Critical literature review template

The outcome is an indirect indicator of recovery as it reduces the risk of reintubation and longer cardiac ICU stay. In a systematic review, Zhu, Lee and Chee aimed to determine the impact of fast-track interventions in the post-cardiac surgery period on mortality as well as postsurgical complications and length of stay in the ICU and hospital. Comparison interventions were conventional or non-fast track care.

Interventions were early extubation, early ambulation, and the use of low-dose opioids for general anaesthesia during the intraoperative period. Early extubation and ambulation typically occurred within postoperative day zero. Patient surgeries included CABG and valve replacement. Complications included wound infection and major bleeding.

The aggregate sample size of the studies was 4, patients, and most trial samples involved low- to moderate-risk patients. However, patients on fast-track care were noted to have shorter ICU stays indicative of lower risks for critical illness. The findings also show that fast-track care leads to similar outcomes as conventional care in low- to moderate-risk patients but at a lower cost.

The strength of the evidence is the integration of early ambulation within 24 hours following extubation into a multifaceted intervention such as fast-track protocols. This recognises the complex nature of post-cardiac surgery outcomes in that there are many factors that shape the clinical consequences. Indeed, if the patient remains heavily sedated then extubation cannot be performed.

In addition, Kandasamy et al. The quasi-experimental QI approach of Camp et al. For instance, Camp et al. There are limitations to the evidence, however. Therefore, it is difficult to draw conclusions on effectiveness in relation to many of the outcomes when considering the entirety of the evidence.

Another limitation of the evidence is the conduct of studies in single centres. It may be difficult to generalise the findings of one hospital in Bangladesh as in the study by Hoque et al. The randomised trial by Hoque et al. Only the study by Camp et al. These factors reduce the quality of the studies.

Similarly, the systematic review by Zhu, Lee and Chee found that majority of the studies were of moderate quality. The available evidence also does not provide adequate answers to the chosen clinical question. The outcome of early recovery was employed by only two studies — that by Ahmed et al. As such, ICU and hospital length of stay, ICU readmission, reintubation, and reductions in the risk of complications other than wound infection and circulation were considered as proxy or indirect measures of recovery such as in the studies by , Camp et al.

The outcome of wound status was investigated only in the systematic review by Zhu, Lee and Chee while bleeding and haemodynamic parameters as clinical issues related to circulation were studied also in the systematic review and the randomised prospective study by Hoque et al.

All patients in the studies fit the clinical question as they were adults and post-CABG, post-heart valve repair or post-open thoracic aortic surgery. A shared characteristic across studies was that they have mild to moderate-risk for complications because high risk was a common exclusion criterion. However, there is a lack of direct comparison between early ambulation within and beyond 24 hours of extubation. That early ambulation was not the primary focus of all the studies except for Ahmed et al.

If ambulation was done within the same time or day as extubation was mostly inferred from the description of interventions and outcomes. For instance, if extubation was done on postoperative day zero in ultra-fast track and ambulation is also done within the same day as in the study by Kandasamy et al. The paucity of studies relevant to the research question warrants refinement of the question that will guide another literature search and appraisal.

It is better for the time factor of early ambulation to be based not on the duration of time after extubation but on the duration of time after the surgical procedure given that fast-track protocols involve activities per postoperative day. It is also better to focus on more specific measures of recovery, circulation, and wound status — for instance length of stay or number of days before discharge to home, bleeding, and the incidence of wound infection.

The inclusion of other better studied outcomes such as postoperative pneumonia can also be included. Ahmed, H. Alexandria Journal of Anaesthesia and Intensive Care, 9 3 , Quality improvement program increases early tracheal extubation rate and decreases pulmonary complications and resource utilization after cardiac surgery.

Journal of Cardiac Surgery, 24, Freeman, R. Mobilization of intensive care cardiac surgery patients on mechanical circulatory support. Critical Care Nursing Quarterly, 36 1 , Hoque, A. Study on the effect of total intravenous anesthesia TIVA on the post-operative respiratory performance regarding early extubation after coronary artery bypass graft CABG surgery.

Journal of the Bangladesh College of Physicians and Surgeons, 29, Kandasamy, A. Ultra fast-tracking versus a conventional strategy in valve replacement surgery. Indian Journal of Anaesthesia, 57 3 , Murphy, M. Fast track open aortic surgery: Reduced post-operative stay with a goal directed pathway. European Journal of Vascular and Endovascular Surgery, 34 3 , Polit, D. Nursing research: Generating and assessing evidence for nursing practice 9th ed.

Zhu, F. Fast-track cardiac care for adult cardiac surgical patients. We accept sample papers from students via the submission form.

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ID Password recovery email has been sent to email email. Type of Paper. Essay Topics. Educational Tools. Abstract Early ambulation is now recognised as an intervention that confers many positive benefits to patients following cardiac surgery. Review of the Literature Camp et al. Critique The strength of the evidence is the integration of early ambulation within 24 hours following extubation into a multifaceted intervention such as fast-track protocols.

Answer to the Clinical Question The available evidence also does not provide adequate answers to the chosen clinical question. Recommendation The paucity of studies relevant to the research question warrants refinement of the question that will guide another literature search and appraisal. References Ahmed, H. Accessed 14 January January Accessed January 14, Retrieved January 14, Free Essay Examples - WowEssays. Published Jan 29, Share with friends using:. Removal Request.

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