Issues in weaning from mechanical ventilation: literature review.
OBJECTIVE
The aim of this paper is to raise questions on the effect of skill mix and organizational structure on weaning from mechanical ventilation.


BACKGROUND
Mechanical ventilation is an essential life-saving technology. There are, however, numerous associated complications that influence the morbidity and mortality of patients receiving intensive care. Therefore, it was essential to use the safest and most effective form of ventilation for the shortest possible duration. Because of the potential complications and costs of mechanical ventilation, research to date have focused on accurate weaning readiness assessment, methods and organizational aspects that influence the weaning process.


METHODS
In early 2005, the literature was reviewed from 1986 to 2004 by accessing the following databases: Medline, Proquest, Science Direct, CINAHL, and Blackwell Science. The keywords mechanical ventilation, weaning, protocols, critical care, nursing role, decision-making and weaning readiness were used separately and combinations.


CONCLUSIONS
Controversy exists in weaning practices about appropriate and efficacious weaning readiness assessment indicators, the best method of weaning and the use of weaning protocols. Arguably, the implementation of weaning protocols may have little effect in an environment that favours collaboration between nursing and medical staff, autonomous nursing decision-making in relation to weaning practices, and high numbers of nurses qualified at postgraduate level.


CONCLUSIONS
Further research is required that better quantifies critical care nurses' role in weaning practices and the contextual issues that influence both the nursing role and the process of weaning from mechanical ventilation.
Division of Nursing, RMIT University, Melbourne, Victoria, Australia. louise.rose@rmit.edu.au
Louise
L
Rose
Sioban
S
Nelson
D044362:Australasia; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D003431:Cross-Cultural Comparison; D003657:Decision Making; D006801:Humans; D009656:North America; D024802:Nurse's Role; D010348:Patient Care Team; D012121:Respiration, Artificial / Q000009:adverse effects; D006113:United Kingdom; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*; D028761:Withholding Treatment