The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

DECREASE IN DAYS OF MECHANICAL VENTILATION WITH EARLY PLACEMENT IN A DUAL-PATHWAY WEANING GUIDELINE

Shari McKeown1, Cindrich Kiley1, Dean Chittock2



Background: A reduction in ventilator days is an important part of a strategy for preventing Ventilator Associated Pneumonia and produces cost savings in the management of Intensive Care Unit (ICU) patients. Collaborative weaning protocols have been shown to decrease days of mechanical ventilation. We designed and implemented a collaborative dual-pathway weaning guideline specific to our adult ICU to improve weaning consistency, with a focus on early weaning readiness assessment. The primary goals of the guideline were to decrease days of mechanical ventilation and median length of stay (LOS).

Methods: Through interdisciplinary, collaborative meetings, we developed a protocol that included weaning readiness assessment 24 hours a day, followed by a Spontaneous Breathing Trial. A collaborative discussion with the physician, RT and bedside nurse results in patient assignment to one of two weaning pathway options. Weaning Pathway #1 uses pressure-supportive spontaneous ventilation modes to wean patients as rapidly as possible using assessments of patient tolerance to adjust settings. Weaning Pathway #2 is a series of progressive unassisted breathing trials for patients with documented or suspected respiratory muscle weakness or spinal cord injury with diaphragmatic involvement. All further weaning decisions are made by the RT with daily interdisciplinary team input. Data was retrospectively compared 3 months prior to, and 3 months after implementation of the dual-pathway weaning guideline for median mechanical ventilator days, Median LOS, mortality rates, and APACHE II and IV scores.

Results: Statistics were compared 3 months prior to implementing the weaning guideline and 3 months post implementation. 547 ventilated patients were admitted to the ICU over a 6 month period (275 pre-guideline, 272 post-guideline). Median days of mechanical ventilation decreased from 3.90 to 2.70 days (p<0.05). Median length of stay decreased from 5.29 to 5.03 days. ICU mortality rate decreased from 20.31% to 19.51%. Hospital mortality rates also decreased from 29.30% to 26.83%. APACHE II and IV scores were unchanged.

Conclusion: Implementation of a collaborative weaning guideline focusing on early and frequent weaning readiness assessment decreased median days of mechanical ventilation and median length of stay in our ICU.