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
Design: Prospective, randomized,
Setting: University medical
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.
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.
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.