REDUCING THE DURATION OF MECHANICAL VENTILATION - 3 EXAMPLES OF CHANGE IN THE INTENSIVE-CARE UNIT

Mechanical ventilation is one of the most common medical therapies adm inistered within ICUs. Similarly, the ''weaning'' or ''liberation'' of patients from mechanical ventilation is a common and extremely import ant task performed in ICUs and specialized ventilator units within hos pitals. Various methods exist for assessing a patient's readiness to b e liberated from mechanical ventilation and for conducting the weaning process. Clinicians working in ICUs frequently develop their own pers onal preferences regarding the best approach to weaning patients from ventilatory support. Therefore, variability in the practice of weaning patients from mechanical ventilation is frequently demonstrated, even within a single ICU. Recently, several randomized clinical trials hav e produced conflicting results regarding the best technique for carryi ng out the weaning process (e.g., spontaneous breathing trials, interm ittent mandatory ventilation, pressure-support ventilation). Such conf licting findings have further illustrated the complexity of the weanin g process and the difficulties in identifying the ''best'' medical pra ctices for carrying out this endeavor. However, other investigations h ave suggested that the selection of an individual technique for weanin g patients from mechanical ventilation may not be as important as empl oying a systematic approach to this medical process. Protocol-guided w eaning of mechanical ventilation in the ICU setting, often performed b y nonphysicians, has gained in acceptance as a result of these investi gations. We describe the recent experiences of three ICUs which have d emonstrated significant improvements in patient outcomes (e.g., shorte r durations of mechanical ventilation, lower incidence of ventilator-a ssociated pneumonia, fewer patient complications) as a result of imple menting formal weaning protocols. Our hope is that these data will ass ist other hospitals in developing their own systematic guidelines and protocols for weaning patients from mechanical ventilation.