title: Patient transitions relevant to individuals requiring ongoing ventilatory assistance: a Delphi study.
abstract: BACKGROUND
  Various terms, including 'prolonged mechanical ventilation' (PMV) and 'long-term mechanical ventilation' (LTMV), are used interchangeably to distinguish patient cohorts requiring ventilation, making comparisons and timing of clinical decision making problematic.
  
  
  OBJECTIVE
  To develop expert, consensus-based criteria associated with care transitions to distinguish cohorts of ventilated patients.
  
  
  METHODS
  A four-round (R), web-based Delphi study with consensus defined as >70% was performed. In R1, participants listed, using free text, criteria perceived to should and should not define seven transitions. Transitions comprised: T1 - acute ventilation to PMV; T2 - PMV to LTMV; T3 - PMV or LTMV to acute ventilation (reverse transition); T4 - institutional to community care; T5 - no ventilation to requiring LTMV; T6 - pediatric to adult LTMV; and T7 - active treatment to end-of-life care. Subsequent Rs sought consensus.
  
  
  RESULTS
  Experts from intensive care (n=14), long-term care (n=14) and home ventilation (n=10), representing a variety of professional groups and geographical areas, completed all Rs. Consensus was reached on 14 of 20 statements defining T1 and 21 of 25 for T2. 'Physiological stability' had the highest consensus (97% and 100%, respectively). 'Duration of ventilation' did not achieve consensus. Consensus was achieved on 13 of 18 statements for T3 and 23 of 25 statements for T4. T4 statements reaching 100% consensus included: 'informed choice', 'patient stability', 'informal caregiver support', 'caregiver knowledge', 'environment modification', 'supportive network' and 'access to interprofessional care'. Consensus was achieved for 15 of 17 T5, 16 of 20 T6 and 21 of 24 T7 items.
  
  
  CONCLUSIONS
  Criteria to consider during key care transitions for ventilator-assisted individuals were identified. Such information will assist in furthering the consistency of clinical care plans, research trials and health care resource allocation.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.forename: Roger
authors.initials: R
authors.lastname: Goldstein
authors.forename: Sherri
authors.initials: S
authors.lastname: Katz
authors.forename: David
authors.initials: D
authors.lastname: Leasa
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pedersen
authors.forename: Douglas
authors.initials: D
authors.lastname: McKim
mesh_terms: D003697:Delphi Technique; D006801:Humans; D010360:Patient Transfer; D012121:Respiration, Artificial; D009626:Terminology as Topic