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Canadian Respiratory Journal
Volume 21, Issue 5, Pages 287-292
http://dx.doi.org/10.1155/2014/484835
Original Article

Patient Transitions Relevant to Individuals Requiring Ongoing Ventilatory Assistance: A Delphi Study

Louise Rose,1,2,3 Robert A Fowler,1,4 Roger Goldstein,1,5 Sherri Katz,6,7,8 David Leasa,9,10 Cheryl Pedersen,11 Douglas McKim,8,12,13 and the CANuVENT Group

1University of Toronto, Canada
2Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Canada
3Mount Sinai Hospital and the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Canada
4Sunnybrook Health Sciences Centre, Canada
5West Park Healthcare Centre, Toronto, Canada
6Children’s Hospital of Eastern Ontario (CHEO), Canada
7CHEO Research Institute, Canada
8University of Ottawa, Ottawa, Canada
9London Health Sciences Centre, Canada
10University of Western Ontario, London, Canada
11Centre for Research on Inner City Health, Toronto, Canada
12The Ottawa Hospital Respiratory Rehabilitation, Ottawa, Ontario, Canada
13The Ottawa Hospital Sleep Centre, Ottawa, Ontario, Canada

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Various terms, including ‘prolonged mechanical ventilation’ (PMV) and ‘long-term mechanical ventilation’ (LTMV), are used interchangeably to distinguish patient cohorts requiring ventilation, making comparisons and timing of clinical decision making problematic.

OBJECTIVE: To develop expert, consensus-based criteria associated with care transitions to distinguish cohorts of ventilated patients.

METHODS: A four-round (R), web-based Delphi study with consensus defined as >70% was performed. In R1, participants listed, using free text, criteria perceived to should and should not define seven transitions. Transitions comprised: T1 – acute ventilation to PMV; T2 – PMV to LTMV; T3 – PMV or LTMV to acute ventilation (reverse transition); T4 – institutional to community care; T5 – no ventilation to requiring LTMV; T6 – pediatric to adult LTMV; and T7 – active treatment to end-of-life care. Subsequent Rs sought consensus.

RESULTS: Experts from intensive care (n=14), long-term care (n=14) and home ventilation (n=10), representing a variety of professional groups and geographical areas, completed all Rs. Consensus was reached on 14 of 20 statements defining T1 and 21 of 25 for T2. ‘Physiological stability’ had the highest consensus (97% and 100%, respectively). ‘Duration of ventilation’ did not achieve consensus. Consensus was achieved on 13 of 18 statements for T3 and 23 of 25 statements for T4. T4 statements reaching 100% consensus included: ‘informed choice’, ‘patient stability’, ‘informal caregiver support’, ‘caregiver knowledge’, ‘environment modification’, ‘supportive network’ and ‘access to interprofessional care’. Consensus was achieved for 15 of 17 T5, 16 of 20 T6 and 21 of 24 T7 items.

CONCLUSION: Criteria to consider during key care transitions for ventilator-assisted individuals were identified. Such information will assist in furthering the consistency of clinical care plans, research trials and health care resource allocation.