Abstract
Objectives: We aimed to (i) 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 (ii) understand responsibilities for ventilation weaning decisions across Australia and New Zealand (ANZ).
Methods: A cross-sectional survey of ANZ intensive care units who routinely intubate and ventilate children (<18 years) was conducted. We worked with the Australian and New Zealand Intensive Care Society Paediatric Study Group to identify units and potential respondents (senior nurse representative per unit) and to administer questionnaires. Survey questions (n = 35) examined current protocols, practices, unit staffing, and decision-making responsibilities for ventilation weaning and extubation. Open-ended questions examined respondents' experiences of weaning and extubation.
Results: A senior nursing respondent from 18/22 intensive care units (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 that ventilation weaning protocols (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.
Conclusion: In 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.
| Original language | English |
|---|---|
| Journal | Australian Critical Care |
| Early online date | 27 Aug 2022 |
| DOIs | |
| Publication status | Early online date - 27 Aug 2022 |
Bibliographical note
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
Keywords
- Critical care
- Liberation
- Mechanical ventilation
- Paediatrics
- Survey of practice
ASJC Scopus subject areas
- Emergency
- Critical Care