Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses - Effect on weaning time andincidence of ventilator-associated pneumonia

Study objectives: (1) To determine the effect of a single ventilator manage ment protocol (VMP) used in medical and surgical ICUs on the duration of me chanical ventilation. (2) To determine the effect of a VMP on the incidence of ventilator-associated pneumonia (VAP). Design: Prospective, randomized, controlled study. Setting: University medical center. Patients: Three hundred eighty-five patients receiving mechanical ventilati on between June 1997 and May 1998. Interventions: A respiratory care practitioner- and registered nurse-driven VMP. Results: Intervention and control groups were comparable with respect to ag e, sex, severity of illness and injury, and duration of respiratory failure at the time of randomization. The duration of mechanical ventilation for p atients was decreased from a median of 124 h for the control group to 68 h in the VMP group (p = 0.0001). Thirty-one total instances of VAP were noted . Twelve patients in the surgical control group had VAP, compared with 5 in the surgical VMP group (p = 0.061). The impact of the VMP on VAP frequency was less for medical patients. Mortality and ventilator discontinuation fa ilure rates were similar between control and VMP groups. Conclusions: A VMP designed for multidisciplinary use was effective in redu cing duration of mechanical. ventilatory support without any adverse effect s on patient outcome. The VMP was also associated with a decrease in incide nce of VAP in trauma patients. These results, in conjunction with prior stu dies, suggest that VMPs are highly effective means of improving care, even in university ICUs.