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Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians.
- Source :
- Journal of Critical Care; 2013, Vol. 28 Issue 4, p433-441, 9p
- Publication Year :
- 2013
-
Abstract
- Purpose: Ventilator weaning protocols can improve clinical outcomes, but their impact may vary depending on intensive care unit (ICU) structure, staffing, and acceptability by ICU physicians. This study was undertaken to examine their relationship. Design/Methods: We prospectively examined outcomes of 102 mechanically ventilated patients for more than 24 hours and weaned using nurse-driven protocol-directed approach (nurse-driven group) in an intensivist-led ICU with low respiratory therapist staffing and compared them with a historic control of 100 patients who received conventional physician-driven weaning (physician-driven group). We administered a survey to assess ICU physicians' attitude. Results: Median durations ofmechanical ventilation (MV) in the nurse-driven and physician-driven groups were 2 and 4 days, respectively (P = .001).Median durations of ICUlength of stay (LOS) in the nurse-driven and physician-driven groups were 5 and 7 days, respectively (P = .01). Time of extubation was 2 hours and 13 minutes earlier in the nurse-driven group (P b .001). There was no difference in hospital LOS, hospital mortality, rates of ventilator-associated pneumonia, or reintubation rates between the 2 groups.We identified 4 independent predictors of weaning duration: nurse-drivenweaning, Acute Physiology and Chronic Health Evaluation II score, vasoactive medications use, and blood transfusion. Intensive care unit physicians viewed this protocol implementation positively (mean scores, 1.59-1.87 on a 5-point Likert scale). Conclusions: A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients for more than 24 hours without adverse effects and was well accepted by ICU physicians. [ABSTRACT FROM AUTHOR]
- Subjects :
- PATIENT selection
APACHE (Disease classification system)
CHI-squared test
CRITICAL care medicine
FISHER exact test
LENGTH of stay in hospitals
INTENSIVE care units
LONGITUDINAL method
MEDICAL protocols
MEDICAL practice
NURSES
PHYSICIANS
RACE
STATISTICS
T-test (Statistics)
MECHANICAL ventilators
DATA analysis
ACQUISITION of data
KAPLAN-Meier estimator
Subjects
Details
- Language :
- English
- ISSN :
- 08839441
- Volume :
- 28
- Issue :
- 4
- Database :
- Supplemental Index
- Journal :
- Journal of Critical Care
- Publication Type :
- Academic Journal
- Accession number :
- 89299067
- Full Text :
- https://doi.org/10.1016/j.jcrc.2012.10.012