Liberation from invasive mechanical ventilation: a nationwide survey among intensive care units in the Netherlands.

IF 3.4 3区 医学 Q1 RESPIRATORY SYSTEM
Carline N L Groenland, Matthijs L Janssen, Kim S van den Bosch, Vivan J M Baggen, Leo Heunks, Henrik Endeman, Evert-Jan Wils
{"title":"Liberation from invasive mechanical ventilation: a nationwide survey among intensive care units in the Netherlands.","authors":"Carline N L Groenland, Matthijs L Janssen, Kim S van den Bosch, Vivan J M Baggen, Leo Heunks, Henrik Endeman, Evert-Jan Wils","doi":"10.1136/bmjresp-2024-002868","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Liberation from invasive mechanical ventilation is a milestone in critical care, but approaches vary. This survey aimed to describe current ventilator liberation practices, relate them to available evidence, and identify areas for improvement.</p><p><strong>Methods: </strong>A survey was performed among Dutch intensive care unit (ICU) sites. The survey evaluated practice in seven domains of ventilator liberation: protocol availability, transition from controlled to assisted ventilation, spontaneous breathing trials (SBT), cuff-leak test, postextubation support, weaning failure and tracheostomised weaning.</p><p><strong>Results: </strong>The survey response rate was 93% (132/142), representing 97% (69/71) of Dutch ICUs. Protocols for postextubation support and weaning failure were available in less than half of the ICUs (44% and 49%, respectively). The transition from controlled to assisted ventilation is regularly evaluated daily in 78% of ICUs. Assisted ventilation tolerance is mainly assessed by clinical signs, respiratory parameters and non-invasive manoeuvres that assess respiratory drive (P<sub>0.1</sub>). SBTs are regularly performed in 58% of ICUs, using one or more of the following methods: T-piece (52%), pressure support+positive end expiratory pressure (32%) and continuous positive airway pressure (28%). Cuff-leak tests are seldom performed (1.4%), predominantly in cases of intubation for upper-airway obstruction (92%). Postextubation respiratory support with high-flow nasal oxygen or non-invasive ventilation is used at least as often with therapeutic (43%/13%) rather than preventive (35%/4%) of facilitative intent (29%/3%). Delirium screening (87%) and reconsidering sedation (84%) are frequently assessed in case of weaning failure. Regular use of closed-loop ventilation is reported in a minority of ICUs throughout the process of ventilator liberation (3-9%).</p><p><strong>Conclusions: </strong>Various aspects of ventilator liberation practices show only limited alignment with existing guidelines. The results of this survey pinpoint areas to prioritise in guideline and practice improvement.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281335/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Respiratory Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjresp-2024-002868","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Liberation from invasive mechanical ventilation is a milestone in critical care, but approaches vary. This survey aimed to describe current ventilator liberation practices, relate them to available evidence, and identify areas for improvement.

Methods: A survey was performed among Dutch intensive care unit (ICU) sites. The survey evaluated practice in seven domains of ventilator liberation: protocol availability, transition from controlled to assisted ventilation, spontaneous breathing trials (SBT), cuff-leak test, postextubation support, weaning failure and tracheostomised weaning.

Results: The survey response rate was 93% (132/142), representing 97% (69/71) of Dutch ICUs. Protocols for postextubation support and weaning failure were available in less than half of the ICUs (44% and 49%, respectively). The transition from controlled to assisted ventilation is regularly evaluated daily in 78% of ICUs. Assisted ventilation tolerance is mainly assessed by clinical signs, respiratory parameters and non-invasive manoeuvres that assess respiratory drive (P0.1). SBTs are regularly performed in 58% of ICUs, using one or more of the following methods: T-piece (52%), pressure support+positive end expiratory pressure (32%) and continuous positive airway pressure (28%). Cuff-leak tests are seldom performed (1.4%), predominantly in cases of intubation for upper-airway obstruction (92%). Postextubation respiratory support with high-flow nasal oxygen or non-invasive ventilation is used at least as often with therapeutic (43%/13%) rather than preventive (35%/4%) of facilitative intent (29%/3%). Delirium screening (87%) and reconsidering sedation (84%) are frequently assessed in case of weaning failure. Regular use of closed-loop ventilation is reported in a minority of ICUs throughout the process of ventilator liberation (3-9%).

Conclusions: Various aspects of ventilator liberation practices show only limited alignment with existing guidelines. The results of this survey pinpoint areas to prioritise in guideline and practice improvement.

Abstract Image

Abstract Image

Abstract Image

从有创机械通气中解放:荷兰重症监护病房的一项全国性调查。
背景:从有创机械通气中解放出来是重症监护的一个里程碑,但方法各不相同。本调查旨在描述当前通风机解放实践,将其与现有证据联系起来,并确定需要改进的领域。方法:对荷兰重症监护病房(ICU)进行调查。该调查评估了呼吸机解放的七个领域的实践:方案可用性、从受控通气到辅助通气的过渡、自主呼吸试验(SBT)、袖漏试验、拔管后支持、脱机失败和气管造口脱机。结果:调查应答率为93%(132/142),占荷兰icu的97%(69/71)。不到一半的icu(分别为44%和49%)提供拔管后支持和脱机失败的方案。78%的icu每天定期评估从受控通气到辅助通气的过渡。辅助通气耐受性主要通过临床体征、呼吸参数和评估呼吸驱动的无创操作来评估(P0.1)。58%的icu定期进行sbt,使用以下一种或多种方法:t片(52%)、压力支持+呼气末正压(32%)和持续气道正压(28%)。很少进行袖漏试验(1.4%),主要是在因上气道阻塞而插管的情况下(92%)。拔管后使用高流量鼻氧或无创通气的呼吸支持至少与促进目的(29%/3%)的治疗性(43%/13%)而非预防性(35%/4%)相同。在脱机失败的情况下,经常评估谵妄筛查(87%)和重新考虑镇静(84%)。据报道,少数icu在整个呼吸机解放过程中经常使用闭环通气(3-9%)。结论:呼吸机解放实践的各个方面显示与现有指南的一致性有限。这项调查的结果指出了在指导方针和实践改进方面需要优先考虑的领域。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信