Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians

Mauricio Danckers, Horiana Grosu, Raymonde Jean, Raul B. Cruz, Amelita Fidellaga, Qifa Han, Elizabeth Awerbuch, Nagesh Jadhav, Keith Rose, Hassan Khouli

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Purpose: Ventilator weaning protocols can improve clinical outcomes, but their impact may vary depending on intensive care unit (ICU) structure, staffing, and acceptability by ICU physicians. This study was undertaken to examine their relationship. Design/Methods: We prospectively examined outcomes of 102 mechanically ventilated patients for more than 24 hours and weaned using nurse-driven protocol-directed approach (nurse-driven group) in an intensivist-led ICU with low respiratory therapist staffing and compared them with a historic control of 100 patients who received conventional physician-driven weaning (physician-driven group). We administered a survey to assess ICU physicians' attitude. Results: Median durations of mechanical ventilation (MV) in the nurse-driven and physician-driven groups were 2 and 4 days, respectively (P = .001). Median durations of ICU length of stay (LOS) in the nurse-driven and physician-driven groups were 5 and 7 days, respectively (P = .01). Time of extubation was 2 hours and 13 minutes earlier in the nurse-driven group (P < .001). There was no difference in hospital LOS, hospital mortality, rates of ventilator-associated pneumonia, or reintubation rates between the 2 groups. We identified 4 independent predictors of weaning duration: nurse-driven weaning, Acute Physiology and Chronic Health Evaluation II score, vasoactive medications use, and blood transfusion. Intensive care unit physicians viewed this protocol implementation positively (mean scores, 1.59-1.87 on a 5-point Likert scale). Conclusions: A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients for more than 24 hours without adverse effects and was well accepted by ICU physicians.

Original languageEnglish
Pages (from-to)433-441
Number of pages9
JournalJournal of Critical Care
Volume28
Issue number4
DOIs
StatePublished - Aug 2013
Externally publishedYes

Keywords

  • Mechanical ventilation
  • Physician's acceptance
  • Protocol
  • Weaning

Fingerprint

Dive into the research topics of 'Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians'. Together they form a unique fingerprint.

Cite this