Perspectives of intensive care professionals on extubation practices, causes of delays, and proposed solutions: A cross-sectional study.

BACKGROUND

Timely extubation is essential to ensure patient safety and efficient intensive care unit (ICU) management. Delays in extubation can lead to adverse outcomes and extended hospital stays. Although several factors affect timely extubation, those contributing to delays, especially in Saudi Arabian ICUs, have not been well described. This study aimed to identify factors contributing to delayed extubation in Saudi Arabian ICUs from the perspective of ICU healthcare professionals (HCPs), including physicians, nurses, and respiratory therapists (RTs).

METHODS

A cross-sectional survey was conducted in Saudi Arabia among physicians, respiratory therapists (RTs), and nurses with at least three months of ICU experience. The questionnaire assessed perceived extubation timing, comfort with extubation order placement, perceived barriers to delayed extubation, and suggested solutions. Likert-scale items were interpreted as perceived barrier scores, with higher scores indicating stronger perceived barriers to delay. Open-ended responses were analyzed using Braun and Clarke's thematic analysis framework.

RESULTS

In total, 292 ICU professionals participated in the study (22% physicians, 31% nurses, and 45% RTs). Although most respondents (78%) reported that extubation usually occurred within 3 hours of a successful spontaneous breathing trial (SBT), their perceptions of the appropriateness of this timing differed. The most frequently reported barriers to timely extubation were staffing limitations (18%), communication and teamwork issues (16%), and procedural inefficiencies (14%). Physician comfort levels with placing extubation orders varied significantly by seniority (p < .001). Suggested solutions included standardized protocols (20%), adequate staffing (18%), and routine assessments (16%).

CONCLUSIONS

ICU healthcare professionals perceived delayed extubation as mainly associated with modifiable organizational and workflow-related barriers. Addressing these barriers through interprofessional collaboration, protocol standardization, and targeted training may optimize the extubation process and ultimately may inform future quality improvement initiatives in Saudi ICUs.