The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

REDUCTION OF DURATION OF MECHANICAL VENTILATION BY USE OF A VENTILATION MANAGEMENT PROTOCOL

Laura Mandel, R.R.T., Thomas Arrowsmith, R.R.T, Nancy Collar, R.R.T, B. J. Kingsley, R.N., James Lamberti, M.D., Inova Fairfax Hospital)

Background: We screened patients daily to identify those able to breathe spontaneously and notified physicians of a passing screen. We requested two-hour trials of spontaneous ventilation and notified physicians of a passing spontaneous ventilation trial. We studied whether this ventilation management protocol affected physicians' behavior and improved patients' outcomes.

Methods: A randomized, controlled trial in adult patients receiving mechanical ventilation (Ely E, N Engl J Med 1996; 335:1864-9) documented a significant decrease in duration of mechanical ventilation and cost of intensive care. We followed the methods of this trial, including all adult patients in our medical and surgical intensive care units receiving mechanical ventilation. Patients requiring ventilation > 21 days were excluded from analysis. October 1996 to March 1997 served as the control period. In April 1997, we began daily screening of patients (provided that: FiO_{2} < 0.50, PEEP < = 5, no vasopressors or intravenous sedatives). A passing screen was defined as f/V_{t} < 105. We notified physicians of the daily screening results and beginning in September 1997 we requested a two-hour trial of spontaneous breathing in patients passing the screen (78% compliance by physicians). If the breathing trial was successful we notified the patient's physician who independently decided upon discontinuation of mechanical ventilation. October 1997 to December 1997 represented the first three month period following complete institution of our protocol (intervention group).

Results:

End Point Intervention Group Control Group

(n=188) (n=358)

median (interquartile range)

mechanical ventilation 2.5 (1-6.25) days 3 (2-8) days

hospital days 9 (4-18) days 11 (4-21) days

hospitalization cost $19,701 $21,999

($9,315-$35,328) ($12,226-$38,857)

End Point p value

mechanical ventilation 0.01

hospital days 0.11

hospitalization cost 0.06

Experience: The authors worked as a team to implement the protocol, educate physicians, collate, and analyze data.

Conclusions: A ventilation management strategy including daily screening of patients and two-hour trials of spontaneous ventilation reduced time on mechanical ventilation. A trend toward reduction in hospital time and hospital cost was noted. Utilizing a median cost reduction of $2,298 per patient, we postulate an annual cost savings of $1,728,096.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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