Table 2.

Examples of Aggressiveness of Care and Responsiveness of Care in Liberation from Prolonged Mechanical Ventilation

Care Type	Examples and Supporting Quotes
Aggressive care	“If the patient subjectively wants to. . . feels distressed, but objectively looks pretty good, I think a good therapist. . . an aggressive therapist, will say, ‘No. let’s keep pushing. We’re going to wean you off the ventilator a little bit more. Let’s stay off the ventilator a little bit more’.”—Physician, high-performing site
	“And we pretty much let them wean until they don’t tolerate it anymore. We don’t just wean them 2 h and then put them back on. . . If we’re going to start the weaning process, we want to push. We want to wean them as long as the patient tolerates it. . . At that point, we would do an end. So, then we would do a [respiratory] note, patient was tolerating weaning up to this many hours today. Then, we’d probably let them rest for a few hours. Then, proceed again. . . We try to be as aggressive as we can.”—Respiratory therapist, low-performing site
	“Sometimes I think the weaning process is a little too aggressive for them. So, they may start people out guns ablaze and, ‘Okay, let’s go 8 h! Let’s go 16 h’! ​And they do great like 1 d, and then the next day, they are so worn out from what they did the day before that they can’t do anything.”—Respiratory therapist, low-performing site
Responsive care	“The anxiety and depression play a big part in barriers to weaning, especially anxiety. The fear. They’ve been sick for so long. They’ve been dependent on this machine. And to have to breathe on their own really scares them. They’re afraid to be left alone. . . And so, when we’re starting weaning trials, respiratory will stay with the patient just to alleviate that.”—Advanced practice provider, high-performing site
	“I had a guy last week. He was on high-pressure support. And I said, the second I came in, ‘We got to wean him down. He’s never going to get anywhere’. He was pulling in huge tidal volumes. It didn’t make sense. So, I slowly throughout the day weaned him down. I explained everything I did with him. I sat in the room. He asked me a thousand questions. I didn’t care. That’s fine. He’s now, today, doing 24 h off the vent.”—Respiratory therapist, high-performing site
	“It’s like, ‘Look, I don’t think the patient is going to go long; maybe 4 h. Try 6 [h]. But if not, 4 h is.…’ And [respiratory therapists] go and do their assessment. And they see the ultrasound, heartbeat, labored breathing. Patient himself, or herself, complains of being short of breath.”—Physician, low-performing site