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Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol
D J Scheinhorn1, D C Chao, M Stearn-Hassenpflug
1Barlow Respiratory Hospital and Research Center, Los Angeles, CA, USA. djs@barlow2000.org
Chest
|February 7, 2001
Summary
A new therapist-implemented patient-specific (TIPS) protocol significantly reduced the time to wean patients from prolonged mechanical ventilation (PMV) in a long-term acute-care setting, with similar patient outcomes compared to historical controls.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Pulmonology
Background:
- Therapist-implemented protocols are utilized for mechanical ventilation weaning in intensive care units.
- Barlow Respiratory Hospital (BRH), a long-term acute-care (LTAC) facility, specializes in weaning patients from prolonged mechanical ventilation (PMV).
- A therapist-implemented patient-specific (TIPS) protocol was developed at BRH to standardize PMV weaning.
Purpose of the Study:
- To evaluate the effectiveness of a newly developed therapist-implemented patient-specific (TIPS) weaning protocol.
- To compare the time to wean and patient outcomes in patients treated with the TIPS protocol versus historical controls.
- To assess the impact of a standardized protocol on weaning patients from prolonged mechanical ventilation in an LTAC setting.
Main Methods:
- A prospective cohort study with a historical control group was conducted.
- A TIPS weaning protocol was developed based on scientific evidence and expert consensus, incorporating LTAC weaning procedures.
- The protocol was implemented hospital-wide after staff training and pilot data analysis, with monitoring for outcomes, variances, and compliance.
Main Results:
- The study included 252 patients undergoing weaning from PMV, compared to 238 historical controls.
- Median time to wean decreased significantly from 29 days in the control group to 17 days in the TIPS protocol group (p < 0.001).
- Patient outcomes at discharge were comparable between groups: weaned (54.7% vs 58.4%), ventilator-dependent (17.9% vs 10.9%), and mortality (27.4% vs 30.7%).
Conclusions:
- The therapist-implemented patient-specific (TIPS) protocol significantly reduced the time to wean patients from prolonged mechanical ventilation.
- Patient outcomes remained comparable between the TIPS protocol group and the historical control group.
- High compliance with the TIPS protocol supports its role in achieving improved weaning times in LTAC facilities.