Objectives: This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making.
Design: Cross-sectional electronic survey.
Setting: European PICUs.
Participants: Senior ICU nurse and physician from participating PICUs.
Interventions: None.
Measurements And Main Results: Response rate was 64% (65/102) representing 19 European countries. Determination of weaning failure was most commonly based on collaborative decision making (81% PICUs; 95% CI, 70-89%). Compared to this decision, selection of initial ventilator settings and weaning method was least likely to be collaborative (relative risk, 0.30; 95% CI, 0.20-0.47 and relative risk, 0.45; 95% CI, 0.32-0.45). Most PICUs (> 75%) enabled physicians in registrar (fellow) positions to have responsibility for key ventilation decisions. Availability of written guidelines/protocols for ventilation (31%), weaning (22%), and noninvasive ventilation (33%) was uncommon, whereas sedation protocols (66%) and sedation assessment tools (76%) were common. Availability of protocols was similar across European regions (all p > 0.05). High-flow nasal cannula (53%), noninvasive ventilation (52%) to avoid intubation, and spontaneous breathing trials (44%) were used in approximately half the PICUs greater than 50% of the time. A nurse-to-patient ratio of 1:2 was most frequent for invasively (50%) and noninvasively (70%) ventilated patients. Perceived nursing autonomy (median [interquartile range], 4 [2-6]) and influence (median [interquartile range], 7 [5-8]) for ventilation and weaning decisions varied across Europe (p = 0.007 and p = 0.01, respectively) and were highest in Northern European countries.
Conclusions: We found variability across European PICUs in interprofessional team involvement for ventilation decision making, nurse staffing, and perceived nursing autonomy and influence over decisions. Patterns of adoption of tools/adjuncts for weaning and sedation were similar.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/PCC.0000000000001100 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Prolonged mechanical ventilation in critically ill patients: six-month mortality, care pathways, and quality of life.
Chest
January 2025
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany. Electronic address:
Background: There is limited knowledge about long-term mortality, care pathways and health-related quality of life (HrQoL) among intensive care unit (ICU) patients receiving prolonged mechanical ventilation (PMV).
Research Question: What are the long-term mortality, care pathways, and HrQoL of patients receiving invasive PMV, stratified by weaning success?
Study Design: and methods: We conducted a secondary analysis of patients from the cluster-randomised controlled Enhanced Recovery after Intensive Care trial who were treated in two ICU clusters and received invasive PMV (≥21 days via endotracheal tube/tracheostomy or ≥four days via tracheostomy). Data on weaning success, mortality, care place transitions, readmissions, and HrQoL were collected for six months after ICU discharge.
Early weaning from invasive mechanical ventilation via high-flow nasal oxygen versus conventional weaning in patients with hypoxemic respiratory failure: a prospective randomized controlled study.
Crit Care Sci
January 2025
Anaesthesiology and Critical Care, All India Institute of Medical Sciences - Jodhpur, India.
Objective: Although the efficacy of high-flow nasal oxygen therapy in delaying or avoiding intubation in patients with hypoxemic respiratory failure has been studied, its potential for facilitating early weaning from invasive mechanical ventilation remains unexplored.
Methods: In this randomized controlled trial, 80 adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation for > 48 hours were enrolled and divided into two groups: conventional weaning and early weaning via high-flow nasal oxygen. In the conventional weaning group, the spontaneous breathing trial was performed after the PaO2/FiO2 ratio was ≥ 200, whereas in the high-flow nasal oxygen group, the spontaneous breathing trial was conducted earlier when the PaO2/FiO2 ratio was 150 - 200.
Optimizing Sedation Strategies in the Cardiac ICU: Induction, Maintenance and Weaning.
Curr Cardiol Rep
January 2025
Cardiovascular Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
Purpose Of Review: We aim to summarize the available literature guiding tailored sedation practices for specific conditions encountered in the Cardiovascular Intensive Care Unit (CICU).
Recent Findings: Data specific for the CICU population is lacking. Preclinical data and observational studies guide sedation approaches for specific pathologies that we have used to generate a guideline for sedative choice for various scenarios.
Ketogenic diet treatment for super-refractory status epilepticus in the intensive care unit: feasibility, safety and effectiveness.
Front Neurol
January 2025
Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
Background And Aims: To investigate the feasibility, safety and effectiveness of the ketogenic diet (KD) for super-refractory status epilepticus (SRSE) in the intensive care unit (ICU).
Methods: We conducted a prospective investigation on patients with SRSE treated with the KD. The primary outcome measures were ketosis development as a biomarker of feasibility and resolution of SRSE as effectiveness.
Developing and validating a machine learning model to predict multidrug-resistant -related septic shock.
Front Immunol
January 2025
Department of Medical Laboratory, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China.
Background: Multidrug-resistant Klebsiella pneumoniae (MDR-KP) infections pose a significant global healthcare challenge, particularly due to the high mortality risk associated with septic shock. This study aimed to develop and validate a machine learning-based model to predict the risk of MDR-KP-associated septic shock, enabling early risk stratification and targeted interventions.
Methods: A retrospective analysis was conducted on 1,385 patients with MDR-KP infections admitted between January 2019 and June 2024.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!