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Respiratory Care |

Definitional Criteria for Patient Transitions Relevant to Prolonged and Long-term Mechanical Ventilation: A Delphi Study

Louise Rose, PhD; Rob Fowler, MD; Sherri Katz, MD; David Leasa, MD; Mairi Omand, MS; Cheryl Pedersen, MS; Douglas McKim, MD
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Univeristy of Toronto, Toronto, ON, Canada


Chest. 2013;144(4_MeetingAbstracts):893A. doi:10.1378/chest.1700453
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Abstract

SESSION TITLE: Ventilatory Strategies in Severe Hypoxemia

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM

PURPOSE: To develop consensus based definitional criteria of key transition points across the care continuum for patients requiring, or at risk of, prolonged and long-term mechanical ventilation (PMV/LTMV).

METHODS: Four round (R) Delphi study using purposeful sampling of experts across professional groups, Canadian provinces, adult/paediatric specialists, in acute care, LTMV and home ventilation. R1 comprised an email questionnaire seeking all criteria perceived should and should not define seven transition points identified during a prior one-day workshop. R2 listed a summary of responses following content analysis and requested agreement rating on a 5-point scale. Subsequent rounds confirmed responses. Consensus was set at ≥70% participant agreement.

RESULTS: 38/73 invited experts completed all rounds; 14 from acute care, 14 institutional LTMV, 10 home ventilation; 5 specialized in paediatrics. R1 generated 291 statements of what should define transitions; 221 what should not. Statements were collapsed into 150 definitional criteria. Consensus was reached on 14/20 (70%) criteria defining transition from ventilation during acute illness to PMV and 21/25 (84%) criteria on transition from PMV to LTMV with physiological stability having the highest consensus for both (97.4% and 100%). Duration of ventilation did not achieve consensus for either transition. Reverse transition i.e. PMV/LTMV to acute critical care achieved consensus on 13/18 (72%) items with highest consensus for loss of physiological stability. Consensus was reached on 24/26 (92%) criteria for transition from institutional to community care. Nine (35%) criteria reached 100% consensus: informed choice; patient stability; informal caregiver support; caregiver knowledge/skill; environment modification; supportive network; adequately funded equipment; ongoing access to interprofessional care; and timeliness in securing resources. Consensus was achieved for 15/17 (88%) criteria for transition from no ventilation to requiring LTMV, 16/20 (80%) transition from paediatric to adult LTMV, and 21/24 (88%) active treatment to end of life care for PMV/LTMV patients.

CONCLUSIONS: Using Delphi-derived expert consensus we identified a minimum set of criteria that should be in place during key care transitions for PMV/LTMV.

CLINICAL IMPLICATIONS: Consensus definitions of key transition points may inform more seamless integrated care for this patient population.

DISCLOSURE: The following authors have nothing to disclose: Louise Rose, Rob Fowler, Sherri Katz, David Leasa, Mairi Omand, Cheryl Pedersen, Douglas McKim

No Product/Research Disclosure Information


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