More active efforts to reduce the ventilation time of patients in an intensive care unit can both save their suffering and free up resources for intensive care, as a dissertation from the University of Gothenburg shows.
Mechanical ventilation (MV) in an intensive care unit (ICU) is often required to save a patient’s life. However, prolonged stay in the intensive care unit also increases the risk of serious complications and higher mortality.
Removing the patient from the ventilator so that the patient can breathe spontaneously is usually straightforward. However, weaning from MV for more than a week can get complicated. The process requires individual strategies, which in turn require Critical Care Nurses (CCN) and advanced skills on the care team.
The dissertation examines the care of adult patients who require seven or more days of MV and, accordingly, a longer time to wean off the ventilator. Author Carl-Johan Cederwall, PhD in Health and Nursing Sciences at Sahlgrenska Academy, is also a CCN at Sahlgrenska University Hospital.
“Patients who are ventilated for a longer period of time are often men, but also older patients with high comorbidities. An aging population therefore poses a health care challenge and will require resources in the intensive care unit in the future, ”he says.
The dissertation is based on data from the Swedish intensive care register and questionnaires sent to almost all Swedish intensive care units. In-depth interviews were also conducted with 19 intensive CCNs.
The results showed that intensive care with MV occurred for seven days or more in 5% of all adult ICU admissions, but accounted for 32% of the number of ICU beds.
Another aim of the dissertation was to identify the patient group, care routines and the presence of person-centered care during extended weaning. As a rule, this care was planned individually and care decisions were made by the care team in cooperation.
“The CCN played a key role in creating a work team and in prioritizing, initiating and continuing the weaning process,” says Cederwall.
In most of the intensive care units examined, the routines were based on person-centered care and there was no patient involvement. Nevertheless, person-centered care was available during the weaning process. A lack of teamwork and resources were identified as obstacles.
A shortening of the MV time in combination with more effective care would have a significant impact on the resources of the acute intensive care unit. At the same time, ventilator prolonged weaning, which requires working teamwork, would likely be facilitated by separating it from acute critical care in an environment with resources for prolonged weaning, says Cederwall.
The pursuit of more person-centered care during prolonged mechanical ventilation could enable further individualization and patient involvement to reduce ICU stay and the risk of more serious complications, ”he concludes.
Title: Extended Mechanical Ventilation in Swedish Intensive Care Units: Patient Characteristics, Prevalence, Weaning, and Nursing Challenges, http: // hdl.