The Efficacy of Nurse-Driven, Protocol Guided Ventilator Weaning in a Medical-Surgical Intensive Care Unit (ICU)
Summary
1. Mechanically ventilated patients weaned by nurse-driven ventilator weaning protocol will have a mean length of stay on ventilator at least one day shorter than patients weaned by physician-initiated, non-protocol methods
2. Mechanically ventilated patients weaned by nurse-driven ventilator weaning protocol will have al least similar Ventilator, ICU, and Hospital Length Of Stay (LOS) compared to patients weaned by physician-initiated, non-protocol method
3. Nurse-driven ventilator weaning protocol is well accepted by other services: physicians, nurses, and respiratory therapists.
Description
Ventilatory support is one of the most common indications for admission to ICU (1).
The duration of mechanical ventilation is associated with several serious complications, increase mortality, prolong ICU stay, and increase hospital cost (7,8).
Traditionally, the process of ventilator weaning is initiated and carried out my physicians.
Recently, there have been few studies that supported the utility of protocol guided weaning algorithms. Its use have been associated with earlier initiation of weaning, leading to shorter ventilator time, and a trend for shorter ICU length-of-stay and lower hospital costs (1,2,4,9) Several studies have also shown the relative safety of utilizing nursing (3) and RT staff alone or in cooperation with medical staff in the weaning of patients from mechanical ventilation (1,2,6).
We recently developed a nurse-driven ventilator weaning protocol for all ICUs at St. Luke's and Roosevelt hospitals. The protocol was approved by the Critical Care Committee and is implemented as of May 2007. All ICU nurses, respiratory therapists, and ICU physicians have been educated on this protocol We plan to prospectively collect data to look at length of stay on mechanical ventilation in patients weaned by nurse-driven ventilator weaning protocol. We plan to compare such data to retrospectively collected ventilator LOS data in patients weaned by physician-initiated ventilator weaning method.
Study Design
Observational Model: Cohort, Time Perspective: Prospective
Conditions
Vent Weaning in Medical- Surgical ICUs
Status
Completed
Source
St. Luke's-Roosevelt Hospital Center
Results (where available)
Links
- Source: http://clinicaltrials.gov/show/NCT00786617
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Saint Vincent And The Grenadines
A self-governing state of the Windward Islands in the West Indies, comprising Saint Vincent and the northern islets of the Grenadines. Its capital is Kingstown. It is one of the original homes of the Carib Indians supposed to have been sighted by Columbus in 1498. It was in English hands from 1627 till held by the French 1779-83. Saint Vincent subsequently became a British possession and, with other nearby British territories, was administered by the Governor of the Windward Islands till 1959. It attained a measure of independence in 1969 but achieved full independence as Saint Vincent and the Grenadines in 1979. Saint Vincent was the 4th century Spanish martyr on whose feast day Columbus discovered the island. Grenadines is derived from the Spanish kingdom of Granada. (From Webster's New Geographical Dictionary, 1988, p1054 & The Europa World Year Book 1993, p2441)
Ventilator Weaning
Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation.
Ophthalmology
A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases.
Orthopedics
A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures.
Hospitals, General
Large hospitals with a resident medical staff which provides continuous care to maternity, surgical and medical patients.
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