TY - JOUR
T1 - Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units
T2 - A national survey
AU - Cederwall, Carl Johan
AU - Rose, Louise
AU - Naredi, Silvana
AU - Olausson, Sepideh
AU - Ringdal, Mona
N1 - Funding Information:
This study was financed by grants from the Swedish state under the ALF agreement between the Swedish government and the county councils (ALFGBG-74160).
Publisher Copyright:
© 2022 The Author(s)
PY - 2023/2
Y1 - 2023/2
N2 - Objective: To identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days. Research Methodology: We conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics. Results: We received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units. Conclusion: We found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.
AB - Objective: To identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days. Research Methodology: We conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics. Results: We received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units. Conclusion: We found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.
KW - Clinical protocols
KW - Critical care
KW - Intensive Care Unit
KW - Mechanical ventilation
KW - Prolonged mechanical ventilation
KW - Ventilator weaning
UR - http://www.scopus.com/inward/record.url?scp=85136762631&partnerID=8YFLogxK
U2 - 10.1016/j.iccn.2022.103309
DO - 10.1016/j.iccn.2022.103309
M3 - Article
AN - SCOPUS:85136762631
SN - 0964-3397
VL - 74
JO - Intensive and Critical Care Nursing
JF - Intensive and Critical Care Nursing
M1 - 103309
ER -