The Science Journal of the American Association for Respiratory Care

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.


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