Part 3B: Critical Appraisal of Research Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research. Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research

Part 3B: Critical Appraisal of Research

The four critically appraised articles included studies, a retrospective study (Burja et al., 2018), a systematic review (De Neef et al., 2019), an RCT (Mahmoodpoor et al., 2017), and a prospective cohort study (Triamvisit et al., 2021). All the articles’ authors asked focused clinical questions, with a clearly defined population of interest, interventions, comparator, and target outcomes. The PICOT question my project seeks to answer states: is the ventilator bundle superior to usual care in reducing VAP cases among mechanically ventilated and/or intubated patients in ICU six months after implementation? The PICOT question focuses on the evaluation of a clinical intervention, which necessitates the support from well-designed high-level empirical evidence, such as RCTs, systematic reviews with meta-analysis of RCTs, and prospective cohort studies (Emptage et al., 2018). From the four critically appraised articles, the retrospective nature of Burja et al. (2018) study threatens the validity of its findings, while the inclusion of pre-post interventional studies in the De Neef et al. (2019) meta-analysis diminished the cogency and applicability of the results Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research.

The RCT study offers high-quality findings due to the well-designed procedures. The trial authors asked a focused clinical query using the PICO framework, which involved seeking to determine whether the use of TaperGuard EVAC tubes in subglottic drainage is superior to conventional tubes in reducing the incidence of VAP (Mahmoodpoor et al., 2017). The author used a computer-generated randomizer to randomly assign the participants into treatment cohorts, blinded the research assistant involved in data gathering, and properly accounted for all the patients who entered the trial at its conclusion thereby decreasing the odds of attrition bias (Mansournia et al., 2017). The random allocation of the patients to the treatment cohorts decreased the odds of inadvertent or deliberate biases that might have diminished the cogency of the RCT results (Mittlböck, 2018). Nonetheless, while the patients in Mahmoodpoor et al. (2017) RCT were analyzed in their allocated intervention groups, the authors failed to provide a clear description of the intention-to-treat procedure. Besides, the trial authors based their sample size determination on previous studies reporting the incidence rate of 9 – 27 % for VAP in intubated patients using a power of 89% with α = .05, and an expected failure rate for experimental subjects of 0.135 (Mahmoodpoor et al., 2017). All the above features enhance the validity of the trial findings; however, conducting the study at a single center reduces the likelihood of generalizing the results.

References

Burja, S., Belec, T., Bizjak, N., Mori, J., Markota, A., & Sinkovič, A. (2018). Efficacy of a bundle approach in preventing the incidence of ventilator-associated pneumonia ( VAP ). Bosnia Journal of Basic Medical Science, 18(1), 105–109.

De Neef, M., Bakker, L., Dijkstra, S., Raymakers-Janssen, P., Vileito, A., & Ista, E. (2019). Effectiveness of a ventilator care bundle to prevent ventilator-associated pneumonia at the PICU: A systematic review and meta-analysis. Pediatric Critical Care Medicine, 20(5), 474–480. https://doi.org/10.1097/PCC.0000000000001862

Emptage, N., Koster, M., Schottinger, J., & Petitti, D. (2018). Critical appraisal of clinical studies: An example from computed tomography screening for lung cancer. The Permanente Journal, 11(2), 81–85. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057745/

Khan, M., Khokar, R., Qureshi, S., Al Zahrani, T., Aqil, M., & Shiraz, M. (2017). Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method. Saudi Journal of Anaesthesia, 10(4), 428. https://doi.org/10.4103/1658-354X.179113

Mahmoodpoor, A., Hamishehkar, H., Hamidi, M., Shadvar, K., Sanaie, S., Golzari, S. E., Khan, Z. H., & Nader, N. D. (2017). A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients. Journal of Critical Care, 38, 152–156. https://doi.org/10.1016/j.jcrc.2016.11.007

Mansournia, M. A., Higgins, J. P. T., Sterne, J. A. C., & Hernán, M. A. (2017). Biases in randomized trials. Epidemiology, 28(1), 54–59. https://doi.org/10.1097/EDE.0000000000000564

Mittlböck, M. (2018). Critical appraisal of randomized clinical trials: Can we have faith in