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Decisional responsibility for mechanical ventilation and weaning: an international survey

Rose, Louise; Blackwood, Bronagh; Egerod, Ingrid; Haugdahl, Hege; Hofhuis, Jos�; Isfort, Michael; Kydonaki, Claire (Kalliopi); Schubert, Maria; Sperlinga, Riccardo; Spronk, Peter; Storli, Sissel; McAuley, Daniel F; Schultz, Marcus J

Authors

Louise Rose

Bronagh Blackwood

Ingrid Egerod

Hege Haugdahl

Jos� Hofhuis

Michael Isfort

Claire (Kalliopi) Kydonaki

Maria Schubert

Riccardo Sperlinga

Peter Spronk

Sissel Storli

Daniel F McAuley

Marcus J Schultz



Abstract

Introduction

Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement.


Methods

A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making.


Results

Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs.


Conclusions

Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.

Citation

Rose, L., Blackwood, B., Egerod, I., Haugdahl, H., Hofhuis, J., Isfort, M., …Schultz, M. J. (2011). Decisional responsibility for mechanical ventilation and weaning: an international survey. Critical care : the official journal of the Critical Care Forum, 15, R295. https://doi.org/10.1186/cc10588

Journal Article Type Article
Publication Date 2011
Deposit Date Jan 20, 2016
Publicly Available Date Jan 20, 2016
Print ISSN 1364-8535
Electronic ISSN 1466-609X
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 15
Pages R295
DOI https://doi.org/10.1186/cc10588
Keywords Mechanical ventilation; weaning; decision-making; extubation; intensive-care nursing;
Public URL http://researchrepository.napier.ac.uk/id/eprint/9462
Publisher URL http://dx.doi.org/10.1186/cc10588

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Copyright Statement
© 2011 Rose et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.






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