Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study
Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive car...
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Veröffentlicht in: | Australian critical care 2024-11, Vol.37 (6), p.851-858 |
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creator | Major, Mel E. Sommers, Juultje Horrevorts, Esther Buist, Carmen M. Dettling-Ihnenfeldt, Daniela S. van der Schaaf, Marike |
description | Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs).
The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients.
This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed.
Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: “professional barriers”, “external factors”, and “patient barriers”.
Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice. |
doi_str_mv | 10.1016/j.aucc.2024.01.005 |
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The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients.
This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed.
Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: “professional barriers”, “external factors”, and “patient barriers”.
Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.</description><identifier>ISSN: 1036-7314</identifier><identifier>DOI: 10.1016/j.aucc.2024.01.005</identifier><identifier>PMID: 38320925</identifier><language>eng</language><publisher>Australia: Elsevier Ltd</publisher><subject>Critical care ; Implementation ; Professional practice ; Respiratory muscle training ; Ventilator weaning</subject><ispartof>Australian critical care, 2024-11, Vol.37 (6), p.851-858</ispartof><rights>2024 Australian College of Critical Care Nurses Ltd</rights><rights>Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c351t-de7233a0da3804765f4f6d3d2d671da77a48ed4afcdfdbafb1eb5a530406b46b3</cites><orcidid>0000-0001-5548-125X ; 0000-0001-9176-664X ; 0000-0001-7272-4698</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1036731424000213$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38320925$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Major, Mel E.</creatorcontrib><creatorcontrib>Sommers, Juultje</creatorcontrib><creatorcontrib>Horrevorts, Esther</creatorcontrib><creatorcontrib>Buist, Carmen M.</creatorcontrib><creatorcontrib>Dettling-Ihnenfeldt, Daniela S.</creatorcontrib><creatorcontrib>van der Schaaf, Marike</creatorcontrib><title>Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study</title><title>Australian critical care</title><addtitle>Aust Crit Care</addtitle><description>Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs).
The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients.
This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed.
Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: “professional barriers”, “external factors”, and “patient barriers”.
Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.</description><subject>Critical care</subject><subject>Implementation</subject><subject>Professional practice</subject><subject>Respiratory muscle training</subject><subject>Ventilator weaning</subject><issn>1036-7314</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc9u1DAQh30A0VJ4AQ7IRy4b_C_OLuJSVQUqVeoFztbEnrBexc7WdlbkvXhAnG7hyGk00jffaOZHyDvOGs64_nhoYLa2EUyohvGGsfYFueRM6k0nubogr3M-MCZ2SqtX5EJupWA70V6S33cxH32CMqWFhjnbEWlJ4KOPP-kwJRrQ7iF6C-O40BPG4kco6OgRiq9dpj7SssdaCsbsT0gtJKRz9OUTfehzgarMFKKjA1g_-rLuyk9uH44jhmqprik29JoG_6u6A5b95OjjDBVfVixNpyeQ5jK75Q15OcCY8e1zvSI_vtx-v_m2uX_4endzfb-xsuVl47ATUgJzILdMdbod1KCddMLpjjvoOlBbdAoG6wbXw9Bz7FtoJVNM90r38op8OHvr_scZczHBZ4vjCBGnORuxq36htVAVFWfUpinnhIM5Jh8gLYYzsyZkDmZNyKwJGcZNTagOvX_2z31A92_kbzwV-HwGsF558phMtvXrFp1PaItxk_-f_w_Sl6qg</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Major, Mel E.</creator><creator>Sommers, Juultje</creator><creator>Horrevorts, Esther</creator><creator>Buist, Carmen M.</creator><creator>Dettling-Ihnenfeldt, Daniela S.</creator><creator>van der Schaaf, Marike</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5548-125X</orcidid><orcidid>https://orcid.org/0000-0001-9176-664X</orcidid><orcidid>https://orcid.org/0000-0001-7272-4698</orcidid></search><sort><creationdate>20241101</creationdate><title>Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study</title><author>Major, Mel E. ; Sommers, Juultje ; Horrevorts, Esther ; Buist, Carmen M. ; Dettling-Ihnenfeldt, Daniela S. ; van der Schaaf, Marike</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-de7233a0da3804765f4f6d3d2d671da77a48ed4afcdfdbafb1eb5a530406b46b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Critical care</topic><topic>Implementation</topic><topic>Professional practice</topic><topic>Respiratory muscle training</topic><topic>Ventilator weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Major, Mel E.</creatorcontrib><creatorcontrib>Sommers, Juultje</creatorcontrib><creatorcontrib>Horrevorts, Esther</creatorcontrib><creatorcontrib>Buist, Carmen M.</creatorcontrib><creatorcontrib>Dettling-Ihnenfeldt, Daniela S.</creatorcontrib><creatorcontrib>van der Schaaf, Marike</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Australian critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Major, Mel E.</au><au>Sommers, Juultje</au><au>Horrevorts, Esther</au><au>Buist, Carmen M.</au><au>Dettling-Ihnenfeldt, Daniela S.</au><au>van der Schaaf, Marike</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study</atitle><jtitle>Australian critical care</jtitle><addtitle>Aust Crit Care</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>37</volume><issue>6</issue><spage>851</spage><epage>858</epage><pages>851-858</pages><issn>1036-7314</issn><abstract>Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs).
The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients.
This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed.
Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: “professional barriers”, “external factors”, and “patient barriers”.
Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.</abstract><cop>Australia</cop><pub>Elsevier Ltd</pub><pmid>38320925</pmid><doi>10.1016/j.aucc.2024.01.005</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-5548-125X</orcidid><orcidid>https://orcid.org/0000-0001-9176-664X</orcidid><orcidid>https://orcid.org/0000-0001-7272-4698</orcidid><oa>free_for_read</oa></addata></record> |
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title | Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study |
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