Best Practice in Prolonged Mechanical Ventilation: A Qualitative Study of Healthcare Provider Perspectives

Abstract

Background & Purpose: Patients who require Prolonged Mechanical Ventilation (PMV) are a relatively small but complex and vulnerable subset of patients treated in the intensive care unit (ICU). Significant heterogeneity in practice patterns exists and best practice is largely unknown. The goal of this study is to engage healthcare providers (HCPs) to identify and describe best care practices for patients requiring PMV. Methods: A qualitative descriptive method was used. Using purposeful sampling, we recruited medical doctors (MD), nurse practitioners (NP), registered nurses (RN) and respiratory therapists (RT) from hospitals across Alberta to participate in virtual, semi-structured interviews. Interviews were recorded, transcribed verbatim and analyzed concurrently using the principles of thematic analysis. Results: We identified 5 best practice themes: 1) patient and family engagement 2) team dynamics: collaboration and autonomy 3) developing a structured plan and process 4) ICU physical environment 5) discharge and disposition. Overall, these themes represent a collaborative approach to PMV that includes structured planning and comprehensive care. Conclusion: Patients requiring PMV are a complex clinical population with unique needs. The themes identified can be adopted in existing ICU environments and can guide the expansion of high-quality PMV programs. Key Words: Prolonged Mechanical Ventilation; Healthcare Providers; Qualitative Description Critical Care Medicine; Patient-Centered Care; Intensive Care Unit.