Efstathiou Nikolaos, Diridis Fotini Kristina Michaela, Orr Michelle, Baernholdt Marianne, Vanderspank-Wright Brandi
Department of Nursing and Midwifery, University of Birmingham, Birmingham, UK
Intensive Care Medicine and Anaesthesia, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
BMJ Open. 2025 Aug 8;15(8):e096527. doi: 10.1136/bmjopen-2024-096527.
To explore intensive care unit (ICU) clinicians' experiences of withdrawing mechanical ventilation during end-of-life care.
An exploratory qualitative design was used, with data collected via semistructured, face-to-face online interviews and analysed using reflexive thematic analysis.
We recruited ICU clinicians from two hospitals within the West Midlands region of the UK.
Semistructured, face-to-face online interviews were used to explore experiences with limitation of life-sustaining treatments in ICU, decision-making and practices for withdrawing mechanical ventilation.
22 ICU clinicians were interviewed (Physiotherapist=1, Advanced Critical Care Practitioners=4, Physicians=9 and Nurses=8), of which 13 were women (59%). Four themes were developed. (1) Multilayered communication: effective communication was key in planning withdrawal and informing family members, with conflicts arising from cultural differences. (2) Considerations regarding the mode of withdrawing invasive mechanical ventilation: clinicians expressed differing preferences for the method of mechanical ventilation withdrawal. (3) Multiprofessional teamwork: collaborative teamwork was vital, with palliative care practitioners consulted during conflicts or challenging symptoms. (4) Clinicians' feelings and impact: clinicians empathised with families and experienced psychological burden.
Physician preferences influence the withdrawal process, which is communicated within the multidisciplinary team. Clear protocols can help reduce ambiguity and support less experienced clinicians. Reflection on these practices may help mitigate burnout and compassion fatigue. Further research should examine the effects of physician demographics and patient cultural diversity on the withdrawal process.
探讨重症监护病房（ICU）临床医生在临终关怀期间撤除机械通气的经验。
采用探索性定性设计，通过半结构化面对面在线访谈收集数据，并使用反思性主题分析法进行分析。
我们从英国西米德兰兹地区的两家医院招募了ICU临床医生。
采用半结构化面对面在线访谈，以探讨ICU中维持生命治疗的限制、撤除机械通气的决策和实践经验。
共访谈了22名ICU临床医生（物理治疗师1名、高级重症护理从业者4名、医生9名、护士8名），其中13名女性（59%）。形成了四个主题。（1）多层沟通：有效的沟通是计划撤除和告知家属的关键，文化差异会引发冲突。（2）关于撤除有创机械通气方式的考量：临床医生对机械通气撤除方法表达了不同的偏好。（3）多专业团队合作：协作性团队合作至关重要，在出现冲突或症状棘手时会咨询姑息治疗从业者。（4）临床医生的感受及影响：临床医生同情家属并承受心理负担。
医生的偏好会影响撤除过程，这在多学科团队中进行沟通。明确的方案有助于减少不确定性并支持经验不足的临床医生。对这些实践进行反思可能有助于减轻职业倦怠和同情疲劳。进一步的研究应考察医生人口统计学特征和患者文化多样性对撤除过程的影响。
