2004 OPEN FORUM Abstracts
Use of a Respiratory Therapist–Driven Weaning Protocol by a Respiratory Care Student at a Long-Term Adult Care Facility
By
Marcia Haymans, B.S., R.R.T., DiAnn Larson, R.R.T., David Snyder,
M.D., Marty
Arnson R.N., and Larry Arnson, Ph.D., R.R.T. Gwinnett
Technical College, Lawrenceville GA
At
Decatur Hospital, a long-term ventilator dependent care facility, a
large percentage of our patients go directly home from the hospital.
Decatur Hospital’s comprehensive approach to patient care
assures that patients receive treatment that is tailor-made to their
needs. To further improve patient care and to increase the number of
patients that go directly home without mechanical ventilator
assistance, the Respiratory Care Department implemented a ventilator
weaning protocol. As a student in a respiratory care program, I
worked with participants of the heath care weaning team which
consisted of nine full-time respiratory therapists, 11 part-time
respiratory care practitioners, 5 employees of the Rehab Group, one
nurse practitioner, 6 nurses, one nutritionist, 2 physician
assistants and one pulmonologist. The patients at this Long-Term
Acute Care Ventilator Dependent Hospital are sent to us from the
intensive care units of area hospitals. These are difficult patients
to wean because of physical and mental dependency of the ventilator
and the need for endurance training. Weaning success comprised of
moving through each of the stages of the protocol from full
ventilator dependency to 24 hour spontaneous unassisted breathing and
then discharge. The patient was not counted as successful if they
expired after being weaned from the ventilator. To be counted as a
successful wean, patients had to be discharged home without
ventilator support. During the time of my clinical rotation, as a
member of the weaning team, I utilized the Ventilator Weaning
Protocol. This is an easy straight forward approach to weaning the
difficult patient. The Ventilator Weaning Protocol was developed by
DiAnn Larson RRT, Dan Pike RRT, and David Snyder M.D., FCCP. The
patient was not counted as successful if they expired after being
weaned from the ventilator. To be counted as a successful wean,
patients had to be discharged home without ventilator support.
Patients that were ventilator dependent because of neurological
disorders/diseases were excluded from the weaning protocols. During
the first quarter of 2004, the mean age of the weaned patients was
62.1 years of age with a range of 47 to 83 years. Of those 29
ventilated patients, 53% were Caucasian, 32% were African-American.
The majority of the patients (75%) were ventilated due to respiratory
failure with a mean age of 60.7. These patients were primarily
African-American (71%) and 77% were female. Fifty-four percent of the
patients had been weaned successfully with an average length of time
on the ventilator of 17 days. The purpose of the protocol was to
establish department wide policies with strict provisions for the
care and safety of patients who have artificial airways and are being
mechanically ventilated. The following policies describe specific
practices the department will abide by in
caring for the ventilator patient. The entire protocol would be
presented at the open forum.