Intensive Care Medicine

, Volume 22, Issue 10, pp 1052–1056 | Cite as

Clinical consequences of the implementation of a weaning protocol

  • P. Saura
  • L. Blanch
  • J. Mestre
  • J. Vallés
  • A. Artigas
  • R. Fernández
Original

Abstract

Objective

To analyze the clinical and economic consequences of the implementation of a weaning protocol in patients mechanically ventilated (MV) for more than 48 h.

Design

Comparative study

Setting

General intensive care unit (ICU) in a county hospital covering 360 000 inhabitants.

Patients

51 patients weaned by a fixed protocol were studied prospectively and compared with 50 retrospective controls.

Measurements

The following variables were assessed: Acute Physiology and Chronic Health Evaluation (APACHE) II score, age, cause of respiratory failure, type of extubation (direct extubation or extubation using a weaning technique), number of days on MV before the weaning trial, weaning time, total duration of MV, complications (reintubations and tracheostomies), length of ICU stay, and mortality.

Results

The groups were comparble in terms of age, APACHE II score, and main cause of acute respiratory failure. Number of days on MV up to the weaning trial were similar in the two groups (8.4±7.7 in the protocol group vs 7.5±5.5 in the control group, NS). Most of the patients (80%) in the protocol group were directly extubated without a weaning technique, unlike the control group (10%) (p<0.01). When a weaning technique was used, the weaning time was similar in both groups (3.5±3.9 days vs 3.6±2.2 days in the control group). Duration of MV was shorter in the protocol group (10.4±11.6 days) than in the control group (14.4±10.3 days) (p<0.05). As a result, the ICU stay was reduced by using the weaning protocol (16.7±16.5 days vs 20.3±13.2 days in the control group,p<0.05). We found no differences in reintubation rate (17 vs 14% in the control group) and need for tracheostomies (2 vs 8% in the control group).

Conclusion

The implementation of a weaning protocol decreased the duration of MV and ICU stay by increasing the number of safe, direct extubations.

Key words

Mechanical ventilation Weaning Weaning criteria Weaning incidence ICU stay 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324: 1445–1450Google Scholar
  2. 2.
    Tobin MJ, Perez W, Guenther SM, Semmes BJ, Mador J, Allen SJ, Lodato RF, Dantzer DR (1986) The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am J Respir Crit Care Med 134:1111–1118Google Scholar
  3. 3.
    Sahn SA, Lakshminarayan MB (1973) Bedside criteria of discontinuation of mechanical ventilation. Chest 63:1002–1005Google Scholar
  4. 4.
    Sassoon C, Te T, Mahutte CK, Light RW (1987) Airway occlusion pressure: an important indicator of successful weaning in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 135:107–113Google Scholar
  5. 5.
    Yang KL (1993) Inspiratory pressure/ maximal inspiratory pressure ratio: a predictive index of weaning outcome. Intensive Care Med 19:204–208Google Scholar
  6. 6.
    Fernández R, Cabrera J, Calaf N, Benito S (1990) P0.1/PIMax: an index for assessing respiratory capacity in acute respiratory failure. Intensive Care Med 16:175–179Google Scholar
  7. 7.
    Gandia F, Blanco J (1992) Evaluation of indexes predicting the outcome of ventilator weaning and value of adding supplemental inspiratory load. Intensive Care Med 18:327–333Google Scholar
  8. 8.
    Esteban A, Alía I, Ibáñez J, Benito S, Tobin MJ, Spanish Lung Failure Collaborative Group (1994) Modes of mechanical ventilation and weaning: a national survey of Spanish hospitals. Chest 106:1188–1193Google Scholar
  9. 9.
    Wagner DP (1989) Economics of prolonged mechanical ventilation. Am Rev Respir Dis 140:S14-S18Google Scholar
  10. 10.
    Cohen IL, Bari N, Strosberg MA, Weinberg PF, Wacksman RM, Millstein BH, Fein IA (1991) Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of ventilatory management team. Crit Care Med 19:1278–1284Google Scholar
  11. 11.
    Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, Fernandez R, De la Cal MA, Benito S, Tomàs R, Carriedo D, Macias S, Blanco J for the Spanish Lung Failure Collaborative Group (1995) A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 332:345–350Google Scholar
  12. 12.
    Knaus WA, Draper E, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829Google Scholar
  13. 13.
    Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J (1993) Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270:2478–2486Google Scholar
  14. 14.
    Holliday JE, Hyers TM (1990) The reduction of weaning time from mechanical ventilation using tidal volume and relaxation biofeedback. Am J Respir Crit Care Med 141:1214–1220Google Scholar
  15. 15.
    Strickland JH, Hasson JH (1991) A computer-controlled ventilator weaning system. Chest 100:1096–1099Google Scholar
  16. 16.
    Tong DA (1991) Weaning patients from mechanical ventilation. A knowledgebased system approach. Comput Methods Programs Biomed 35:267–278Google Scholar
  17. 17.
    Henneman EA (1989) Effect of nursing contact on the stress response of patients being weaned from mechanical ventilation. Heart Lung 18:483–489Google Scholar
  18. 18.
    Thorens JB, Kaelin RM, Jolliet P, Chevrolet JC (1995) Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med 23:1807–1815Google Scholar
  19. 19.
    Weinberg SE, Weiss JW (1995) Weaning from ventilatory support. N Engl J Med 332:388–389Google Scholar
  20. 20.
    Epstein SK (1995) Etiology of extubation failure and the predictive value of the rapid shallow index. Am J Respir Crit Care Med 152:545–549Google Scholar
  21. 21.
    Tahvanainen J, Salmenpera M, Nikki P (1983) Extubation criteria after weaning from intermittent mandatory ventilation and continuous positive airway pressure. Crit Care Med 11:702–707Google Scholar
  22. 22.
    Sassoon CSH, Mahutte CK (1993) Airway occlusion pressure and breathing pattern as predictors of weaning outcome. Am J Respir Crit Care Med 148:860–866Google Scholar
  23. 23.
    Brochard I, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150:896–903Google Scholar
  24. 24.
    Lee KH, Hui KP, Chan TB, Tan WC, Lim TK (1994) Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest 105:540–543Google Scholar
  25. 25.
    Demling RH, Read T, Lind LJ, Flanagan HL (1988) Incidence and morbidity of extubation failure in surgical intensive care patients. Crit Care Med 16:573–577Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • P. Saura
    • 1
  • L. Blanch
    • 1
  • J. Mestre
    • 1
  • J. Vallés
    • 1
  • A. Artigas
    • 1
  • R. Fernández
    • 1
  1. 1.Intensive Care DepartmentHospital de Sabadell Parc Taulí s/nSabadellSpain

Personalised recommendations