PURPOSE: To determine if using protocol-based mechanical ventilator (MV) weaning approach result in early extubation of patients admitted in the critical care units of St. Luke's Medical Center (SLMC) compared to physician-driven weaning.
METHODS: All patients in the critical care units of SLMC from November 2005 –August 2006, >18 yrs old and intubated for > 24 Hrs were included. Quasi-randomization of patients into 2 groups was done. Both groups underwent daily screening (DS) for readiness to be weaned. Once the study group had passed the DS, they underwent weaning assessment (WA). When the study group had passed the WA, they did spontaneous breathing trials (SBT) either via T piece or CPAP of 5 cm H20. After a successful SBT, the attending physician were then notified and left to decide whether to extubate or not. Duration of mechanical ventilatory support, length of stay in the critical care units, duration of time from weaning to discontinuation of ventilatory support, cost of respiratory care and complications like rate of reintubation, self-extubation, tracheostomy, prolonged mechanical ventilation and death were compared using Pearson's Correlation and Independent T.
RESULTS: There was significant reduction in the duration of mechanical ventilation (p value=0.017) and the need for tracheostomy (p value=0.011) in the protocol-driven weaning group as compared to the physician-driven weaning group. Although not significant, there was a decreasing trend in the length of weaning time in the protocol group. There was no significant difference between length of ICU stay and frequency of self-extubation, re-intubation and prolonged mechanical ventilatory support as well as death. Respiratory cost was significantly reduced by a mean of P52,578.08 in the protocol group.
CONCLUSION: A weaning protocol shortened the time spent on mechanical ventilatory support, time spent on weaning, reduced cost of respiratory care and number of patients who had to undergo tracheostomy compared to physician-driven weaning.
CLINICAL IMPLICATIONS: Weaning protocols aid to facilitate discontinuation of MV support hence reduces utilization of ICU resources and decrease complications.
DISCLOSURE: Maria Peachy La Villanueva, No Financial Disclosure Information; No Product/Research Disclosure Information