American Journal of Respiratory Care and Critical Medicine, Article Critique Example

Lorente, L., Lecuona, M., Jimenez, A., Mora, M.L., and Sierra, A. (2007). Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. American Journal of Respiratory Care and Critical Medicine, 176: 1079-1083.

Abstract

The title of the article referenced above provides key words regarding the key concepts of this article, and summarizes what the article will address, and the type of patients that will be considered. The article abstract provides a number of important summary statements regarding the purpose of the research, including its primary objectives, methods, measurements, results, conclusions, and key words (Lorente et.al, 2007).

Introduction

The article’s introductory section provides a summary of the primary concern of the study, which is Ventilator-Associated Pneumonia (VAP). The introduction considers subglottic secretions, which are the primary cause of VAP, and how to remove them from the respiratory tract (Lorente et.al, 2007). This section provides persuasive evidence that an endotracheal tube, combined with a polyurethane cuff, may be effective in reducing subglottic secretion drainage and the potential damage it causes with VAP (Lorente et.al, 2007). This study does not specifically address nursing practice; however, since nurses will be part of implementing these procedures, it is only natural that this research will be valuable to nursing practice. For the purposes of this comparison study, a quantitative approach is appropriate, and it provides an increased understanding of the direction in which the researchers are headed.

Hypothesis or Research Questions

The primary hypothesis for this research study attempts to determine if different methods are useful in preventing subglottic secretions in the formation of VAP (Lorente et.al, 2007). By using a combined approach of an endotracheal tube and polyurethane cuff with subglottic secretion drainage, there is a greater potential to prevent VAP in this patient population (Lorente et.al, 2007). This hypothesis is consistent with the objectives of the study as a whole and its overall research direction, and it is anticipated that there will be additional insights regarding the relationship between subglottic secretions and the selected tools to overcome this condition.

Literature Review

The literature that is addressed in this study provides a number of points that are relevant contributors to the study framework and design. There are 25 different references used for the study, and this demonstrates that the researchers wanted to further develop their existing knowledge regarding the subject matter to improve patient outcomes and the success of the method in question. The literature in question also clarifies a number of points that are significant to the study, and provides knowledge regarding the devices to be used and their appropriateness for the study (Lorente et.al, 2007). The literature review is designed to provide additional evidence of the hypothesis, and this article, based upon this section, deems this hypothesis appropriate.

Conceptual/Theoretical Framework

The proposed framework for this study is appropriate, based upon existing rationale and research, which demonstrates that the use of two devices in a combined manner will positively prevent VAP from occurring in critically ill patients who face a high risk of this condition (Lorente et.al, 2007). This framework also demonstrates an effective rationale which supports the study objectives rather effectively.

Method

In developing the study design and executing the objectives, the institutional review board was properly notified of the study protocol, and subsequently approved the study framework and design involving human subjects (Lorente et.al, 2007). In addition, all patients provided informed consent prior to their participation in the study (Lorente et.al, 2007). This is an essential component of the study in order to support its legitimacy and ethical appropriateness.

Research Design

The selected research design, a randomized clinical trial using patients from a medical-surgical intensive care unit, is appropriate, given the purpose of the study and the primary objectives (Lorente et.al, 2007). Randomization of patients into two separate groups distinguished the use of ETT-C versus ETT-PUC-SSD (Lorente et.al, 2007). This option is sufficiently rigorous for the study’s purpose, and was likely to provide the type of data that was necessary to accomplish the desired objectives more effectively (Lorente et.al, 2007). The study did not provide significant detail regarding the population other than the randomization factor, which may lead to possible gaps in how to use this data effectively for future populations.

Population and Sample

The population that was considered for this study was determined by a number of exclusion criteria, including those under 18 years of age, those patients diagnosed with HIV, low blood leukocyte count, tumors, and immunosuppressive therapy (Lorente et.al, 2007). For each group, 140 patients were selected for inclusion in the study, which appears to be a sufficient number for further consideration and evaluation (Lorente et.al, 2007).

Data Collection and Measurement

The data collection techniques used for this study and the subsequent measurement strategies are congruent, and represent a means of exploring the relationship between the different variables. Secondary variables such as sex, age, and APACHE II score are used, along with the integration of antibiotic therapies (Lorente et.al, 2007). Preventing VAP in both patient groups was identical, and demonstrated the knowledge of the condition and the overall potential for improvement (Lorente et.al, 2007).

Procedures

The intervention that was conducted on each patient was an intubation, either using ETT-C or ETT-PUD-SSD, depending on which group was assigned (Lorente et.al, 2007). The utilization of antibiotics was also implemented, with the choice of therapies dependent upon the type of surgery that had been performed prior to the intervention (Lorente et.al, 2007). This is a consistent method of determining how VAP is prevented within this specific patient population. However, additional insights should be considered to improve the selection of patients, based upon their underlying condition.

Results/Data Analysis

Using the standard t-test, chi-square test, and/or Fisher’s exact test, the key variables were deconstructed and analyzed (Lorente et.al, 2007). Furthermore, other statistical measures were identified and implemented, using a number of control variables to enhance the possible findings, using the Cox Regression Model as the primary method (Lorente et.al, 2007).

Findings

The study findings note no significant differences between the two groups with respect to control variables; however, other analytical measures demonstrated that there are a number of factors that are statistically different in terms of a VAP diagnosis (Lorente et.al, 2007). In addition, the discovery of VAP in some patients further enhances the study findings in different ways (Lorente et.al, 2007).

Discussion/Interpretation of Findings

The study findings provide further evidence that the ETT-PUC-SSD offers a positive influence in reducing the potential risks associated with VAP, by reducing the amount of subglottic secretions (Lorente et.al, 2007). A number of tables further demonstrate that these findings are legitimate and warrant further investigation. In this portion of the study, additional literature is provided which supports the development of other considerations to reduce subglottic secretions in patients (Lorente et.al, 2007). These considerations should be identified and integrated into future studies in this subject area.

Implications/Recommendations

The evidence generated from the study further enhances the argument that ETT-PUC-SSD is an active preventer of VAP in both the early and late stages (Lorente et.al, 2007). This evidence provides additional insights regarding how to prevent VAP in the critically ill population, and what steps are necessary to incorporate additional findings in future studies to improve outcomes for other patients (Lorente et.al, 2007). The study also supports the development of other factors that will enable the researchers to identify other criteria that may apply to the use of these devices in a combined manner in future studies (Lorente et.al, 2007).

Global Issues/Presentation

The study does demonstrate that there are a number of limitations to this research; however, these limitations could be accounted for in future studies, such as the evaluation of fluid leakage (Lorente et.al, 2007). In addition, other findings suggest that the study might benefit from an analysis of SSD and the polyurethane cuff on an independent basis (Lorente et.al, 2007). These efforts will further enhance future studies, and will eliminate any bias that might have existed within this study framework.

Researcher Credibility

The researchers in question have demonstrated their skills and knowledge in performing this study, while also providing evidence that will be useful as a background for future studies. It is believed that these efforts also influenced other studies, such as that conducted by Lacherade et.al (2011) to address subglottic secretion drainage and its role in VAP. The researchers were well-qualified to perform the study in question, and provided a strong platform to enhance future research within this area of study.

Summary Assessment

Overall, the study by Lorente et.al (2007) was effective in achieving the desired objectives, in spite of its limitations. Future studies will benefit from the use of this information to accomplish other related objectives. VAP is a complex condition, and prevention is an essential requirement for critically ill patients who face this possibility. Therefore, this research is useful in addressing device-based solutions to prevent further damage as a result of this condition in this patient population. At the same time, additional research in related areas is likely to improve diagnostic tools for VAP patients to reduce the prevalence of this condition in postsurgical settings.

References

Lacherade, J.C., De Jonghe, B., and Bastuji-Garin, S. (2011). Intermittent subglottic secretion drainage and ventilator-associated pneumonia. American Journal of Respiratory Critical Care Medicine, 183(10): 1436-1437.

Lorente, L., Lecuona, M., Jimenez, A., Mora, M.L., and Sierra, A. (2007). Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. American Journal of Respiratory Critical Care Medicine, 176: 1079-1083.