PURPOSE: PURPOSE: To determine the efficacy of an electronic screening tool using standardized ventilator protocols, to better identify patients that can be weaned from mechanical ventilation to decrease mechanical ventilator days in a tertiary care center intensive care unit.
METHODS: METHODS: Every morning between 0500 and 0600 patients being mechanically ventilated that met nursing criteria received a sedation vacation so that the patient’s ability to be weaned from the ventilator can be assessed. In order to identify patients that can be weaned from mechanical ventilation respiratory therapists perform sedation, respiratory, and hemodynamic assessments, as well as check for a leak around the ETT cuff, once the patients sedation has been titrated appropriately. If the patient meets the criteria identified within the wean screen the patient is then weaned by the dayshift therapist on a spontaneous breathing trial of PS 5cmH2O and a Peep of 5cmH2O for two hours. If the patient tolerates the PS trial and meets further extubation criteria they are then extubated by nursing and respiratory therapy. Those that do not tolerate PS trial are placed back on the previous mode of ventilation.
RESULTS: RESULTS: Mechanical ventilator days/1000 patient days was 630.1 before and 585.9 post process. A decrease of 44.2 mechanical ventilator days per 1000 ICU days was observed.
CONCLUSIONS: CONCLUSION: During the first three months of implementation we observed a decrease in mechanical ventilator days.
CLINICAL IMPLICATIONS: CLINICAL IMPLICATIONS: When used properly a standardize tool to aid in the identification of patients that may be weaned from mechanical ventilation when used with ventilator protocols can decrease mechanical ventilator days per 1000 ICU days. An unexpected benefit was an increase in overall job satisfaction among Respiratory Therapists, as they felt their input in interdisciplinary team rounds and bedside rounds was more valued. Having a standardized tool in place also aided new ICU therapists in decision making as well.
DISCLOSURE: The following authors have nothing to disclose: Michael Bingaman, Omar Rahman
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