title: Mechanical Ventilation, Weaning Practices, and Decision Making in European PICUs.
abstract: OBJECTIVE
  This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making.
  
  
  METHODS
  Cross-sectional electronic survey.
  
  
  METHODS
  European PICUs.
  
  
  METHODS
  Senior ICU nurse and physician from participating PICUs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Response rate was 64% (65/102) representing 19 European countries. Determination of weaning failure was most commonly based on collaborative decision making (81% PICUs; 95% CI, 70-89%). Compared to this decision, selection of initial ventilator settings and weaning method was least likely to be collaborative (relative risk, 0.30; 95% CI, 0.20-0.47 and relative risk, 0.45; 95% CI, 0.32-0.45). Most PICUs (> 75%) enabled physicians in registrar (fellow) positions to have responsibility for key ventilation decisions. Availability of written guidelines/protocols for ventilation (31%), weaning (22%), and noninvasive ventilation (33%) was uncommon, whereas sedation protocols (66%) and sedation assessment tools (76%) were common. Availability of protocols was similar across European regions (all p > 0.05). High-flow nasal cannula (53%), noninvasive ventilation (52%) to avoid intubation, and spontaneous breathing trials (44%) were used in approximately half the PICUs greater than 50% of the time. A nurse-to-patient ratio of 1:2 was most frequent for invasively (50%) and noninvasively (70%) ventilated patients. Perceived nursing autonomy (median [interquartile range], 4 [2-6]) and influence (median [interquartile range], 7 [5-8]) for ventilation and weaning decisions varied across Europe (p = 0.007 and p = 0.01, respectively) and were highest in Northern European countries.
  
  
  CONCLUSIONS
  We found variability across European PICUs in interprofessional team involvement for ventilation decision making, nurse staffing, and perceived nursing autonomy and influence over decisions. Patterns of adoption of tools/adjuncts for weaning and sedation were similar.
authors.affiliation: 1University of Central Lancashire, College of Health and Wellbeing, Preston, United Kingdom. 2PICU, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom. 3Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands. 4Critical Care, Anaesthesiology, Peri-operative and Emergency medicine (CAPE), The University of Groningen, Groningen, The Netherlands. 5Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland. 6Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 7Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. 8Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 9Provincial Centre of Weaning Excellence, Toronto East General Hospital, Toronto, ON, Canada.
authors.forename: Lyvonne N
authors.initials: LN
authors.lastname: Tume
authors.forename: Martin C J
authors.initials: MC
authors.lastname: Kneyber
authors.forename: Bronagh
authors.initials: B
authors.lastname: Blackwood
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D008297:Male; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017009:Professional Autonomy; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D057566:Self Report; D015300:Ventilator Weaning / Q000379:methods / Q000706:statistics & numerical data