2002 OPEN FORUM Abstracts
RESPIRATORY CARE-DIRECTED WEANING PROTOCOL: Clinical Outcomes with its Implementation
Laura D. Smith, DO, Paul R. Bast, RRT, Thomas M. Kane, RRT, Jackie OÕBrien, RN, Steven Trottier, MD, Lisa Mansaro, RN, Carla Cappadoro, RN St. JohnÕs Mercy Medical Center, St. Louis, Missouri
BACKGROUND: Protocol-guided weaning of mechanical ventilation has been shown efficacious in the adult Intensive Care Unit (ICU) without harm to the patient. A Respiratory Care-Directed Weaning Protocol (RCDWP) for mechanical ventilation (MV) was developed as a means to monitor and improve the quality of care of patients in the ICU. The purpose of this study was to evaluate the safety of a RCDWP.
METHOD: An eight-month prospective, interventional study including adult medical/surgical ICU patients receiving MV was conducted from May 1, 2001 through December 31, 2001. Data collected was divided into two periods: four months prior to and after the implementation of the RCDWP. The Society of Critical Care Medicine Project Impact database facilitated data collection including days of MV, ICU length of stay, ventilator-associated pneumonia, APACHE II probablility of survival, and patient demographics. Each patient underwent a daily screen performed by the Respiratory Care Practitioner (RCP). A successful screen prompted initiation of our protocol by the RCP. Physicians were notified when patients passed their spontaneous breathing trial and ready for extubation.
Results: 709 ICU patients were admitted to a medical surgical ICU over an eight-month period and 249 received MV. The average number of days on MV was 5.8, as compared with 6.2 prior to protocol institution. Ventilator-associated pneumonia decreased from 20% (n=25) to 11.3% (n=14) after protocol implementation (p<0.05). Reintubation rate and number of tracheostomies were unchanged.
Conclusions: The implementation of a RCDWP with daily screening noted an associated decrease in the incidence of ventilator-associated pneumonia. This protocol safely accelerated the weaning process with a trend toward decreasing the average number of days on MV, yet this was not statistically significant.