Abstract
Objectives
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).
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 27, 2022
Accepted:
June 26,
2022
Received in revised form:
June 22,
2022
Received:
February 28,
2022
Publication stage
In Press Corrected ProofFootnotes
☆This study was conducted at Queensland Children's Hospital and the Centre for Children's Health Research.
Identification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
