Mechanical ventilation, weaning practices, and decision making in European PICUs

Tume, LN; Knebyer, M; Blackwood, B; Rose, L

Abstract

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
inter professional 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.

Citation

Tume, L., Knebyer, M., Blackwood, B., & Rose, L. (2017). Mechanical ventilation, weaning practices, and decision making in European PICUs. Pediatric Critical Care Medicine, 18(4), https://doi.org/10.1097/PCC.0000000000001100

• Journal Article Type: Article
• Publication Date: Feb 14, 2017
• Deposit Date: Sep 2, 2019
• Journal: Pediatric Critical Care Medicine
• Print ISSN: 1529-7535
• Publisher: Lippincott, Williams & Wilkins
• Volume: 18
• Issue: 4
• DOI: https://doi.org/10.1097/PCC.0000000000001100
• Publisher URL: http://dx.doi.org/10.1097/PCC.0000000000001100
• Related Public URLs: https://journals.lww.com/pccmjournal/pages/default.aspx