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Nurses-Driven, Protocol-Directed Weaning From Mechanical Ventilation: Clinical Consequences and Acceptance by Intensive Care Unit Physicians FREE TO VIEW

Mauricio Danckers, MD; Hassan Khouli, MD; Horiana Grosu, MD; Raul Cruz, MD; Nagesh Javhad, MD; Elizabeth Awerbuch, DO; Keith Rose, MD; Raymonde Jean, MD; Amelita Fidellaga, MHSA; Qifa Han, PhD
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Saint Luke's-Roosevelt Hospital Center, New York, NY

Chest. 2011;140(4_MeetingAbstracts):1028A. doi:10.1378/chest.1107985
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PURPOSE: To assess clinical outcomes of nurse-driven protocol-directed weaning from mechanical ventilation (MV) and to evaluate the attitudes of the Intensive Care Unit (ICU) physicians toward implementation of this protocol.

METHODS: We performed a prospective, case-control study in a 13-bed medical-surgical ICU with low respiratory therapist staffing in a teaching hospital from January 2008 to June 2008 in patients mechanically ventilated for more than 24 hrs. 102 patients receiving nurse-driven protocol-directed ventilator weaning (nurse-driven group) were compared to 100 patients who received conventional physician-directed weaning (physician-directed group) a year earlier from January 2007 to June 2007. A survey to assess the attitudes of ICU physicians was administered.

RESULTS: The median duration of MV in the nurse-driven and physician-directed groups were 2 and 4 days respectively [P=0.001; median difference, -1 (-2, 0)]. The median duration of ICU length of stay (LOS) in the nurse-driven and physician-directed groups were 5 and 7 days respectively [P=0.01; median difference, -1 (-2, 0)]. The time of extubation was two hours and thirteen minutes earlier in the nurse-driven group (p<0.001). There was no difference in hospital LOS, hospital mortality, rate of ventilator-associated pneumonia, or reintubation rates between the two groups. We identified four independent predictors of weaning: nurse-driven protocol-directed weaning (risk ratio 1.66; 95% CI 1.24-2.22; p= 0.007), APACHE-II score (risk ratio 0.98; 95% CI 0.96-0.99; p= 0.02), use of vasoactive medications (risk ratio 0.67; 95% CI 0.49-0.93; p= 0.01), and blood transfusion (risk ratio 0.65; 95% CI 0.48-0.90; p= 0.007). ICU physicians had an overall positive attitude towards the implementation of this protocol (mean scores 1.59-1.87 on a 5-point Likert scale with 1-2 score indicating favorable rating).

CONCLUSIONS: A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in patients mechanically ventilated for more than 24 hours without increasing incidence of adverse effects and was well accepted by ICU physicians.

CLINICAL IMPLICATIONS: Nurses driven ventilator-weaning protocols are safe, well accepted, and associated with positive clinical outcomes.

DISCLOSURE: The following authors have nothing to disclose: Mauricio Danckers, Hassan Khouli, Horiana Grosu, Raul Cruz, Nagesh Javhad, Elizabeth Awerbuch, Keith Rose, Raymonde Jean, Amelita Fidellaga, Qifa Han

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