TY - JOUR
T1 - Ventilator weaning and extubation practices in critically ill children
T2 - An Australian and New Zealand survey of practice
AU - Schults, Jessica A.
AU - Charles, Karina
AU - Harnischfeger, Jane
AU - Erikson, Simon
AU - Burren, Juerg
AU - Waak, Michaela
AU - Blackwood, Bronagh
AU - Tume, Lyvonne N.
AU - Long, Debbie
AU - Australian and New Zealand Intensive Care Society Paediatric Study Group
N1 - Funding Information:
To include binational perspectives, ANZ ICUs who contribute paediatric data to the Australian and New Zealand Paediatric Intensive Care Registry (ANZPICR) were eligible to participate. We excluded units that did not routinely provide invasive mechanical ventilation support to five or more children per annum. The survey invitation was distributed through investigators’ networks, supported by the Australian and New Zealand Intensive Care Society Paediatric Study Group, to recruit one senior nursing respondent per unit. A senior nurse was defined as the nurse unit manager, nurse educator, or patient quality and safety clinical nurse consultant. An information sheet was sent to the participants' email address with a link for the online survey. Three email reminders were sent at 2-week intervals.
Funding Information:
Questions were based on a previously developed survey (survey of mechanical ventilation weaning and decision-making approaches in European PICUs15) and adapted for the ANZ healthcare context following a review of the literature and consultation with national stakeholders (Australian and New Zealand Intensive Care Society Paediatric Study Group) and international content experts (L.N.T.and B.B.). Respondents rated items across the domains of unit and staffing characteristics (nine items) and current sedation, ventilation weaning, and extubation practices (17 items) using either a three (yes, no, or unsure) or five-point Likert response scale. Two open-ended response questions were included to capture additional information regarding perceptions of usual practices: (i) Can you tell me about how your unit develops policies and procedures related to ventilation liberation and are nurses involved in this process? and (ii) Do you have any further comments regarding mechanical ventilation weaning and tracheal extubation in paediatrics? The final survey included 35 items. Following approval from the director of each responding units, unit-level data (seven items), including extubation times for the preceding financial year (2019–2020), were obtained from the ANZPICR.We gratefully acknowledge nurses and directors of participating Intensive Care Units for their time and contribution. We also acknowledge the support of the Australian and New Zealand Intensive Care Society Paediatric Study Group. We would like to thank the Australian and New Zealand Paediatric Intensive Care Registry for supplying clinical data.
Publisher Copyright:
© 2022 Australian College of Critical Care Nurses Ltd
PY - 2022/8/27
Y1 - 2022/8/27
N2 - Objectives: We aimed to 1) describe current weaning and extubation practices in children (protocols to identify weaning candidates, spontaneous breathing trials and other aspects of care such as sedation weaning); and 2) understand responsibilities for ventilation weaning decisions across Australian and New Zealand (ANZ). Methods: Cross-sectional survey of ANZ intensive care units (ICUs) who routinely intubate and ventilate children (Results: A senior nursing respondent from 18/22 ICUs (82%) completed the survey. Across units, most used sedation assessment tools (88%), and less often, sedation weaning tools (55%). Spontaneous awakening protocols were not used, one unit (5%) reported the use of a spontaneous breathing protocol. Two respondents reported ventilation weaning protocol (11%) were in use, with 44% of units reporting the use of extubation protocols. Weaning and extubation practices were largely perceived as medically driven, with qualitative data demonstrating a desire from most respondents for greater shared decision making. ConclusionIn ANZ, ventilation weaning and extubation practices are largely medically driven with variation in the use of protocols to support mechanical ventilation weaning and extubation in children. Our findings highlight the importance of future research to determine the impact of greater collaboration of the multidisciplinary team on weaning practices.
AB - Objectives: We aimed to 1) describe current weaning and extubation practices in children (protocols to identify weaning candidates, spontaneous breathing trials and other aspects of care such as sedation weaning); and 2) understand responsibilities for ventilation weaning decisions across Australian and New Zealand (ANZ). Methods: Cross-sectional survey of ANZ intensive care units (ICUs) who routinely intubate and ventilate children (Results: A senior nursing respondent from 18/22 ICUs (82%) completed the survey. Across units, most used sedation assessment tools (88%), and less often, sedation weaning tools (55%). Spontaneous awakening protocols were not used, one unit (5%) reported the use of a spontaneous breathing protocol. Two respondents reported ventilation weaning protocol (11%) were in use, with 44% of units reporting the use of extubation protocols. Weaning and extubation practices were largely perceived as medically driven, with qualitative data demonstrating a desire from most respondents for greater shared decision making. ConclusionIn ANZ, ventilation weaning and extubation practices are largely medically driven with variation in the use of protocols to support mechanical ventilation weaning and extubation in children. Our findings highlight the importance of future research to determine the impact of greater collaboration of the multidisciplinary team on weaning practices.
KW - Critical care
KW - Liberation
KW - Mechanical ventilation
KW - Paediatrics
KW - Survey of practice
UR - http://www.scopus.com/inward/record.url?scp=85136633500&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85136633500&partnerID=8YFLogxK
U2 - 10.1016/j.aucc.2022.06.004
DO - 10.1016/j.aucc.2022.06.004
M3 - Article (journal)
AN - SCOPUS:85136633500
SN - 1036-7314
JO - Australian Critical Care
JF - Australian Critical Care
ER -