The Science Journal of the American Association for Respiratory Care
Introduction: Mechanical ventilation (MV) is one of the most common forms of medical therapy administered in the intensive care unit (ICU). Shortening the duration of MV decreases the incidence of ventilator-associated complications and may decrease both ICU and hospital length of stay. We sought to evaluate the use of protocol-guided weaning by nurses and respiratory therapists to accomplish rapid and safe extubation of critically ill patients.
Methods: Phase 1 consisted of a prospective data collection of baseline ventilator information in the NeuroTrauma ICU of a 600-bed tertiary referral center with level I trauma center for patients admitted from October 1997 through February 1998. An algorithm for directed weaning by nurses and respiratory therapists was then developed by a multidisciplinary team and was instituted in July 1998 (phase 2). Data was prospectively obtained for comparative analysis from July 1998 through February 1999. The primary outcome measure was the duration of MV from tracheal intubation until discontinuation of ventilation.
Results: There were 93 patients with MV in phase 1 and 164 in phase 2. The average APACHE II score was 17.1 in phase 1 and 14.1 in phase 2. The average time of MV prior to first extubation was reduced from 106 hours in phase 1 to 88 hours in phase 2. Re-intubation rate was 9% in phase 1 and 6% in phase 2. Total time of MV was 227 hours in phase 1 and 113 hours in phase 2. ICU length of stay and hospital length of stay were reduced from 12.0 days and 20.3 days to 7.5 and 15.0 days, respectively. Hospital mortality remained the same (27% versus 28%).
Conclusions: Protocol-guided weaning of mechanical ventilation, as performed by nurses and respiratory therapists, is safe and leads to extubation more rapidly than physician-directed, non-algorithmic weaning. With more rapid extubation, both ICU and hospital length of stay are reduced.