The Science Journal of the American Association for Respiratory Care
Background: Previous studies have demonstrated the efficacy of weaning protocols when utilized in medical and surgical intensive care units. This study has examined a sample of ventilator dependent patients from a trauma population and proved the effectiveness of a weaning protocol when utilized by respiratory therapists working under physician guidance.
Methods: ?Trauma patients? were identified and selected from a sample of multiple injured patients admitted following accident to a designated trauma intensive care unit. The patients were randomized into two study groups, i.e.; protocol and non-protocol. Both groups were examined and chest x-rays compared for equality of associated co-morbidities as defined by the radiographic presence of infiltrates, contusions, atelectasis, hemothorax, pneumothorax, ARDS or other post traumatic sequelae. The main outcome measure was weaning time. Secondary outcomes were the need for re-intubation, duration of mechanical ventilation and total hospital costs related thereto.
Results: 48 patients were randomized into two groups. Patient demographics including age, trauma score, associated co-morbidities and re-intubation rates were similar between the two groups.
|Variable||1993 Physician Directed (n=24)||1997 Protocol Directed (n=24)||P-Value|
|Age, Yr.||36.7± 20.4||37.9± 20.2|
|Trauma Score||13.3± 3.32||13.5± 3.42|
|Co-Morbidity Chest, %||19/24 79%||19/24 79%|
|Duration of MV, hrs.||132.2± 163.1||103.4± 159.1||0.186|
|Weaning Time, hrs.||19.3± 28.0||13.6± 26.8||0.345|
Conclusions: Protocol guided weaning of mechanically ventilated patients by respiratory therapists in the trauma intensive care unit is safe. The protocol group led to an earlier and faster extubation rate than the group guided solely by physicians. A conservative per annum cost savings for the protocol group for hospital costs is $ 265,800/ yr.