Nurse led weaning from ventilatory and respiratory support

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Nursing Practice

Background:

• Weaning from mechanical ventilation is a complex process requiring specialized expertise.
• Literature review indicates no single superior weaning method; protocol use is more effective in reducing weaning duration.
• A retrospective audit revealed significant average ventilation duration (16.8 days) in patients ventilated for 7+ days, with no established protocols.

Purpose of the Study:

• To evaluate the effectiveness of implementing weaning protocols and nurse-led weaning.
• To identify barriers to early initiation of weaning from mechanical ventilation.
• To improve the consistency and coordination of the weaning process.

Main Methods:

• Retrospective audit of patients ventilated for 7 or more days.
• Process mapping to identify delays in initiating weaning decisions.
• Implementation of weaning protocols and nurse-led weaning, supported by nurse consultants.
• Monthly collation of statistics to track changes in ventilation duration.

Main Results:

• Implementation of weaning protocols and nurse-led weaning led to a reduction in average ventilation time.
• Process mapping identified a 96-hour delay in initiating the decision to wean prior to protocol implementation.
• Despite protocol implementation, early weaning initiation remains problematic.

Conclusions:

• Protocol-led weaning is effective in reducing the duration of mechanical ventilation.
• Barriers to early weaning initiation include over-sedation, specific medication use (morphine, midazolam) in vulnerable patients, and delayed tracheostomy placement.
• Further interventions are needed to address knowledge gaps, support staff, and ensure consistent guideline adherence for early weaning.