International perspectives on the influence of structure and process of weaning from mechanical ventilation

TY - JOUR

T1 - International perspectives on the influence of structure and process of weaning from mechanical ventilation

AU - Rose, Louise

AU - Blackwood, Bronagh

AU - Burns, Suzanne M

AU - Frazier, Susan K

AU - Egerod, Ingrid

PY - 2011/1

Y1 - 2011/1

N2 - Background: Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such pro cess, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing context and processes. Objective: To compare international data to assess differences in context and processes in intensive care units that could influence weaning. Methods: Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education, roles, and responsibilities for weaning in intensive care units of selected countries. Results: Australia, New Zealand, Denmark, Norway, Sweden, and the United Kingdom showed similarities in critical care provision, structure, skill mix, and staffing ratios in intensive care units. Weaning in these countries is generally a collaborative process between nurses and physicians. Notable differences in intensive care units in the United States were the frequent use of an open structure and inclusion of respiratory therapists on the intensive care unit's health care team. Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives. Availability of critical care beds was highest in the United States and lowest in the United Kingdom. Conclusion: Context and processes of care that could influence ventilator weaning outcomes varied considerably across countries. Further quantification of these contextual influences should be considered when translating research findings into local clinical practice and when designing randomized controlled trials.

AB - Background: Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such pro cess, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing context and processes. Objective: To compare international data to assess differences in context and processes in intensive care units that could influence weaning. Methods: Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education, roles, and responsibilities for weaning in intensive care units of selected countries. Results: Australia, New Zealand, Denmark, Norway, Sweden, and the United Kingdom showed similarities in critical care provision, structure, skill mix, and staffing ratios in intensive care units. Weaning in these countries is generally a collaborative process between nurses and physicians. Notable differences in intensive care units in the United States were the frequent use of an open structure and inclusion of respiratory therapists on the intensive care unit's health care team. Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives. Availability of critical care beds was highest in the United States and lowest in the United Kingdom. Conclusion: Context and processes of care that could influence ventilator weaning outcomes varied considerably across countries. Further quantification of these contextual influences should be considered when translating research findings into local clinical practice and when designing randomized controlled trials.

KW - Developed Countries

KW - Hospital Bed Capacity

KW - Humans

KW - Intensive Care Units

KW - Internationality

KW - Medical Errors

KW - Nurse's Role

KW - Nursing Staff, Hospital

KW - Review Literature as Topic

KW - Ventilator Weaning

U2 - 10.4037/ajcc2011430

DO - 10.4037/ajcc2011430

M3 - Journal article

C2 - 21196563

SN - 1062-3264

VL - 20

SP - e10-18

JO - American Journal of Critical Care

JF - American Journal of Critical Care

IS - 1

ER -