Abstract
IntroductionThe aim of the study was to determine whether the use of a nurses' protocol-directed weaning procedure, based on the French intensive care society (SRLF) consensus recommendations, was associated with reductions in the duration of mechanical ventilation and intensive care unit (ICU) length of stay in patients requiring more than 48 hours of mechanical ventilation.MethodsThis prospective study was conducted in a university hospital ICU from January 2002 through to February 2003. A total of 104 patients who had been ventilated for more than 48 hours and were weaned from mechanical ventilation using a nurses' protocol-directed procedure (cases) were compared with a 1:1 matched historical control group who underwent conventional physician-directed weaning (between 1999 and 2001). Duration of ventilation and length of ICU stay, rate of unsuccessful extubation and rate of ventilator-associated pneumonia were compared between cases and controls.ResultsThe duration of mechanical ventilation (16.6 ± 13 days versus 22.5 ± 21 days; P = 0.02) and ICU length of stay (21.6 ± 14.3 days versus 27.6 ± 21.7 days; P = 0.02) were lower among patients who underwent the nurses' protocol-directed weaning than among control individuals. Ventilator-associated pneumonia, ventilator discontinuation failure rates and ICU mortality were similar between the two groups.DiscussionApplication of the nurses' protocol-directed weaning procedure described here is safe and promotes significant outcome benefits in patients who require more than 48 hours of mechanical ventilation.
Highlights
The aim of the study was to determine whether the use of a nurses' protocol-directed weaning procedure, based on the French intensive care society (SRLF) consensus recommendations, was associated with reductions in the duration of mechanical ventilation and intensive care unit (ICU) length of stay in patients requiring more than 48 hours of mechanical ventilation
Those studies were mainly conducted by respiratory therapists in North American intensive care units (ICUs), whereas in Europe the respiratory therapist's roles are mainly assumed by nurses and physicians
The aim of the present prospective cohort study, which included a matched historical control group, was to determine whether a routine nurses' protocol-directed weaning procedure based on these recommendations and daily screening were efficient in terms of mechanical ventilation (MV) duration and ICU length of stay (LOS) in patients who required more than 48 hours of MV
Summary
The aim of the study was to determine whether the use of a nurses' protocol-directed weaning procedure, based on the French intensive care society (SRLF) consensus recommendations, was associated with reductions in the duration of mechanical ventilation and intensive care unit (ICU) length of stay in patients requiring more than 48 hours of mechanical ventilation. A great number of studies have demonstrated that prompt recognition of reversal of respiratory failure using standardized procedures and daily screening may shorten the overall duration of MV [2,3,4,5]. Those studies were mainly conducted by respiratory therapists in North American intensive care units (ICUs), whereas in Europe the respiratory therapist's roles are mainly assumed by nurses and physicians.
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