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dc.contributor.authorRose, Louise
dc.contributor.authorBlackwood, Bronagh
dc.contributor.authorEgerod, Ingrid
dc.contributor.authorHaugdahl, Hege Selnes
dc.contributor.authorHofhuis, Josè
dc.contributor.authorIsfort, Michael
dc.contributor.authorKydonaki, Kalliopi
dc.contributor.authorSchubert, Maria
dc.contributor.authorSperlinga, Ricardo
dc.contributor.authorSpronk, Peter
dc.contributor.authorStorli, Sissel Lisa
dc.contributor.authorMcAuley, Daniel
dc.contributor.authorSchultz, Marcus J
dc.date.accessioned2022-06-27T12:20:16Z
dc.date.available2022-06-27T12:20:16Z
dc.date.issued2011-12-14
dc.description.abstractIntroduction: 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.<p> <p>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. <p>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. <p>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.en_US
dc.identifier.citationRose, Blackwood, Egerod I, Haugdahl Hs, Hofhuis, Isfort, Kydonaki, Schubert, Sperlinga, Spronk, Storli SL, McAuley, Schultz. Decisional responsibility for mechanical ventilation and weaning: an international survey. Critical Care. 2011;15(6:R295)en_US
dc.identifier.cristinIDFRIDAID 901752
dc.identifier.doi10.1186/cc10588
dc.identifier.issn1364-8535
dc.identifier.issn1466-609X
dc.identifier.urihttps://hdl.handle.net/10037/25583
dc.language.isoengen_US
dc.publisherBMCen_US
dc.relation.journalCritical Care
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2011 The Author(s)en_US
dc.titleDecisional responsibility for mechanical ventilation and weaning: an international surveyen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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