A Single Site Survey of Mechanical Ventilation Weaning Practice
Published on: 2018-03-02
Introduction: Mechanical ventilation (MV) is a routine part of ICU patient management. Ventilatory support is quickly withdrawn when no longer required, however in approximately one third of patients this process is complex and prolonged. Weaning difficult patients from MV is controversial, with a number of valid approaches and little high-quality evidence. The reason for the lack of conformity in approach may be due to uncertainty regarding the best method, variable individual experience and different understanding of the application of support. Aim: The aim of this study was to describe MV weaning practice and define differences between professionals where they existed at a single site. Method: A 30 question survey was disseminated to medical, nursing and physiotherapy staff at the intensive care unit of Sir Charles Gairdner Hospital. Questions related to clinical experience, perception of current practise, and clinical rationale underlying decisions to commence and progress weaning in four patient scenarios. Results: A 48% response rate demonstrated consistency in broad weaning principles, but variation in detail. Readiness to commence weaning was indicated by the resolution of primary disease and restoration of consciousness; complex cardiac patients were most difficult to manage. The most common pattern of weaning was a gradual stepwise reduction in support on a spontaneously breathing ventilator mode such as pressure support and this occurred preferentially during daytime, with rest overnight. Most practitioners agreed that practice was variable and could be improved. Conclusion: This study described MV weaning practices at one site and may provide the basis for the development of specific MV weaning guidelines to enhance future uniformity.
Mechanical Ventilation; Ventilator Weaning; Intensive Care