2001 OPEN FORUM Abstracts
PRESSURESUPPORT LEVELS FOR SUCCESSFUL WEANING FROM MECHANICAL VENTILATION
GlenR. Coddington, RCP, RRT Kaiser Permanente Orange County MedicalCenter, Anaheim, Ca.
BACKGROUND:A recent study (Am J Respir Crit Care Med 1998 Dec) demonstrated that T-tubetrials of a few hours in duration may serve as an indicator of a patient?s abilityand readiness to be weaned from mechanical ventilation. Another study (N EnglJ Med 1995 Feb) utilized the technique of placing the patient on a PressureSupport of 18 cmH2O and then reducing the pressure 2 to 4 cmH20 per day as tolerated.Although both studies suggest that these methods may be somewhat effective,they require additional utilization of Respiratory staffing resources, as wellas the associated cost of materials and supplies. PURPOSE: To identify and demonstratean optimal pressure support levels that successfully promote weaning from mechanicalventilation without utilizing labor and time intense T-tube or Pressure Supporttrials.
METHOD: A samplepopulation of 100 patients requiring invasive mechanical ventilation were randomlyselected and retrospectively reviewed to evaluate what pressure support levelswere utilized immediately prior to discontinuing mechanical ventilation. Mechanicalventilation for all patients in the study was performed using the Puritan Bennett7200AE ventilator. Neonates (<6 months) and ?DNR? (Do Not Resuscitate) patientswere excluded from the study criteria. However, 2 pediatric patients (ages 15and 17) that were cared for in our adult ICU were included in the study. Unsuccessfulweaning was defined as re-institution of mechanical ventilation within 72 hoursand was determined by the patient?s clinical presentation and pertinent invasiveand non-invasive data.
EXPERIENCE:The QI tool developed by our Respiratory Care Services Department proved extremelyuseful for outcome analysis of ventilator management. CONCLUSION: There wasa 96% success rate when weaning patients from mechanical ventilation utilizinga mean pressure support level of 13.2 cmH20 and this may be a highly effectiveand less resource alternative to T-tube and Pressure Support trials. However,additional data would be helpful to better suggest which management techniqueshould be utilized for different patient populations. With so many variablesinvolved with the weaning process, it would behoove us as bedside cliniciansto note a conclusion that was reached in another study (Crit Care Med 1999 Nov)that stated: ?The manner in which the mode of weaning is applied may have agreater effect on the likelihood of weaning than the mode itself.?