1998 OPEN FORUM Abstracts
IMPACT OF MECHANICAL VENTILATOR PROTOCOL IN A LEVEL I TRAUMA UNIT.
Scott Sick, Med, RRT, Joseph Smith, MD, Vicki Harter, BA, RRT.
Background: As part of a multidisciplinary team, respiratory therapists(RT), physicians assistants and physicians developed a mechanical ventilation protocol. The protocol was designed to standardize care and empowered the RT to initiate, decrease and increase mechanical ventilatory support based on patient need.
Method: The guidelines were evaluated prospectively on 1202 patients from 5/95 to 8/97. The study group (SG) was compared to a historical control group (HC) of 510 patients treated in the Shock Trauma Unit from 6/94 - 4/95.
Results: APACHE II scores were used to estimate severity of illness in both groups. During the first 17 months after protocol implementation, length of stay (LOS) and mechanical ventilator days/patient (VD) decreased across 4 out of 5 APACHE groups. Mortality rates showed no significant change. 18 months after protocol implementation, the number of ventilator days increased.
Experience: Based on these preliminary results, greater RT autonomy in ventilator management may facilitate improved care. Decreased dedicated RT staffing impacted the success of the protocol as evidenced by the increase in ventilator days at 18 months.
Conclusion: RT involvement in mechanical ventilation management resulted in an over all decrease in length of stay and mechanical vent days patient with no increase in mortality.
(See original for figure)
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.