The Mortality Rates of Advanced Ventilator Modes vs Intravenous Medications in the Adult ICU Setting - Research Proposal Example

The mortality rates of advanced ventilator modes vs intravenous (IV) medications in the adult ICU setting Introduction Patients in intensive care units have special needs that require supportive facilities for sustaining their mechanisms. A patient in the care environment may be too weak to support the normal gaseous exchange process, a condition that may require breathing aid and mechanical ventilator modes aids this. Similarly, a patient may not be able to take in medication through the oral cavity to warrant intravenous medications. These intervention measures are however not always successful in helping patients and have been associated with mortality rates. the study seeks to investigate and compare mortality rates associated with the two measures. Mechanical ventilation is a common application in the intensive care unit but their usage is not entirely safe. Fernandez, Miguelena, Mulett, Godoy and Martinon-Tore contends that such applications require high degree of care and this further means that associated risk can occur without cases of practitioner’s negligence (2013). New mechanical ventilators continue to emerge but the risk has persisted. Adaptive support ventilation is one of the latest models but despite its advantages such as reduced ventilation period and less human management, it has diversified disadvantages such as lack of direct programming options, inadequate experience, and limited availability. Consequently, application is limited and even when it is available; it has significant risks that can contribute to mortality rate among patients in the ICU (Fernandez et al., 2013). In addition to direct risks of ventilator application, a patient may not be tolerant to its usage and this may hinder its efficiency. Consequently, usage may not imply benefits to patients who may succumb to breathing difficulties. Associated complications of ventilator applications such as pressure on a patient’s respiratory system, irritation, and air leaks among other complications may, if not detected and corrected in time, be significant to the patient’s condition and lead to death (Grossbach, Chlan and Tracy, 2011). Fan, Villar and Slutsky’s review of acute respiratory distress syndrome that ventilators induce confirms significance of associated risks with mechanical ventilator modes into high mortality rate despite continued usage of the technology in intensive care units (2013). Like mechanical ventilator modes, intravenous medications have associated risks. In a study to investigate risk of intravenous medication on blood stream infections, the researchers identified significant risk levels but noted that application of point of care-activated and closed system for intravenous medication had lower risks and would therefore be recommended. This identifies potential risk of bloodstream infection should a practitioner be moral enough to use the recommended methods but the risk still occur (Mercaldi, Lanes and Bradt, 2013). Consequently, manageable mortality rate exist in application of intravenous medication. The low risk of intravenous medication is further evident from a study that investigated mortality rate between organizations that prefer intravenous medications and those that use the medication approach in few circumstances. While the study identified large organizations with preference for intravenous medications that small and for non-profit organizations, large organizations reported lower rations for mortality, such as 1.13 and 1.14, that small organizations whose ratios included 1.25 and 1.18 (Zhang, Thamer, Kshirsagar and Cotter, 2013). This suggests that intravenous medication is effective in improving quality of life and reducing mortality rates, with an implication that it is not a threat to life. Existing data identifies risks in mechanical ventilator modes and intravenous medications to suggest their significance to mortality rates. The literature also notes that the interventions can be managed for safety. No comparative information on the two measures, and on ICU is however available. This paper seeks to investigate associated mortality rates of the two intervention measures to ascertain effectiveness in management of their associated risks and to determine the more risky intervention of the two. Research question and hypothesis The following research questions will help in exploring the research objective. Do advance mechanical ventilator modes and intravenous medications report significant mortality rates in adult ICU setting? Does advance mechanical ventilator account for higher mortality rate than intravenous medication? The following null hypotheses will be tested for the two research questions. H1O: Advance mechanical ventilator modes and intravenous medications do not report significant mortality rates H20: There is no significant difference in mortality rates for the two intervention measures. Operational definitions Ventilator mode: Ventilator mode is an intervention measure for enhancing respiratory process and one of the study’s independent variables. Intravenous medication: Intravenous medication defines medication through the blood stream and is another independent variable Mortality rate: Mortality rate defines frequency of reported death per population size and is the dependent variable Population and sampling method Patients in the intensive care unit will be the study’s population. Sample will be drawn from units from five care facilities through stratified random sampling. Methods A survey design will be used for the study with a stratified random sampling strategy. 12 participants will be sampled into each intervention groups from each of the selected care facility. Research participants will be identified by the interventions and percentage of those who succumb to their condition measured per intervention. Ethical approval will be sought from relevant authority in the medical profession and informed consent from administrations of selected facilities obtained. Patients will then recruited upon admission, based on recommended intervention and informed consent sought from their next of kin. The patients will then be monitored over their stay in the unit with focus on whether they recover or succumb to death. Internal threats to validity Threat of construct validity is the significant threat in the study. The reported mortality rates could be caused by patients’ original conditions and not the applied interventions. Interventions shall however be blind to the original conditions and this controls the threat because the severity of the original conditions shall be randomly allocated to the intervention measures. Ethical consideration The study will be observational and therefore free from ethical considerations that are pertinent to experimental and quasi-experimental studies that involve treatment measures. Care will however be taken to ensure ethical approval and informed consent from relevant authority. Considerations will also be made with respect to psychological sensitivity of research patients and their relatives and to ensure anonymity. References Fan, E., Villar, J. and Slutsky, A. Novel approaches to minimize ventilator-induced lung injury. BMC Medicine 11(1), 1-9. Fernandez, J. et al. (2013). Adaptive support ventilation: State of the art review. Indian Journal of Critical Care Medicine 17(1), 16-22. Grossbach, I., Chlan, L. and Tracy, M. (2011). Overview of mechanical ventilator support and management of patient-and ventilator- related responses. Critical Care Nurse 31(3), 30-45. Mercaldi, C., Lanes, S. and Bradt, J. (2013). Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems. American Journal of Health-System Pharmacy 70(11), 957-965. Zhang, R., Thamer, S., Kshirsagar, J. and Cotter, D. (2013). Organizational status of dialysis facilities and patient outcome: Does higher injectable medication use mediate increased mortality? Health Services Research 48(3), 949-971. Read More