Abstract
Objective
To analyze bedside clinicians' perspectives regarding the decision process to optimize
timing of intubation in sepsis-associated acute respiratory failure.
Participants and Methods
This mixed methods study was conducted from March 1, 2015, through June 30, 2016.
Using qualitative research methods, factors that influenced variability in the decision
to intubate were organized into categories and used to build a theoretical explanatory
model grounded in current practice variance. All coding schemes were independently
reviewed for accuracy and consistency. Themes and findings were then refined with
member checking by feedback from individuals and from an anonymous questionnaire until
saturation was achieved.
Results
The practice of intubation varied according to 3 domains: (1) patient factors included
the nature of the acute illness, comorbidities, clinical presentation, severity, trajectory,
and values and preferences; (2) clinician factors included background, training, experience,
and practice style; and (3) system factors included workload, policies and protocols,
hierarchy, communications, culture, and team dynamics. In different contexts, intubation
was considered early (elective), just in time (urgent), or late (rescue). The initial
assessment, initial decision, and reassessment mattered.
Conclusion
Recognizing that the variability in both the decision to intubate and its timing depends
on many factors, and not on clinical criteria alone, should render the clinician more
attentive to the eventual progression of the acute respiratory failure.
Abbreviations and Acronyms:
APACHE (Acute Physiology and Chronic Health Evaluation), ARDS (acute respiratory distress syndrome), ICU (intensive care unit), IQR (interquartile range), LOS (length of stay), NP/PA (nurse practitioner/physician assistant), PaO2/FiO2 (partial pressure of oxygen/fraction of inspired oxygen), PCO2 (partial pressure of carbon dioxide), SOFA (Sequential Organ Failure Assessment)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: September 01, 2017
Footnotes
Grant Support: Dr Bauer was the recipient of the 2015 Innovation Awards from the Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. This project was funded by a grant from the Critical Care Research Committee, Mayo Clinic, Rochester. This publication was supported by grant UL1 TR000135 from the National Center for Advancing Translational Sciences . Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
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