2004 OPEN FORUM Abstracts
USE OF VENTILATOR WEANING PROTOCOL IN PEDIATRIC PATIENTS
Clifton Dennis,
RRT Renuka Mehta, M.D., Anthony Pearson-Shaver M.D. FAAP Medical College of
Georgia Health System, Children’s Medical Center, Augusta,
Georgia
OBJECTIVE: Compare
outcomes in time to extubation and total ventilator cost between
physician-directed and protocol-directed weaning by respiratory
therapist from mechanical ventilation in pediatric patients. DESIGN:
Prospective- randomized.
SETTING: 14 bed Pediatric Intensive Care
Unit (PICU) in a 125 bed tertiary referral Children’s Hospital
INTERVENTIONS: The control group was weaned according to physician
directed orders for reductions in tidal volume (Vt), mechanical
ventilator rate (R), Fraction of inspired oxygen (FiO2),
end-expiratory pressure (PEEP) and Pressure support levels( PS) The
protocol group was weaned according to a specific weaning protocol
developed for this study
METHODS: This study enrolled 230
consecutive patients ( 102 physician directed, 100 protocol
directed). All patients were monitored for date of admission,
discharge from PICU, date of intubation, date of extubation, ,
initial ventilator settings, diagnosis upon admission, Use of
neuromuscular blockade, if patient required reintubation at 48 hours,
PEEP level, Pressure control level, use of Nitric Oxide, High
frequency oscillatory ventilator use, ventilator settings when
extubated and cost of mechanical ventilation. The protocol directed
group was monitored for all of the above listed parameters in
addition to date weaning began; date spontaneous breathing trial was
completed. Data analysis was done according to intent to treat.
RESULTS: The protocol directed group had shorter number of total
ventilator days, weaning time, time to extubation, and lower cost of
mechanical ventilation.
CONCLUSIONS: Protocol directed weaning from
mechanical ventilation applied to pediatric patients resulted in
shorter weaning times and reduced total ventilator cost compared to
physician directed weaning.
