Protocol-directed weaning: a process of continuous performance improvement

Venkat Ramachandran¹ , Mary Jo Grap² and Curtis N Sessler¹

¹The Department of Medicine, Medical College of Virginia Campus of the Virginia Commonwealth University, Richmond, Virginia, USA

²School of Nursing, Medical College of Virginia Campus of the Virginia Commonwealth University, Richmond, Virginia, USA

author email corresponding author email

Critical Care 2005, 9:138-140doi:10.1186/cc3053


Published:	28 January 2005

See related research article http://ccforum.com/content/9/2/R83

Abstract

The use of a nursing-directed and/or respiratory therapist-directed protocol in many intensive care units for weaning from mechanical ventilation is associated with a shorter duration of ventilation and length of stay in the ICU. Most protocols have two formal components: the daily screening of a set of simple observations or interventions to identify readiness to proceed, followed by a spontaneous breathing trial that tests the patient's ability to breathe independently. The daily screen is designed to identify potential barriers regarding medical stability, level of consciousness, oxygenation, ventilation, and airway patency and protection. However, one must avoid selecting criteria that are too restrictive, potentially delaying the discontinuation of ventilation.