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Decrease in Ventilation Time With a Standardized Weaning Process
H. Mathilda Horst, MD;
Deidre Mouro, RRT;
Ruth Ann Hall-Jenssens, RN;
Nikolai Pamukov, RRT
Arch Surg. 1998;133:483-489.
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.
From the Division of Trauma and Critical Care Surgery, Department of Surgery (Dr Horst), Department of Respiratory Therapy (Ms Mouro and Mr Pamukov), and Surgical Intensive Care Unit (Ms Hall-Jenssens), Henry Ford Hospital, Detroit, Mich.
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