The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

MODIFICATION OF A WEANING PROTOCOL DECREASES VENTILATOR LENGTH-OF-STAY

Mark Grzeskowiak, Andrew Martin, Michael McPeck; Respiratory Care, Long Beach Memorial Medical Center, Long Beach, CA

BACKGROUND. Our department’s ventilator weaning protocol required night shift RTs to perform a daily assessment on MICU ventilator patients for their readiness to wean. Patients who met criteria (hemodynamic stability, level of consciousness, adequate oxygenation, stable vital signs) also had measurements of “weaning parameters” (WP), i.e., NIF, RSBI, performed by night shift staff. If test results met or exceeded established thresholds, day shift would start the patient on a spontaneous breathing trial (SBT). When compared to the APACHE IV database, we found that Length of Stay on Ventilator (LOSv) was frequently 1- 2 days longer than predicted by APACHE. Two possible reasons for this were identified during Performance Improvement review: (1) Some patients were excluded from weaning by virtue of relative hypoxemia; Oxygenation Index (OI) <200 (P02/FI02). (2) WP data obtained by night shift did not always represent patient condition observed hours later on day shift. METHODS. We modified our weaning protocol to include 3 fundamental changes: (1) the threshold for OI was lowered from 200 to 170; (2) responsibility for both screening and starting SBT became the sole responsibility of day shift RTs; (3) the practice of routinely using WP as the basis for starting an SBT was eliminated. Monthly data was compiled and submitted to APACHE to obtain actual and predicted LOSv. We calculated ΔLOSv (deviation from APACHEpredicted value). RESULTS. During the first 6 months on the modified protocol, mean LOSv fell from 5.41 ±0.78 days (n=23 months) to 3.54 ±0.46 days (n=6 months). ΔLOSv over the same period fell from +1.47 ±0.773 days to -0.31 ±0.378 days. During the first 6 months using the modified protocol, there were no significant changes in patient volume or morbidity or mortality that could have skewed these results. CONCLUSIONS. Implementation of a modified version of an established weaning protocol resulted in a decrease in the number of vent days and a closer correlation to what was predicted from the APACHE IV data base. Sponsored Research - None

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