1998 OPEN FORUM Abstracts
Control trial of protocol based RCP-controlled weaning verus physician-controlled weaning for critically ill children.
Mark J. Heulitt, MD
This study is designed to determine if the length of time a child spends on mechanical ventilation can be reduced if respiratory therapist as compared to a physician makes the decisions for changes in this support. Physicians currently control when ventilator weaning occurs. However, delays in weaning patients ready to be weaned occur when physicians are pre-occupied with providing emergency care to sicker patients. Passing the responsibility of ventilator weaning to intensive care respiratory therapists has been demonstrated to be more effective and as safe as physician-controlled weaning. The respiratory therapists in these adult studies screened patients with pre-established extubation criteria and weaned the ventilator support with protocols created by physicians. This approach to weaning has not been studied in children.
The study will have three study arms. One a physician directed arm and two respiratory therapists directed arms. The therapist directed arms will have an open loop protocol utilizing Pressure Regulated Volume Control/Volume Support and a closed loop arm utilizing Auto-mode. In the physician directed arm the patient may be weaned by any method the physician desires except Auto-mode.
Patients in the study will include those intubated on mechanical ventilator support greater than 36 weeks gestation and less than 17 years of age. Patients excluded from the study will include patients intubated for airway protection, with multiple injuries or diseases incompatible with survival, status asthmaticus, cyanotic congenital heart disease, and whose mechanical ventilation is likely to be < =24 hours.
A total of 300 patients will be enrolled in an 18 month period.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.