The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

EFFECT OF WEANING ASSESSMENT TIMES ON VENTILATOR DAYS AND ICU LENGTH OF STAY

Roger Reichenbach BGS RRT, John Crawford RRT, Nikolai Pamukov RRT Department of Respiratory Therapy, Henry Ford Hospital, Detroit, Mich.

Background: Mechanical Ventilation has become a common place intervention in Critical Care. Weaning or discontinuation of mechanical ventilation has evolved from simple post-anesthesia reversal to a complex collaborative multidisciplinary approach. Weaning protocols are one approach that can be used in a collaborative weaning strategy. Timing of weaning assessment times has traditionally been based on institutional norms or individual practitioner bias. A review of literature (Pubmed.gov) revealed no studies that examined timing of weaning assessments and their effect on weaning outcomes such as ventilator days and ICU length of stay (LOS).

Setting: Forty-fourBed (4 ICU's) Medical Intensive Care in an urban university-affiliated teaching hospital

Methods: A retrospective chart review was conducted of 3,573 patients (n=3,573) to determine if timing of assessments influenced ventilator days and ICU LOS. The patients were divided into 3 groups. Group I (n=1,102) were weaned without a protocol. These patients were assessed at random times before or after physician rounds after an order was received. Group II (n=1,177) were assessed at 0730-0800 in a protocol weaning plan. Group III (n= 1,294) were assessed at 0600-0700 in a protocol weaning plan. The mean, median, and standard deviation (SD) were calculated (Excel- Microsoft Corp.) for Ventilator Days and ICU LOS.

Results: Group I (n=1,102) Ventilator days mean=10.7, median=11.4, SD =1.77; LOS mean= 4.8, median =4.9, SD=0.43. Group II (n=1,177), Ventilator days mean=8.9, median= 9.0, SD=1.19; LOS mean=4.7, median=4.6, SD= 0.60. Group III (n=1,294), Ventilator days mean=8.1, median =7.9, SD = 1.18; LOS mean=4.1, median=4.0, SD= 0.03 .

Conclusion: With limited available data our retrospective study noted the following observations: A 6am assessment as a part of a Respiratory Therapist driven weaning protocol, ventilator days on average decreased by 3 (38%), ICU LOS decreased 0.7 days (17%) from when no weaning protocol was in place. An 8am assessment decreased ventilator days by 2 (22%), ICU LOS is statistically the same (mean 4.8 vs. mean 4.7). Finally, given the high volume of ICU ventilated patients and depending on the reimbursement formula (ICU cost & Ventilator /day), one can readily appreciate the cost savings ($ millions) of doing 6am assessments in a weaning protocol. This author encourages further prospective-randomized studies.

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