title: Prolonged mechanical ventilation in Canadian intensive care units: a national survey.
abstract: BACKGROUND
  We sought to describe prevalence and care practices for patients experiencing prolonged mechanical ventilation (PMV), defined as ventilation for 21 or more consecutive days and medical stability.
  
  
  METHODS
  We provided the survey to eligible units via secure Web link to a nominated unit champion from April to November 2012. Weekly telephone and e-mail reminders were sent for 6 weeks.
  
  
  RESULTS
  Response rate was 215 (90%) of 238 units identifying 308 patients requiring PMV on the survey day occupying 11% of all Canadian ventilator-capable beds. Most units (81%) used individualized plans for both weaning and mobilization. Weaning and mobilization protocols were available in 48% and 38% of units, respectively. Of those units with protocols, only 25% reported weaning guidance specific to PMV, and 11% reported mobilization content for PMV. Only 30% of units used specialized mobility equipment. Most units referred to speech language pathologists (88%); use of communication technology was infrequent (11%). Only 29% routinely referred to psychiatry/psychology, and 17% had formal discharge follow-up services.
  
  
  CONCLUSIONS
  Prolonged mechanical ventilation patients occupied 11% of Canadian acute care ventilator bed capacity. Most units preferred an individualized approach to weaning and mobilization with considerable variation in weaning methods, protocol availability, access to specialized rehabilitation equipment, communication technology, psychiatry, and discharge follow-up.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada M5T 1P8; Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Toronto, Ontario, Canada M4C 3E7; Mt. Sinai Hospital, Toronto, Ontario, Canada M5G 1X5; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada M5B 1W8; Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5; Sunnybrook Research Institute, Toronto, Ontario, Canada M4N 3M5. Electronic address: louise.rose@utoronto.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5; Sunnybrook Research Institute, Toronto, Ontario, Canada M4N 3M5; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, M5G 2C4. Electronic address: rob.fowler@sunnybrook.ca.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.affiliation: Toronto General Hospital and University Health Network, Toronto, Ontario, Canada M5G 2C4; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, M5G 2C4. Electronic address: Eddy.Fan@uhn.ca.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.affiliation: Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Toronto, Ontario, Canada M4C 3E7. Electronic address: ifras@tegh.on.ca.
authors.forename: Ian
authors.initials: I
authors.lastname: Fraser
authors.affiliation: Department of Critical Care, London Health Sciences Centre, London, Ontario, Canada N6G 2V4; University of Western Ontario. Electronic address: David.Leasa@LHSC.ON.CA.
authors.forename: David
authors.initials: D
authors.lastname: Leasa
authors.affiliation: Department of Critical Care, London Health Sciences Centre, London, Ontario, Canada N6G 2V4. Electronic address: Cathy.Mawdsley@LHSC.ON.CA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Mawdsley
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada M5B 1W8. Electronic address: PedersenC@smh.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pedersen
authors.affiliation: Sunnybrook Research Institute, Toronto, Ontario, Canada M4N 3M5; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, M5G 2C4; Trauma, Emergency, and Critical Care Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5. Electronic address: gordon.rubenfeld@sunnybrook.ca.
authors.forename: Gordon
authors.initials: G
authors.lastname: Rubenfeld
mesh_terms: D055371:Acute Lung Injury / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy / Q000706:statistics & numerical data; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003422:Critical Care; D003430:Cross-Sectional Studies; D003679:Deglutition; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000592:standards / Q000706:statistics & numerical data*; D012138:Respiratory Therapy; D018805:Sepsis / Q000628:therapy; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Intensive care; Mechanical ventilation; Mobilization; Prolonged mechanical ventilation; Rehabilitation; Weaning