Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia.
School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia.
Aust Crit Care. 2023 Jul;36(4):509-514. doi: 10.1016/j.aucc.2022.06.004. Epub 2022 Aug 27.
We aimed to (i) describe current weaning and extubation practices in children (protocols to identify weaning candidates, spontaneous breathing trials, and other aspects of care such as sedation weaning) and (ii) understand responsibilities for ventilation weaning decisions across Australia and New Zealand (ANZ).
A cross-sectional survey of ANZ intensive care units who routinely intubate and ventilate children (<18 years) was conducted. We worked with the Australian and New Zealand Intensive Care Society Paediatric Study Group to identify units and potential respondents (senior nurse representative per unit) and to administer questionnaires. Survey questions (n = 35) examined current protocols, practices, unit staffing, and decision-making responsibilities for ventilation weaning and extubation. Open-ended questions examined respondents' experiences of weaning and extubation.
A senior nursing respondent from 18/22 intensive care units (82%) completed the survey. Across units, most used sedation assessment tools (88%), and less often, sedation weaning tools (55%). Spontaneous awakening protocols were not used; one unit (5%) reported the use of a spontaneous breathing protocol. Two respondents reported that ventilation weaning protocols (11%) were in use, with 44% of units reporting the use of extubation protocols. Weaning and extubation practices were largely perceived as medically driven, with qualitative data demonstrating a desire from most respondents for greater shared decision-making.
In ANZ, ventilation weaning and extubation practices are largely medically driven with variation in the use of protocols to support mechanical ventilation weaning and extubation in children. Our findings highlight the importance of future research to determine the impact of greater collaboration of the multidisciplinary team on weaning practices.
（i）描述儿童目前的撤机和拔管实践（确定撤机候选者的方案、自主呼吸试验以及镇静撤机等其他方面的护理），以及（ii）了解澳大利亚和新西兰（ANZ）的通气撤机决策责任。
对常规进行小儿气管插管和通气的 ANZ 重症监护病房进行了横断面调查。我们与澳大利亚和新西兰重症监护学会儿科研究小组合作，确定了单位和潜在的受访者（每个单位的高级护士代表），并进行了问卷调查。调查问题（n=35）调查了通气撤机和拔管的现行方案、实践、单位人员配备和决策责任。开放式问题考察了受访者在撤机和拔管方面的经验。
22 个重症监护病房中的 18 个（82%）的高级护理人员代表完成了调查。在各单位中，大多数使用镇静评估工具（88%），而较少使用镇静撤机工具（55%）。未使用自主唤醒方案；一个单位（5%）报告使用自主呼吸方案。有 2 名受访者报告使用通气撤机方案（11%），44%的单位报告使用拔管方案。撤机和拔管实践主要由医疗驱动，定性数据表明大多数受访者希望更多地共同决策。
在 ANZ，通气撤机和拔管实践主要由医疗驱动，在支持儿童机械通气撤机和拔管的方案使用方面存在差异。我们的研究结果强调了未来研究的重要性，以确定多学科团队的更大协作对撤机实践的影响。
