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1: Arch Surg. 1998 May;133(5):483-8; discussion 488-9.
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Decrease in ventilation time with a standardized weaning process.

Horst HM, Mouro D, Hall-Jenssens RA, Pamukov N.

Department of Surgery, Henry Ford Hospital, Detroit, Mich 48202, USA.

OBJECTIVE: To test the hypothesis that standardizing the process of weaning from mechanical ventilation would decrease ventilation times and length of stay in a surgical intensive care unit. DESIGN: Comparison of historic ventilation times with physician-directed weaning with those obtained with protocol-guided weaning by respiratory therapists. SETTING: Urban, teaching surgical intensive care unit with open admission policy and no dominant diagnosis related group. RESULTS: From January 1, 1995, through December 31, 1995, 378 patients who underwent physician-directed weaning from a ventilator had 64488 hours of ventilation, compared with 57796 ventilation hours in 515 patients with protocol-guided weaning (April 1, 1996, through May 31, 1997). The mean hours of ventilation decreased by 58 hours, a 46% decrease (P<.001). The length of hospital stay decreased by 1.77 days (29% change), while the Acute Physiology and Chronic Health Evaluation III score remained at 50 to 51. The number of reintubations did not change. The marginal cost savings was $603580. CONCLUSION: Protocol-guided weaning from mechanical ventilation leads to more rapid extubation than physician-directed weaning and has great potential for cost savings.

PMID: 9605909 [PubMed - indexed for MEDLINE]