care unit?
1.b.
1. Population/Problem Patients with severe burns who require mechanical
ventilation of a prolonged manner
2. Intervention Early placement of a tracheostomy
3. Comparison
Intervention/Group
Compared to long term intubation with oral care
4. Outcomes Reduction of incidence of ventilator assisted pneumonia,
ICU delirium and improvement of overall patient
outcomes
5. Time to achieve outcome
(if applicable)
within seven days versus 28 days
1. c.
This PICO question is important to identify the patients who have severe burns and
are need of long term intubation along with mechanical ventilation as an important part of

2EVIDENCE BASED NURSING RESEARCH
their care. The main aim of this clinical question is to investigate and identify the risk factors
that are involved in prolonged periods of intubation, additionally how early tracheostomy
will lead to decrease these risks and how early tracheostomy can prevent/decrease the onset
of VAP, ICU delirium and thus reduce the ICU LOS and provide a better patient outcome
(Durbin, Perkins &Moores, 2010).
2. The type of PICO question is Prognosis (Agency for Healthcare Research and Quality
(2013).
3. a. The inclusion criteria will involve the following:
Populations- the population will involve both the male and the female patients who
are suffering from severe burns
Interventions- The intervention involves the early tracheotomies performed to addressing
severe burns
Comparison Group or Intervention- It involves the same populationwho choose to participate
to weaning from the ventilator
Outcomes- It involves thedecreased rates of pneumonia, ICU delirium and shorter length of
stay in the intensive care unit along with the symptom management
Time Factors- will include studies published or updated between 2010- 2018.
Types of Studies that will be included- It will include thesynthesis of cohort studies or case-
control studies along with single cohort studies or case-control studies, meta-synthesis of
qualitative or descriptive studies, single qualitative studies, and single descriptive studies. All
the studies that will be included should be published in English language and should be peer
reviewed (Glas, Levi & Schultz, 2016).

3EVIDENCE BASED NURSING RESEARCH
3. b.
The study will exclude the randomized trials since it may pose a potential harm to the
case of symptom management to the population of people suffering from severe burns. The
study will also exclude the opinion of the experts since there is lack of results from the
evidence based results. There will also be no inclusion of diagnostic studies as there this
clinical question does not involve any diagnostic procedures (Akhtar, 2010).
4. Databases will search: Cochrane, PUBMED, and CINAHL
Search terms will initially use: severe burns;prolonged mechanical ventilation,
tracheostomy
5.
Serial no. Date of
Search
Search
Terms:
Search Limits Databases
Searched
# of Hits
(Results)
# of keeper
studies
Search 1 5/9/18 Use of
tracheoto
my in
severe
burns
Cochrane Review
Trials
Publication Date:
2010-2018
Cochrane
Library
6070 5670

4EVIDENCE BASED NURSING RESEARCH
Search 2 5/9/18 Tracheot
omy
Cochrane
Reviews and
Trials
Publication Date:
2010-2018
Cochrane
Library
27000 9660
Search 3 5/9/18 incidence
of
ventilator
assisted
pneumon
ia
Cochrane
Reviews and
Trials
Publication Date:
2010-2018
Cochrane
Library
16,300 7800
Search 4 5/9/18 ICU
delirium
Cochrane
Reviews and
Trials
Publication Date:
2010-2018
Cochrane
Library
17,100 6990
Search 5 5/9/18 Early
placemen
t of a
tracheost
omy
Cochrane
Reviews and
Trials
Publication Date:
2010-2018
National
Guideline
Clearingho
use
10,900 7300
Search 6 5/9/18 long term
intubatio
n with
oral care
Publication Date:
2010-2018
English language
Medline 18,100 16400

5EVIDENCE BASED NURSING RESEARCH
Search 7 5/9/18 Severely
burned
patients
requiring
prolonge
d
mechanic
al
ventilatio
n.
Publication Date:
2010-2018
English
Language
Peer Reviewed
CINAHL 17,800 5600
Search 8 5/9/18 overall
patient
outcomes
in burns
Publication Date:
2010-2018
English
Language
Peer Reviewed
CINAHL 17,400 8700

6EVIDENCE BASED NURSING RESEARCH
6. Reference list
Agency for Healthcare Research and Quality (2013, September 8). “About us”. Retrieved
from http://www.ahrq.gov/about/index.html.
Akhtar, S. (2010). Tracheotomy: Why and When. Critical Care Alert, 18(4), 25-26. Retrieved
on August 28, 2018 from http://ehis.ebscohost.com
Durbin, C., Perkins, M., &Moores, L. (2010). Should Tracheostomy be Performed as Early as
72 Hours in Patients Requiring Prolonged Mechanical Ventilation? Respiratory Care,
55(1), 76-87. Retrieved on August 28, 2018 from http://ehis.ebscohost.com
Glas, G. J., Levi, M., & Schultz, M. J. (2016). Coagulopathy and its management in
patients with severe burns. Journal of Thrombosis and Haemostasis, 14(5), 865-
874.