Efficacy of weaning protocol in medical intensive care unit of tertiary care center

Abstract

Objective: To evaluate the efficacy of the protocol-directed weaning from a mechanical ventilator compared to physician-directed weaning. Material and Method: A comparative study between retrospective studies of physician-directed weaning as controls (N = 198) reviewed from July 2000 to July 2002 and the prospective studies of protocol-directed weaning as intervention (N = 196) enrolled from October 2002 to October 2003 in the medical ICU of Maharaj Nakorn Chiang Mai Hospital, tertiary care center of northern Thailand. Study results were concluded by Fisher's exact test. Results: Baseline characteristics data of both groups including sex, age, illness severity which demonstrated by APACHE II score and PaO2/FiO2 ratio, causes of respiratory failure and mode of mechanical ventilation used were similar. The duration of mechanical ventilation before weaning was 5.89 ± 3.71 days in the protocol-directed group and 7.41 ± 5.54 days in the physician-directed group (p < 0.05). Weaning duration in the protocol-directed group was significantly shorter than the physician-directed group (14.58 ± 16.98 hours VS 47.09 ± 38.23 hours; p < 0.05). Kaplan-Meire analysis demonstrated that patients in the protocol-directed group had significantly shorter durations of mechanical ventilation compared to patients in the physician-directed group (p = 0.001, log-rank test). The ICU LOS was significantly shorter in the protocol-directed group (7.91 ± 4.71 vs 11.53 ± 7.80 days; p < 0.05). The 28 days mortality rate and the incidence of hospital acquired pneumonia seemed to be less in the protocol-directed group (4.60% vs 6.10% and 5.60% vs 10.10% consecutively) and reintubation rate seemed to be higher in the protocol-directed group (6.1% vs 4.5%) than the physician-directed group but differences were not significant (p > 0.05). Conclusion: Protocol-directed weaning proved to have more efficacy in weaning patients from a ventilator than physician-directed weaning in terms of weaning duration and ICU length of stay without a deteriorating effect to the patients.