0
Clinical Investigations in Critical Care |

Protocol Weaning of Mechanical Ventilation in Medical and Surgical Patients by RespiratoryCare Practitioners and Nurses*: Effect on Weaning Time and Incidence of Ventilator-Associated Pneumonia

Gregory P. Marelich, MD, FCCP; Susan Murin, MD, FCCP; Felix Battistella, MD; John Inciardi, PharmD; Terry Vierra, RRT, RCP; Marc Roby, RN, MSN
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine, Departments of Internal Medicine (Drs. Marelich and Murin), Surgery (Dr. Battistella), Respiratory Care (Mr. Vierra), and Nursing (Mr. Roby), and Center for Health Services Research in Primary Care (Dr. Inciardi), University of California, Davis Medical Center, Sacramento, CA.

Correspondence to: Gregory P. Marelich, MD, FCCP, 6600 Bruceville Rd, Sacramento, CA 95823; e-mail: gregory.p.marelich@kp.org



Chest. 2000;118(2):459-467. doi:10.1378/chest.118.2.459
Text Size: A A A
Published online

Study objectives: (1) To determine the effect of a single ventilator management protocol (VMP) used in medical and surgical ICUs on the duration of mechanical ventilation. (2) To determine the effect of a VMP on the incidence of ventilator-associated pneumonia (VAP).

Design: Prospective, randomized, controlled study.

Setting: University medical center.

Patients: Three hundred eighty-five patients receiving mechanical ventilation between June 1997 and May 1998.

Interventions: A respiratory care practitioner– and registered nurse–driven VMP.

Results: Intervention and control groups were comparable with respect to age, sex, severity of illness and injury, and duration of respiratory failure at the time of randomization. The duration of mechanical ventilation for patients was decreased from a median of 124 h for the control group to 68 h in the VMP group (p = 0.0001). Thirty-one total instances of VAP were noted. Twelve patients in the surgical control group had VAP, compared with 5 in the surgical VMP group (p = 0.061). The impact of the VMP on VAP frequency was less for medical patients. Mortality and ventilator discontinuation failure rates were similar between control and VMP groups.

Conclusions: A VMP designed for multidisciplinary use was effective in reducing duration of mechanical ventilatory support without any adverse effects on patient outcome. The VMP was also associated with a decrease in incidence of VAP in trauma patients. These results, in conjunction with prior studies, suggest that VMPs are highly effective means of improving care, even in university ICUs.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Outcomes in Post-ICU Mechanical Ventilation*: A Therapist-Implemented Weaning Protocol
Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support*: A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543