The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

COMPARISON OF VENTILATOR LENGTH OF STAY (VLOS) IN PEDIATRIC PATIENTS USING A PATIENT-DRIVEN PROTOCOL (PDP) VS A PHYSICIAN-DIRECTED PROTOCOL: A PILOT STUDY

R. D. Restrepo, MD, RRT, Georgia State University (GSU) and Children's Health Care of Atlanta at Egleston (CHOA), L. Thomas, EdD, RRT (GSU), C. Spainhour, RRT, J. Fortenberry, MD, J. Stockwell, MD, (CHOA). Atlanta, GA

BACKGROUND: Patient-driven protocols (PDP's) have been widely used to guide several aspects of respiratory care including mechanical ventilation. Several studies have focused specifically on weaning from mechanical ventilation in the adult population. The use of PDP's in these patients resulted in less expensive care and without detriment to the quality of care. Few studies, however, have reported the use of PDP's in mechanically ventilated pediatric patients. PURPOSE: To compare the ventilator length of stay (VLOS) using a PDP vs physician-directed protocol in a tertiary pediatric ICU.

Methods:
Historical review of ventilated patients both prior to (physician-directed) and post implementation of the PDP. Patients with head injury were excluded from the study. PRISM and Murray Lung Injury scores were obtained prior to initiation of mechanical ventilation. The VLOS was divided in four subsequent phases: adjustment: time to make changes on the ventilator settings to keep SpO2 ³ 0.9, pH ³ 7.25, PaCO2 £ 80 mmHg immediately after intubation; weaning: time necessary to have the patient on minimal settings; minimal settings: time on a rate= 10-12, FiO2= 0.25, PEEP £ 5 cmH2O; spontaneous mode: time on either volume support (VS) or pressure support (PS) before extubation. The study endpoint was extubation.

Results:
34 patients were reviewed, 17 on each group. Age in years averaged 3.7. Independent t-tests for equality of means were used to compare VLOS on both groups. Means ± standard deviations are reported in the table below.

PRISM Murray VLOS (days)
Physician n=17 10 ± 6.6 2.9 ± 2.8 6.0 ± 6.47
PDP n=17 8.8 ± 6.1 2.3 ± 2.9 2.3 ± 2.47* * p < 0.05



Conclusions: These data suggests that the use of a PDP may significantly reduce VLOS in pediatric patients when compared to the traditional physician-directed approach. The use of PDP allowed more rapid changes on the initial phase of ventilation that could potentially reduce the time patients are exposed to relatively high initial ventilator parameters. (See Original for Figure)
You are here: RCJournal.com » Past OPEN FORUM Abstracts » 2000 Abstracts » COMPARISON OF VENTILATOR LENGTH OF STAY (VLOS) IN PEDIATRIC PATIENTS USING A PATIENT-DRIVEN PROTOCOL (PDP) VS A PHYSICIAN-DIRECTED PROTOCOL: A PILOT STUDY