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Respiratory Care |

Outcomes of a Ventilator Weaning Guideline: Use by an Intensivist Versus Hospitalists

Herbert Patrick*, MD; Barbara Salapata, BSN; Marc Schlessinger, BS
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ARIA Health - Frankford Campus, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):945A. doi:10.1378/chest.1388844
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Abstract

SESSION TYPE: Respiratory Support Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Guidelines for weaning critical care patients from ventilator support have gained importance with the emphasis on reducing ventilator associated pneumonia. The fewer days a patient receives mechanical ventilation, the lower the infection rate. Reduced ventilator days also correlate to reduced ICU days. Our institution implemented a Ventilator Weaning Guideline as part of the Electronic Health Record (EHR). While the Guideline was in place and unchanged, the Hospitalists in the Intensive Care Unit were converted to an Intensivist. We questioned whether this change in leadership using the same Guideline would influence the number of ventilator days. We hypothesized that the Intensivist would be responsible for fewer ventilator days compared to the Hospitalists.

METHODS: The Ventilator Weaning Guideline was ordered in the EHR by the Respiratory Care Practitioner for each ventilator patient. The assessment/readiness for weaning was conducted daily by the patient's nurse and Respiratory Care Practitioner using the following 11 criteria: 1) FiO2 0.5 or less, 2) PEEP 5 cmH2O or less, 3) ETT size 7 or greater, 4) GCS 8-15, 5) RR 25 bpm or less, 6) HR 100 bpm or less, 7) SBP 91-159 mmHg and DBP 61-89 mmHg, 8) Oral T below 100.9 F, 9) VT above 400 mL, 10) SpO2 above 92%, and, 11) VE 10 LPM or less. Once all 11 criteria were met, the patient was then placed on Pressure Support at 10 cmH2O with CPAP 5 cmH2O. If the patient tolerated the wean for 30 minutes, then an order to extubate was requested from the physician. If the patient failed to tolerate the wean, then the ventilator mode was returned to the previous settings and the patient made comfortable. Data were compiled retrospectively for twelve months for the Hospitalists and twelve months for the Intensivist as a Quality Assurance project. Ventilator days were the primary outcome measure.

RESULTS: For the twelve months with the Hospitalists in the ICU, the average ventilator days were 6.5 with a range of 4.4 - 11.3 days. For the twelve months with Intensivist leadership, the average ventilator days decreased to 4.9 with a range of 3.4 - 6.9 days.

CONCLUSIONS: Despite the presence of the identical Ventilator Weaning Guideline integrated in the EHR, the Intensivist decreased ventilator days compared to the Hospitalists. The hypothesis was supported.

CLINICAL IMPLICATIONS: The skill set of an Intensivist compared to Hospitalists appears to correlate with reduced ventilator days even with a robust Ventilator Weaning Guideline incorporated into the EHR.

DISCLOSURE: The following authors have nothing to disclose: Herbert Patrick, Barbara Salapata, Marc Schlessinger

No Product/Research Disclosure Information

ARIA Health - Frankford Campus, Philadelphia, PA

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