Key Characteristics and Mechanisms in Ventilator Weaning of Adult Intensive Care Patients-A Qualitative Study With Healthcare Professionals.

چکیده اصلی

BACKGROUND: Weaning from mechanical ventilation appears to be a complex intervention as defined by the Medical Research Council Framework. However, there is a lack of theoretical insights into ventilator weaning, and the underlying causal mechanisms have not yet been uncovered sufficiently. To understand its complexity in theory and develop it in practice, a program theory is currently being developed in a multi-method study. AIM: To identify key characteristics and mechanisms in ventilator weaning of adult intensive care patients. STUDY DESIGN: In this sub-study, we conducted semi-structured group discussions and workshops with 29 healthcare professionals in intensive care over 3 days in 2025 in Germany, using a qualitative design. The data were collected using audio recordings, field notes and photographs. After transcription, a deductive-inductive thematic analysis was performed. FINDINGS: The analysis revealed four principal themes: (1) complexity of ventilator weaning, (2) outcomes, (3) interventions and (4) links and relationships. The first theme combines factors such as definition and delimitation, dynamics, structure and individualization, which together describe the inherent complexity. The second theme covers different endpoints during the process, including preconditions and postconditions as well as intermediate, immediate and ultimate outcomes. The third theme comprises direct and indirect interventions, as well as nonprogram external factors. The fourth theme explores the connections between interventions, outcomes and contextual factors. CONCLUSION: The findings of this study support the understanding that ventilator weaning is a complex intervention. The identified interaction of the various interventions, outcomes and contextual factors needs to be theoretically organized and evaluated in future studies. RELEVANCE TO CLINICAL PRACTICE: Identifying the interactions between key characteristics in this process can improve HCPs' sensitivity to the effects of their own actions. A theoretical understanding of the mechanisms underlying ventilator weaning enables the targeted development and evaluation of a complex weaning intervention. TRIAL REGISTRATION: Open Science Framework YGJ3T; https://doi.org/10.17605/OSF.IO/YGJ3T, registered on 14 May 2025.

ترجمه فارسی چکیده

پس از تنفس مصنوعی، یک مداخله پیچیده تعریف شده توسط چارچوب شورای تحقیقات پزشکی به نظر می‌رسد. با این حال، درک نظری کافی از ترک تنفس مصنوعی و مکانیسم‌های علت‌زا وجود ندارد. هدف این مطالعه شناسایی ویژگی‌های کلیدی و مکانیسم‌ها در ترک تنفس مصنوعی بیماران بالینی مراقبت‌های ویژه بزرگسالان است. در این مطالعه فرعی، گفتگوی گروهی نیمه‌ساختاریافته و کارگاه‌هایی با ۲۹ متخصص مراقبت‌های ویژه در آلمان در ۳ روز سال ۲۰۲۵ انجام شد. تحلیل موضوعی استنتاجی-استنتاجی چهار موضوع اصلی را آشکار کرد: پیچیدگی ترک تنفس مصنوعی، نتایج، مداخلات و ارتباطات. یافته‌ها نشان می‌دهد که ترک تنفس مصنوعی یک مداخله پیچیده است و تعاملات بین مداخلات و نتایج باید نظری سازماندهی شوند.

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