Decisions made by critical care nurses during mechanical ventilation and weaning in an Australian intensive care unit

Rose, Louise, Nelson, Sioban, Johnston, Linda and Presneill, Jeffrey J. (2007) Decisions made by critical care nurses during mechanical ventilation and weaning in an Australian intensive care unit. American Journal of Critical Care, 16 5: 434-443.

Author Rose, Louise
Nelson, Sioban
Johnston, Linda
Presneill, Jeffrey J.
Title Decisions made by critical care nurses during mechanical ventilation and weaning in an Australian intensive care unit
Journal name American Journal of Critical Care   Check publisher's open access policy
ISSN 1062-3264
1937-710X
Publication date 2007-09
Sub-type Article (original research)
Volume 16
Issue 5
Start page 434
End page 443
Total pages 10
Place of publication Aliso Viejo, CA, United States
Publisher American Association of Critical Care Nurses
Language eng
Formatted abstract
Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration.
Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation.
Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined.
Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients.
Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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