The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts


Carla Wollens, Robert L. Chatburn, Jorge Guzman; Respiratory Institute, Cleveland Clinic, Cleveland, OH

We previously reported results of a set of ventilator weaning criteria as baseline data for determining readiness for weaning (wean screen WS), successful spontaneous breathing trials (SBT) or readiness for extubation (extubation screen ES); Respir Care 2008;53(11):1576. The purpose of this study was to evaluate the effects of reducing the number of WS and SBT criteria. METHODS: The ventilator management protocol, as previously reported, had 4 phases of ventilatory support: (1) initial stabilization on full support; (2) daily assessment until WS met; (3) weaning by daily 60 minute SBT alternated with full support; (4) extubation. Wean and SBT criteria are shown in the Table. The strikethrough text indicates the criteria that were deleted in a subsequent group of patients. Extubation screen criteria were not changed. The subsequent group included all patients requiring mechanical ventilation between 12/27/08 and 4/14/09. Patients transferred out of the MICU before extubation were excluded. Outcome data were compared with t-test and Chi Square test; P < 0.05 considered significant. RESULTS: Data from 37 patients were evaluated. The duration of ventilation showed an insignificant drop from the baseline period 4.7 vs 6.4 days; P = 0.248. However, the percentages of patients who failed the first WS dropped significantly from 70% to 50% (P = 0.006). There was no difference in the percentage of patients who failed the first SBT (P = 0.161) or in the percentage of patients needing reintubation within 24 hours (2% vs 8%; P = 0.105). CONCLUSION: A reduced criteria set for WS was associated with a drop in the number of first time WS failures without an increase in SBT failure or reintubation rate. We speculate that the reduced failure of WS would show a reduction in the duration of ventilation if the sample size was larger. We also speculate that labor time was reduced using the reduced criteria set. Sponsored Research - None
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