2003 OPEN FORUM Abstracts
WEANING IN LONG TERM ACUTE CARE: PHYSICIAN-DIRECTED VS PROTOCOL-DIRECTED MANAGEMENT
Wendy Woods Dedrick, RRT, Melanie Ziolkowski, BSN, RRT, Eric Yaeger, MD,
Kent L. Christopher, MD, RRT, Robyn Ziolkowski, MACCCSLP Kindred Hospital Denver, Denver, Colorado
Background: Long term acute care (LTAC) hospitals are vital to the management of difficult-to-wean, ventilator dependent patients who often have complicated medical issues. The Weaning Protocol Program (WPP) at Kindred Hospital Denver (KHD), an LTAC, has incorporated different modes of weaning that have been utilized safely and efficaciously for more than a decade. The WPP consists of 6 interrelated protocols, which include the use of Transtracheal Augmented Ventilation (TTAV), to successfully liberate patients from mechanical ventilation (MV). This study was conducted to compare the length of wean time of difficult-to-wean, ventilator dependent patients from MV using physician directed weaning vs WPP in LTAC.
METHOD: Patients admitted to KHD were assigned to hospitalist management. The hospitalist requested pulmonary consultation or instituted the weaning process by initiating the WPP. Data were collected retrospectively on successfully weaned patients for a 12-month period from Sept 2001 to Sept 2002. Data collection consisted of number of days to successfully wean patients from MV, median age, admitting diagnosis, and admission RSBI, NIF, and Apache III scores.
RESULTS: 77 patients were successfully liberated from MV during this 12-month period. 42 patients were WPP and 35 patients were physician directed. To examine whether patients demonstrated a difference prior to implementation of wean methodology in age, RSBI, NIF, or Apache III scores, ANOVA comparisons were made. No significant statistical differences were reported prior to implementation of wean methodology. A significant main effect was reported for time [F = 16.278, p < .0005]. The average number of days to successfully wean patients from MV was 31.05 for physician directed and 17.98 for WPP. Patients weaning on WPP were successfully liberated from MV an average of 13.07 days faster than patients in the physician directed group.
CONCLUSION: The WPP is more effective in decreasing the average number of days to wean the difficult-to-wean, vent dependent patients from MV than the traditional physician directed wean in the LTAC.