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Implementation of a nurse-driven ventilation weaning protocol in critically ill children: Can it improve patient
Anita Duyndam1, Robert Jan Houmes1, Joost van Rosmalen2
1Intensive Care, Erasmus MC - Sophia Children's Hospital Rotterdam, the Netherlands.
Insights
A nurse-driven ventilation weaning protocol in a pediatric intensive care unit (PICU) did not shorten mechanical ventilation duration. However, the protocol was safe, improved compliance, and did not increase reintubation rates.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Nursing Practice
Background:
- Critically ill children on mechanical ventilation in the pediatric intensive care unit (PICU) face risks of prolonged ventilation and hospital stay.
- Developing effective weaning protocols is crucial for improving patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the impact of a nurse-driven ventilation weaning protocol on the duration of mechanical ventilation in critically ill children.
- To assess secondary outcomes including PICU length of stay, reintubation rates, and protocol compliance.
Main Methods:
- A prospective, pretest-posttest implementation study design was employed.
- A nurse-driven ventilation weaning protocol was implemented and compared to usual physician-driven weaning.
- Primary outcome: duration of mechanical ventilation. Secondary outcomes: PICU stay, reintubation rate, compliance.
Main Results:
- No significant difference in the median duration of mechanical ventilation between the pretest and posttest groups (42.5h vs. 44.5h).
- PICU length of stay was nonsignificantly shorter in the posttest group (5.5 days vs. 7 days).
- Compliance with the prescribed support mode significantly increased (69.9% vs. 55.7%), with no significant difference in reintubation rates (5% vs. 7%).
Conclusions:
- Implementation of a nurse-driven weaning protocol did not significantly shorten mechanical ventilation duration in critically ill children.
- The nurse-driven protocol was found to be safe and successful, with improved compliance and no increase in reintubation rates.
- Further research may explore optimizing nurse-driven protocols for enhanced weaning efficiency in pediatric intensive care settings.
Background:
Critically ill children treated with invasive mechanical ventilation in a paediatric intensive care unit (PICU) may suffer from complications leading to prolonged duration of ventilation and PICU stay.
Objective:
The objective of this study is to find out if the use of a nurse-driven ventilation weaning protocol in a PICU can shorten the duration of mechanical ventilation.
Methods:
In a prospective, pretest-posttest implementation study, we implemented a nurse-driven ventilation weaning protocol and compared its outcomes with those of the usual physician-driven weaning. In the posttest period, nurses weaned the patients until extubation as per this protocol. The primary outcome was duration of ventilation. The secondary outcomes were length of PICU stay, reintubation rate, and compliance with the protocol (measured by use of the prescribed support mode).
Results:
In total, 424 patients aged from 0 to 18 years (212 pretest and 212 posttest) were included; in both groups, the median age was 3 months. The median duration of ventilation did not differ significantly between the pretest and posttest periods: 42.5 h. (interquartile range, IQR 14.3-121.3) vs. 44.5 h (IQR 12.3-107.0), respectively; p = 0.589. In the posttest period, the PICU stay was nonsignificantly shorter: 5.5 days (IQR 2-11) vs. 7 days (IQR 3-14) in the pretest period; p = 0.432. Compliance with the prescribed support mode was significantly higher in the posttest period: 69.9% vs. 55.7% in the pretest period; p = 0.005. The reintubation rate was not significantly different between the pretest and posttest periods (5% vs. 7%, respectively; p = 0.418). The extubation rate during nights was higher in the posttest period but not significantly different (p = 0.097).
Conclusions:
Implementation of a nurse-driven weaning protocol did not result in a significantly shorter duration of invasive mechanical ventilation but was safe and successful. The reintubation rate did not significantly increase compared with usual care.
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