PDF(Pubmed)
Abstract：
BACKGROUND: Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV.
OBJECTIVE: What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU?
METHODS: This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole.
RESULTS: Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes.
CONCLUSIONS: Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.
OBJECTIVE: What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU?
METHODS: This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole.
RESULTS: Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes.
CONCLUSIONS: Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.
摘要：
背景：近四分之一的美国人在ICU死亡。他们的许多死亡是预计的，并且发生在机械通气（WMV）退出后。然而,很少有数据可以作为跨学科ICU团队进行WMV的最佳实践的基础。
目的：ICU临床医生对当前WMV实践的看法是什么，他们对可能改善ICU生命末期WMV实践的过程有何看法？
方法：这项在波士顿进行的前瞻性两中心观察性研究，马萨诸塞州,机械通气退出的观察性研究(OBSERVE-WMV)旨在更好地了解临床医生的观点和WMV患者的经验。本报告侧重于分析从对ICU临床医生(护士，呼吸治疗师,和医生)照顾这些病人。调查评估了广泛的临床医生对规划的看法，以及WMV所需的关键流程。本分析采用独立开放,开放式问题回答的归纳编码。对初始代码进行迭代协调，然后使用主题分析方法进行组织和解释。就如何改善个别患者和整个ICU的WMV进行了评估。
结果：在456名合格临床医生中，临床医生对152名接受WMV的患者进行了312次现场调查。定性分析确定了表征高质量WMV过程的两个主要主题：(1)良好的沟通(例如，ICU团队和家庭之间对家庭偏好的相互理解)；和(2)医疗管理(例如，规划,ICU团队的可用性)，最大限度地减少患者的痛苦。在这两个主题中，团队成员的支持被确定为必不可少的过程组成部分。
结论：临床医生对WMV的适当性或成功的看法优先考虑团队和家庭沟通的质量以及患者症状管理。两者都是旨在优化整体WMV的干预措施的可修改目标。
目的：ICU临床医生对当前WMV实践的看法是什么，他们对可能改善ICU生命末期WMV实践的过程有何看法？
方法：这项在波士顿进行的前瞻性两中心观察性研究，马萨诸塞州,机械通气退出的观察性研究(OBSERVE-WMV)旨在更好地了解临床医生的观点和WMV患者的经验。本报告侧重于分析从对ICU临床医生(护士，呼吸治疗师,和医生)照顾这些病人。调查评估了广泛的临床医生对规划的看法，以及WMV所需的关键流程。本分析采用独立开放,开放式问题回答的归纳编码。对初始代码进行迭代协调，然后使用主题分析方法进行组织和解释。就如何改善个别患者和整个ICU的WMV进行了评估。
结果：在456名合格临床医生中，临床医生对152名接受WMV的患者进行了312次现场调查。定性分析确定了表征高质量WMV过程的两个主要主题：(1)良好的沟通(例如，ICU团队和家庭之间对家庭偏好的相互理解)；和(2)医疗管理(例如，规划,ICU团队的可用性)，最大限度地减少患者的痛苦。在这两个主题中，团队成员的支持被确定为必不可少的过程组成部分。
结论：临床医生对WMV的适当性或成功的看法优先考虑团队和家庭沟通的质量以及患者症状管理。两者都是旨在优化整体WMV的干预措施的可修改目标。
