The Hospital of Saint Raphael's respiratory department has adopted a two step weaning protocol that starts with a daily weaning assessment (DWA) followed by a Spontaneous Breathing Trial (SBT).The objective of this quality improvement project is to assess the adherence of the MICU staff to the Hospital's weaning policy.
Data was collected using the electronic medical record of patients requiring mechanical ventilation between October 1st of 2008 and December 31st of 2008. Each day a patient remained on mechanical ventilation was seen as an opportunity for a DWA. The DWA includes the evaluation of the neurologic, hemodynamic and ventilatory status. A SBT is expected to be performed anytime a DWA is passed. The ratio of DWAs performed over the number of opportunities, and the ratio of spontaneous breathing trials (SBT) done in those who passed the DWA were used as indicators of adherence to protocol.
We reviewed 154 mechanical ventilation events. The most common reason for intubation was hypoxic respiratory failure. The average LOMV was 3.84 days. Out of 639 weaning opportunities, a DWA was performed 432/639 (67.6%) times, passed 102/639 (16%) times, and failed 330/639 (51.6%) times. The most common reason for failure was inadequate mental status. When indicated (DWA passed), a SBT was done in 78/102 times (76.5%). A SBT was done in 96 of 330 (29.1%) failed DWAs and in 87 of 207 (42%) of not done DWAs. Of 164 successful SBTs, 109 were extubated (66.5%), out of which 7 were reintubated within 48 hours.
Our results show an opportunity to improve the adherence to the weaning protocol, as well as to improve documentation of weaning results.
We suggest: modifying our protocol to give the respiratory therapists autonomy to initiate SBTs when indicated without physician orders, coordinating DWAs with cessation of sedation in order to decrease the number of DWA failures secondary to inadequate mental status and finally, educating the respiratory therapists regarding documentation and communication of weaning results.
Felipe Lopez, No Financial Disclosure Information; No Product/Research Disclosure Information