1998 OPEN FORUM Abstracts
RESPIRATORY CARE PRACTITIONER VENTILATOR MANAGEMENT PROTOCOL DECREASES LENGTH OF VENTILATION
Donna Tripp, RRT, Susan Rinaldo-Gallo, RRT, MEd, and Jon Meliones, MD, and Ira M. Cheifetz, MD, Duke University Medical Center, Durham, North Carolina
Background: Pediatric Respiratory Care Practitioners (RCP), along with the Department of Pediatrics began a process to evaluate the utilization of health care resources. A RCP driven ventilator management protocol was developed, in a effort to manage patients more efficiently. The protocol established guidelines for RCPs to manage each phase of ventilator management from the initial ventilator set up through weaning patients from mechanical ventilation without having to obtain a physician order prior to every change. Exclusion criteria include: (a) alveolar hyperventilation. (b) controlled hypoventilation and (c) non-conventional modes of ventilation (i.e. HFOV). Other patients may be excluded at the discretion of their attending physician. The protocol is initiated by a written Physician order for "Ventilator Management Protocol". A formal respiratory care assessment is conducted at the initiation of ventilation, every 12 hours, and following any major change in ventilatory status. The following is a limited description of the protocol: (1.) The ventilator rate is adjusted to maintain end-tidal CO2 35 - 45 torr. (2.) The pH is maintained at >=7.28. (3.) The pressure or volume is limited to deliver a tidal volume(Vt) of 7-10 ml/kg. (4.) The PIP is limited to 35 cmH2O. (5.) FIO2 is titrated to maintain SaO2 >= 92% (in absence of a mixing congenital heart defect). (6.) PEEP is initially set at 4-5 cmH2Oand titrated using a PEEP titration protocol. (7.) Pressure support is set at 10 cmH2O and titrated to maintain a spontaneous Vt of approximately 6 ml/kg. Pressure support may be set to deliver a tidal volume of 10 ml/kg if complete support ventilation is to be used. Physicians may order specific variations in the ventilatory goals as indicated and are always notified of any major changes in the patient's ventilatory status. The protocol was implemented in the PICU February 1, 1998. Methods: Data were extracted from, a RC information system (Clinivision). February, March and April of 1997 and the same months in 1998. Results:
Total Pts Total Days Mean
February - April 1997 151 1013 6.7
February - April 1998 132 800 6.1
Experience: The Ventilator Management Protocol received positive acceptance. 100% of the eligible patients were placed on the protocol. Conclusion: We found an average reduction in ventilator length of .6 days per patient, during the 3 months evaluated. This represents 79.2 fewer ventilator days for this 3 month period.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.