# Roles and responsibilities of nurses in mechanical ventilation in pediatric intensive care units: a national survey in Austria

## TL;DR

This study explores the roles of nurses in managing mechanical ventilation in Austrian pediatric intensive care units, finding limited use of protocols and shared decision-making with physicians.

## Contribution

The study provides the first national survey on nurse roles in mechanical ventilation in Austrian PICUs, highlighting gaps in protocol use and training.

## Key findings

- Only 8.1% of participants reported using a protocol for mechanical ventilation and 1.6% for weaning.
- Nurses independently adjust key ventilator parameters like oxygen saturation and PEEP.
- Nurses' autonomy in weaning correlates with professional experience and specialized training.

## Abstract

In pediatric intensive care units (PICU), mechanical ventilation (MV) and ventilator weaning are common but complex interventions. Internationally, nurses have a central role in ventilator weaning, and the evidence on nurse-led weaning indicates positive effects on the duration of MV. However, little is known about the roles and responsibilities of nurses in Austrian PICUs. This study aims to determine nurses´ roles and responsibilities during MV treatment in Austrian PICUs.

A cross-sectional study was conducted between May and October 2023. To this end, nurses and physicians from all PICUs in Austria (n = 10) completed an online survey with self-developed questionnaires, asking about the use of guidelines, the role in ventilator and sedation weaning and the need for further education. Statistical analysis with SPSS version 29.0 included multiple-response analysis, Pearson´s chi-square test, phi coefficient, Fisher´s exact test, Mann-Whitney-U-test, biserial rank correlation, and Spearman correlation.

107 nurses and 20 physicians responded to the questionnaire. The use of a protocol for MV was reported by 8.1% and for weaning by 1.6% of the participants. Nurses and physicians share responsibility for adjusting the MV settings and assessing weaning readiness. Individual parameters such as oxygen saturation (98.7%), PEEP (30.3%), respiratory rate (50%), pressure control level (42.1%), or ventilation mode (35.5%) are set independently by the nurses. The autonomy of nurses in weaning correlates with increasing professional experience (r = 0.318, p = 0.008) and the completion of special training for pediatric intensive care (r = 0.378, p = 0.001). Safety in dealing with mechanically ventilated children also correlates with increasing professional experience in the PICU (r = 0.252, p = 0.035) and special training for pediatric intensive care (r = 0.401, p < 0.001).

The results of this survey on the roles and responsibilities of nurses in Austrian PICUs show that protocols for mechanical ventilation and ventilator weaning are rarely used and important decisions are made together by physicians and nurses. The results provide important information for planning future intervention studies to implement a standardized approach based on evidence-based protocols and for developing a special training for Respiratory Specialized Nurses in Austria in line with international standards.

Open Science Framework, 7UTYX, April 18th ,2025. This study was registered retrospectively: 10.17605/OSF.IO/7UTYX.