The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

SHIFT IN WEANING MODE USAGE THROUGH WEANING EDUCATION BY A VENTILATOR MANAGEMENT AND EVALUATION PROGRAM (VENTMAN)

John Emberger BS RRT. Gray Gradwell BS RRT. Herbert Patrick MD. Department of Respiratory Care. Thomas Jefferson University Hospital Inc, Philadelphia PA

Background: The Respiratory Care Department implemented the VentMan Program which collects weaning data on all ventilator patients and also provides education of the bedside team (therapists, nurses, and physicians) on ventilator weaning. VentMan weaning education includes a non-mandated protocolized guideline for PSV which is titrated according to 24 hour trends of respiratory rate as a measure of each patient's weaning progress. Our protocolized weaning guidelines have been identified as the most efficient method for weaning patients at our institution, however they remain non-mandatory. Hypothesis: We wanted to determine if educational efforts would result in a shift in wean mode usage in Surgical ICU (SICU) patients with a length of stay on the ventilator (LOSv) 4 to 14 days and > 14 days. Methods: We retrospectively analyzed SICU ventilator weaning data in two periods: before VentMan weaning education, July 93 to April 94 (Pre-Education) and during education, July 94 to April 95 (Education). We separated SICU patients (post trauma or post-operative) into two groups: LOSv 4 to 14 days i.e., patients not weaned immediately post-op and LOSv > 14 days i.e., patients after conversion from endotracheal to tracheostomy tube. The groups were analyzed by Pre-Education or Education period, and by wean mode used. Wean modes included: 1) Protocolized PSV (P-PSV) based on 24 hour respiratory rate trends 2) T-piece and trach collar, ventilator-free breathing once or several times daily (TT) 3) SIMV: reducing the set respiratory rate as tolerated 4) OTHER: SIMV with PSV. or daily switching between wean modes, or Non-Protocolized PSV. Results: 111 patients (n) were examined. Data is shown as n (%) [%=percent within period]

Mode

Group Period P-PSV TT SIMV OTHER Total

LOSv: 4 Pre-Education 6(17) 13(37) 8(23) 8(23) 35(100)

to 14 days Education 31(78)* 1(3)* 5(13)* 3(8)* 40(100)

LOSv > Pre-Education 13(59) 4(18) 1(5) 4(18) 22(100)

14 days Education 10(71)~ 1(7)~ 0(0)~ 3(21) 14(100)

chi-square variance between periods: * p < 0.001, ~ p < 0.05 Weaning significantly shifted to P-PSV (17% to 78%) in the LOSv 4 to 14 days group. Weaning also significantly shifted to P-PSV (59% to 71%) in the LOSv > 14 days group. Conclusion: The large shift to P-PSV in both groups of patients appears to be attributed to the educational efforts of VentMan in the SICU. In future studies, other factors need to be studied such as patient diagnoses, age, and co-morbidities.

Reference: OF-96-042

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