A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation.

@article{Krishnan2004APC,
  title={A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation.},
  author={Jerry A. Krishnan and Dana Moore and Carey Robeson and Cynthia Rand and Henry Eric Fessler},
  journal={American journal of respiratory and critical care medicine},
  year={2004},
  volume={169 6},
  pages={
          673-8
        }
}
Weaning protocols can improve outcomes, but their efficacy may vary with patient and staff characteristics. In this prospective, controlled trial, we compared protocol-based weaning to usual, physician-directed weaning in a closed medical intensive care unit (ICU) with high physician staffing levels and structured, system-based rounds. Adult patients requiring mechanical ventilation for more than 24 hours were assigned to usual care (UC) or protocol weaning based on their hospital… 

Figures and Tables from this paper

A weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation.

Protocol-directed weaning from mechanical ventilation in neurological patients: a randomised controlled trial and subgroup analyses based on consciousness

Protocol-directed weaning reduces weaning time, MV duration, length of NCU stay and NCU cost in neurological patients, and these effects are more significant in conscious patients than in unconscious patients.

Protocol-directed vs. physician-directed weaning from ventilator in intra-abdominal surgical patients.

Daily screening of respiratory function in intra-abdominal surgical patients followed by trials of spontaneous breathing performed by nurses resulted in a shorter duration of mechanical ventilation when compared to traditional physician-directed weaning.

A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit*

This randomized trial provided no evidence of a substantial reduction in the duration of mechanical ventilation or length of stay, in either the intensive care unit or the hospital, with the use of protocol-directed sedation compared with usual local management.

A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation.

The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning process.

Use of a Multidisciplinary Mechanical Ventilation Weaning Protocol to Improve Patient Outcomes and Empower Staff in a Medical Intensive Care Unit

Implementation of a multidisciplinary mechanical ventilation weaning protocol is a safe and effective way to improve patient outcomes and empower ICU staff.

Protocolized ventilator weaning verses usual care: A randomized controlled trial

PW with RT-driven extubation decisions is safe, effective, and associated with decreased re-intubation (early and late), shorter hospital stays, increased intubation duration (statistically but not clinically significant), and unchanged in-patient mortality.

Clinical trial of a weaning protocol

A prospective clinical trial of a weaning strategy previously demonstrated to enhance clinical outcomes of mechanically ventilated patients and draws conclusions quite different from those drawn in an accompanying editorial.

Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients.

There is evidence of reduced duration of mechanical ventilation, weaning duration and ICU length of stay with use of standardized weaning protocols, but not in neurosurgical ICUs, and significant heterogeneity among studies indicates caution in generalizing results.

Commentary Clinical trial of a weaning protocol

A prospective clinical trial of a weaning strategy previously demonstrated to enhance clinical outcomes of mechanically ventilated patients and draws conclusions quite different from those drawn in an accompanying editorial.
...

References

SHOWING 1-10 OF 26 REFERENCES

A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation.

Protocol-guided weaning of mechanical ventilation, as performed by nurses and respiratory therapists, is safe and led to extubation more rapidly than physician-directed weaning.

Weaning children from mechanical ventilation: a prospective randomized trial of protocol-directed versus physician-directed weaning.

Protocol- directed weaning resulted in a shorter weaning time than physician-directed weaning in these pediatric patients, and there was no difference in the incidence of reintubation, new-onset tracheitis, subglottic stenosis, or pneumonia.

Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial.

In contrast with adult patients, the majority of children are weaned from mechanical ventilator support in 2 days or less, and weaning protocols did not significantly shorten this brief duration of weaning.

Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation.

The use of protocol-directed sedation can reduce the duration of mechanical ventilation, the intensive care unit and hospital lengths of stay, and the need for tracheostomy among critically ill patients with acute respiratory failure.

Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days.

The overall 30-d weaning success rate was significantly greater and the time spent under mechanical ventilation by survived and weaned patients was shorter in the patients in the study than in historical control patients, and the LWU and hospital stays were significantly shorter.

Collaborative practice: development, implementation, and evaluation of a weaning protocol for patients receiving mechanical ventilation.

  • M. J. GrapD. Strickland C. Sessler
  • Medicine
    American journal of critical care : an official publication, American Association of Critical-Care Nurses
  • 2003
The weaning protocol introduced in this study demonstrates the benefits of using a collaborative team to identify best practices and implement them in a practice setting and significantly reduced the duration of mechanical ventilation.

Decrease in ventilation time with a standardized weaning process.

Protocol-guided weaning from mechanical ventilation leads to more rapid extubation than physician-directed weaning and has great potential for cost savings.

Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol.

It is demonstrated that respiratory therapists can safely and efficiently wean cardiac surgery patients from mechanical ventilation.

Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines.

Protocols should not represent rigid rules but, rather, guides to patient care and may evolve over time as clinical and institutional experience with them increases.

Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation

A multifaceted, multidisciplinary weaning management program can change the process of care used for weaning patients from mechanical ventilation throughout an acute care hospital and across multiple services, which can lead to large reductions in the duration of mechanical ventilation, length of stay, and hospital costs.