Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: Effect on weaning time and incidence of ventilator-associated pneumonia

Gregory P. Marelich, Susan Murin, Felix Battistella, John Inciardi, Terry Vierra, Marc Roby

Research output: Contribution to journalArticle

303 Scopus citations

Abstract

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 ventilatury support without any adverse effects on patient outcome. The VMP was also associated with a decrease in incidence of VAP in tramna patients. These results, in conjunction with prior studies, suggest that VMPs are highly effective means of improving care, even in universtiy ICUs.

Original languageEnglish (US)
Pages (from-to)459-467
Number of pages9
JournalChest
Volume118
Issue number2
StatePublished - 2000

Keywords

  • Artificial respiration
  • Clinical protocols
  • ICU
  • Pneumonia
  • Time factors
  • Ventilator weaning

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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