School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
Am J Crit Care. 2013 May;22(3):189-97. doi: 10.4037/ajcc2013784.
Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation.
To determine the professional group and seniority of clinicians responsible for key decisions regarding ventilation and weaning; use of ventilation protocols and automated closed loop systems; and provision of education on mechanical ventilation.
Mailed survey to nurse managers of pediatric intensive care units in the United Kingdom.
Response rate was 61%. In most units, nurse managers reported that physicians and nurses usually collaborated in making decisions about initializing (63%) and adjusting (94%) ventilator settings and for determining weaning readiness (88%), weaning method (59%), extubation readiness (82%), and weaning failure (100%). Protocols for mechanical ventilation were available in 35% of units, some specific to weaning (18%) and others for noninvasive ventilation (35%). Automated closed loop systems were used in 18% of units. Competency training was required before nurses could adjust ventilator settings in 35% of responding units; in the remaining units, settings were adjusted by nurses who had no specific competency training.
Key decisions were mainly collaborative, but nurses were limited in their ability to adjust ventilator settings independently. This limitation may be due to a lack of standardized competency programs and the infrequent use of non-physician-led weaning protocols and automated systems. These findings indicate some ways of improving processes to avoid delays in ventilator weaning.
组织流程会影响成人和儿科重症监护病房（intensive care unit，ICU）中机械通气的持续时间，但令人惊讶的是，我们对机械通气和脱机的角色责任以及可能影响及时脱离机械通气的相关背景因素知之甚少。
确定负责通气和脱机关键决策的临床医生专业组别和资历；使用通气方案和自动化闭环系统；以及提供机械通气教育。
对英国儿科 ICU 的护士长进行邮寄调查。
回复率为 61%。在大多数单位，护士长报告说，医生和护士通常在决定初始设置（63%）和调整（94%）呼吸机设置以及确定脱机准备情况（88%）、脱机方法（59%）、拔管准备情况（82%）和脱机失败（100%）方面进行合作。35%的单位有机械通气方案，有些是专门针对脱机（18%），有些是针对无创通气（35%）。18%的单位使用自动化闭环系统。在 35%的应答单位中，护士在调整呼吸机设置前需要进行能力培训；在其余单位中，由没有特定能力培训的护士来调整设置。
主要决策是协作性的，但护士独立调整呼吸机设置的能力有限。这种局限性可能是由于缺乏标准化的能力培训计划以及非医师主导的脱机方案和自动化系统使用不频繁。这些发现表明了一些改进流程的方法，可以避免呼吸机脱机延迟。
