The effect of a mechanical ventilation discontinuation protocol in patients with simple and difficult weaning: impact on clinical outcomes

We sought to determine whether the utilization of a respiratory therapist (RT) driven mechanical ventilation weaning protocol is associated with improvement in clinical outcomes in subjects with simple versus difficult weaning. This was a retrospective analysis of prospectively collected data obtain...

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Bibliographic Details
Published in:	Respiratory care Vol. 59; no. 2; pp. 170 - 177
Main Authors:	Gupta, Pooja, Giehler, Katherine, Walters, Ryan W, Meyerink, Katherine, Modrykamien, Ariel M
Format:	Journal Article
Language:	English
Published:	United States Daedalus Enterprises, Inc 01-02-2014
Subjects:	Adult Aged Analysis of Variance Causes of Clinical Protocols Female Hospital Mortality Humans Intensive Care Units Logistic Models Male Middle Aged Mortality Patient outcomes Quality Improvement Retrospective Studies Treatment Outcome United States Ventilator weaning Ventilator Weaning - methods Ventilator Weaning - mortality Ventilator Weaning - standards United States extubation respiratory failure respiratory therapist mechanical ventilation protocols weaning
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Summary:	We sought to determine whether the utilization of a respiratory therapist (RT) driven mechanical ventilation weaning protocol is associated with improvement in clinical outcomes in subjects with simple versus difficult weaning. This was a retrospective analysis of prospectively collected data obtained during a quality improvement project. We collected data on 803 consecutive mechanically ventilated patients admitted to the ICU of an academic tertiary care hospital. We compared an RT-driven weaning protocol to a physician-driven weaning strategy. Of the 803 patients, 651 with simple weaning and 131 with difficult weaning were included in the analysis. In the subjects with simple weaning, 514 (79%) were weaned with the RT-driven protocol. Among the difficult weaning subjects, 101(77.1%) were liberated with the RT-driven protocol. A multivariate analysis, which included Acute Physiology and Chronic Health Evaluation II, body mass index, and type of primary ICU team under which the subjects were admitted, revealed a significant difference in ventilator-free days at 28-days, which supports the RT-driven protocol over the physician-driven strategy. Specifically, the RT-driven protocol increased ventilator-free days by 20.92% and 68.2% among subjects with simple and difficult weaning, respectively. A multivariate analysis of ICU mortality and extubation failure found no significant difference between the RT-driven protocol and the physician-driven strategy. The RT-driven weaning protocol increased ventilator-free days among subjects with simple and difficult weaning, with no significant differences in ICU mortality or extubation failure.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0020-1324 1943-3654
DOI:	10.4187/respcare.02558