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Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning
E W Ely1, P A Bennett, D L Bowton
1Department of Internal Medicine, Section on Pulmonary/Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
American Journal of Respiratory and Critical Care Medicine
|February 2, 1999
Summary
Respiratory therapists can effectively manage mechanical ventilation weaning using a protocol without daily physician oversight. While protocol adherence is high, barriers to spontaneous breathing trials require further attention for improved patient outcomes.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Healthcare Management
Background:
- Mechanical ventilation is a critical intervention for respiratory failure.
- Protocols for ventilator weaning aim to optimize patient outcomes and reduce duration of mechanical support.
- Respiratory therapist-driven protocols (TDPs) offer a structured approach to patient management.
Purpose of the Study:
- To evaluate the large-scale implementation of a respiratory therapist-driven protocol for mechanical ventilation weaning.
- To assess the feasibility and effectiveness of a TDP managed by respiratory care practitioners (RCPs) without daily physician input.
- To identify barriers to protocol compliance during ventilator weaning.
Main Methods:
- Prospective investigation of a validated protocol including daily screen (DS) and spontaneous breathing trials (SBTs).
- Implementation involved 117 RCPs managing 1,067 patients over 9,048 patient days.
- Staged educational interventions and a questionnaire were used to assess compliance and barriers.
Main Results:
- RCPs demonstrated high completion (97%) and interpretation (95%) rates for the DS.
- Frequency of SBTs after passing DS increased significantly (p < 0.001).
- Physicians ordered more SBTs over time (46% to 65%, p = 0.004), with higher rates in medicine services.
Conclusions:
- A validated weaning strategy is feasible as a TDP without daily physician supervision.
- RCPs can effectively perform and interpret daily screening data.
- Significant barriers to spontaneous breathing trials exist, necessitating targeted interventions for improved protocol compliance.