1996 OPEN FORUM Abstracts
IMPACT OF A PATIENT FOCUSED TEAM (VENTMAN) APPROACH FOR VENTILATOR WEANING.
John Emberger BS RRT. Dori Miller RRT, Respiratory Care Staff, Herbert Patrick MD, Dept. of Respiratory Care, Thomas Jefferson University Hospital, Inc. Philadelphia PA
Background: In 1993, the Department of Respiratory Care implemented a Ventilator Management and Evaluation Program (VentMan) to optimize ventilator services through education and QA & I data gathcring. Our weaning approach centers on educating the beside team (therapists, nurses, and physicians) on defining weaning progress using 24 hour respiratory rate trend monitoring with titration within a wean mode in response to the trend of each patient. Hypothesis: We believed that VentMan would shorten the weaning period. Methods: VentMan weaning data were retrospectively analyzed from July 1993 to April 1995 from four adult ICU's (Medical, Cardiac, Surgical, Neurosensory). The "weaning period" was defined as the days from the first weaning trial until the patient was independent of the ventilator > 48 hours. 24 hour respiratory rate monitoring by impedance was obtained using the Hewlett-Packard monitoring system. We identified 376 patients who had a length of stay on the ventilator (LOSv) > 4 days (patients not quickly extubated) and separated them into three groups based on weaning modes: 1. Respiratory Muscle Endurance Training with PSV (RMET/PSV) - PSV was titrated to maintain respiratory rate trends 20 to 30 BPM during the day. Patients "rested" on Assist Control during each night. 2. T-Tube (TT) -T-piece and trach collar trials either once or several times daily with set durations independent of respiratory rate trends. 3. Other Combinations (OTHER) - SIMV, PSV/SIMV, or switching between modes day to day, independent of respiratory rate trends. Weaning "failures" were defined as patients initiating weaning by one mode and subsequently weaned by another mode, due to intolerance.
RMET/PSV TT OTHER Anova
n, total = 376 194 101 81 NA
Average LOSv, days* 18.8 31.2 20.3 p < 0.001
Avg. days before weaning 11.7 9.8 6.0 NA
Avg. Weaning Period, days 7.1 21.4 14.3 p < 0.001
80% ventilator independent,days 10 30 21 NA
Weaning Failures, # 1 16 21 p < 0.001
*variance between RMET/PSV and OTHER, p < 0.05
The most common weaning approach used was RMET/PSV (52%), followed by TT (27%). and OTHER (21%). Conclusion: A patient focused bedside team approach to weaning using RMET/PSV appears to have significantly decreased the weaning period, length of stay on the ventilator, and the number of weaning failures. In future studies, other factors contributing to LOSv need to be studied such as patient diagnoses, age, and co-morbidities.