2009 OPEN FORUM Abstracts
DEFINING A MINIMUM SET OF WEANING CRITERIA
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