A nurse-driven protocol for early weaning from mechanical ventilation in patients with acute respiratory failure: A...

To assess the compliance and acceptance of a nurse-driven early weaning protocol from the initiation of spontaneous ventilation (SV) to extubation in patients with acute respiratory failure (ARF) in the intensive care unit (ICU).

This monocentric, prospective pilot study included patients admitted to the ICU with ARF and requiring invasive mechanical ventilation (IMV) for more than 48 h, between February 2021 and April 2024. The weaning protocol (WP) was initiated after a successful 30-minute SV trial with pressure support (PS). Every 3 h, nurses reduced PS by 2 cmH₂O, fraction of inspired oxygen (FiO₂) by 5%, and positive end-expiratory pressure (PEEP) according to a predefined protocol. When minimum PS and PEEP levels were reached, the patient was extubated after a successful T-tube test. The primary outcome was compliance with the WP assessed by the percentage of time spent in agreement with WP. The secondary outcome was nurse acceptance, assessed by an anonymous survey on a visual analogue scale from 0 to 10.

Of the 50 patients enrolled, 30 (60 %) had COVID-19 pneumonia. The median duration of IMV was 21 days per patient [IQR: 10-34], with a median WP duration of 11 days [IQR: 4-21.5]. Protocol compliance was 76 %. Thirty-two of 37 nurses (86 %) completed the survey and rated the acceptance of the WP as 8/10 [IQR: 7.75-9]. Workload was identified as a barrier to compliance with a median score of 5/10 [IQR: 2-7]. We reported 9/50 (18 %) extubation failures.

This nurse-driven protocol for early weaning of patients with ARF had good compliance and acceptance by the nurse team despite the COVID-19 pandemic health crisis.

It is essential to incorporate nursing feedback if we are to improve the protocols for ventilatory weaning patients in ICU.