Introduction
Mechanical ventilation is indicated for numerous
clinical and physiological reasons. The nursing
management of the mechanically ventilated
patient is challenging on many levels: from the
acquisition of highly technical skills; expert knowledge
on invasive monitoring; and implementation
of interventions to care for the patient. Each
critically ill patient brings the clinical rationale for
mechanical ventilation and additional complexities
associated with their illness. It is recognised that
the reason for mechanical ventilation and patient
admission impacts on patient assessment and management.
However, there are core evidence-based
collaborative principles which underpin the nursing
management of such patients in the intensive care
unit (ICU), those being patient safety: patient
and equipment assessment; and patient comfort:
patient position; hygiene; management of stressors
and; pain and sedation management.
To identify the evidence supporting practice a
thorough review of current literature was undertaken
using the following steps: electronic search
conducted of MEDLINE, CINAHL, EMBASE and PsychReview
databases for articles published between
1995 and 2006 and; key words used were mechanical
ventilation, patient assessment, airway management,
sedation and comfort.
Many confounding variables exist in the care of
the critically ill mechanically ventilated patient in
the ICU. Consequently not all practice may be supported
by evidence. As evidence-based literature
addressing the overarching care of the mechanically
ventilated patient is scant, for the purpose of
this paper common practice is supported by expert