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American Journal of Critical Care. 2007;16: 434-443
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CE Article

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

By Louise Rose, MN, Adult Ed Cert, BN, ICU Cert, Sioban Nelson, RN, PhD, Linda Johnston, RN, PhD and Jeffrey J. Presneill, MBBS, PhD. When this article was written, Louise Rose was the critical care course coordinator at RMIT University, Bundoora, Melbourne, Australia, and a PhD candidate at the University of Melbourne and the Intensive Care Unit, the Royal Melbourne Hospital, Parkville, Victoria, Australia. She is now an assistant professor in the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto,Toronto, Canada. Sioban Nelson is the dean of nursing at the University of Toronto, Toronto, Ontario, Canada. Linda Johnston is the chair of Neonatal Nursing Research, School of Nursing, University of Melbourne, Royal Children’s Hospital, and Murdoch Children’s Research Institute, Parkville, Victoria, Australia. Jeffrey J. Presneill is a senior physician in the intensive care unit at the Royal Melbourne Hospital.

Corresponding author: Louise Rose, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Room 276, Toronto, ON M5T 1P8, Canada (email: louise.rose{at}utoronto).

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.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the role of critical care nurses in the management of mechanical ventilation.
  2. Discuss critical care nurses’ decision-making role in weaning mechanically ventilated patients.
  3. Identify advantages found in this study of critical care nurses managing mechanically ventilated patients.

To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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