Conectar
To locate and synthesise clinical guidelines for nurses and other health professionals undertaking routine virtual health (telehealth) assessment, triage and follow-up care. To locate practice guidelines where clinician and client are not in the same physical location and health assessments are undertaken ‘virtually’.
This review used JBI methodology for scoping reviews and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension (PRISMA-ScR).
Search considered primary research, practice guidelines, case reports, expert opinions, professional organisation web-based resources and grey literature. Medline (Ovid), Cumulative Index to Nursing & Allied Health (CINAHL) and Scopus databases were searched in relation to all health professions. Grey literature search included guideline databases, literature databases, customised Google search engines, targeted websites and consultation with content experts. Citation searching was included.
Search identified 2359 peer-reviewed articles and 31 sources of grey literature (1997–2024). After screening, 22 peer-reviewed and 9 grey literature sources met the eligibility criteria for inclusion. Studies were spread across diverse practice settings. Chronological sequencing provided visibility to innovations in telehealth practice over time from telephone-based practice to the introduction of video conferencing and the use of wearable devices for the transmission of remotely recorded clinical information.
Standardised guidelines to safe practice for virtual health assessment are not well documented. The paucity of clinically orientated guidelines may be due to complexity and the resourcing needed to maintain clinically current guidelines across the full breadth of clinical specialisations, practice settings and telehealth modalities. Further research and development are needed in this growing area of care.
The review highlights that clinically relevant guidelines are critical to safety and quality in virtual health contexts. Findings will inform future design and development of clinical practice guidelines for nurses engaged in virtual health assessment, triage and follow-up care.
Not applicable.
Patients receiving extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (SARF) often experience significant challenges with airway clearance due to disease severity, ultra-protective ventilation strategies and suppression of mucociliary and cough mechanisms. Extremely low tidal volumes and minimal flow rates further hinder secretion mobilisation. Despite increasing global use of ECMO, there is currently no synthesis of evidence describing airway clearance practices, their physiological rationale or outcomes in this population.
This scoping review aims to explore the extent and nature of evidence on airway clearance interventions in invasively ventilated adult patients receiving ECMO for SARF. Specific objectives include mapping the types of interventions described and specific parameters, their intended physiological effects, reported outcomes and safety considerations.
This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be undertaken across Embase, Ovid Emcare, Ovid Medline, CINAHL and grey literature sources including TRIP and Google Scholar. Eligible studies will include original data on airway clearance interventions in adult patients (≥16 years) receiving ECMO for SARF. Studies focused on paediatric populations, extracorporeal carbon dioxide removal, or solely cardiac ECMO will be excluded.
Two independent reviewers will screen titles, abstracts and full texts, extract data using a piloted tool and summarise findings using descriptive statistics and narrative synthesis. Basic qualitative content analysis will support mapping of interventions including parameters, their physiological and clinical rationale, and reported outcomes including adverse effects.
As this study involves a review of existing literature and does not include collection of primary data, ethical approval is not required. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic and professional meetings. The results are expected to highlight variations in practice and provide a foundation for future research aimed at optimising respiratory care and improving outcomes for patients receiving ECMO for SARF.
osf.io/ptfr7.
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