Protocol-driven ventilator management in a trauma intensive care unit population.
OBJECTIVE
The use of weaning and sedation protocols affects the intensive care unit (ICU) course of a trauma population.


METHODS
Nonrandomized before-after trial.


METHODS
A level I trauma center.


METHODS
Three hundred twenty-eight consecutive trauma patients receiving mechanical ventilation treated in the ICU between October 1, 1997, and November 1, 1999.


METHODS
Sedation and weaning protocols were used to treat patients receiving mechanical ventilation during the second year of this study.


METHODS
Self-extubation rates, ventilator days, number of ICU days, and charges.


RESULTS
There were 168 patients in the preprotocol group (year 1: October 1, 1997, to October 31, 1998) and 160 patients in the postprotocol group (year 2: November 1, 1998, to November 30, 1999). The groups were similar in age (P =.68), Injury Severity Score (P =.06), and Glasgow Coma Scale score (P =.29). There were no differences in self-extubation rates (P =.57), ventilator days (P =.83), ventilator charges (P =.83), number of ICU days (P =.67), or ICU charges (P =.67) between the 2 groups. No statistical difference was identified in any of these categories when long-term ventilator patients (defined as ventilator length of stay > or =3 SDs above the mean) were excluded.


CONCLUSIONS
Use of weaning and sedation protocols did not affect the measured outcomes in this study. These findings may reflect difficulties inherent in the protocols or with their utilization. Further subgroup analysis focusing on ventilator-associated pneumonias and mortality may demonstrate benefits not identified herein.
Duane
Therèse M
TM
Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA. brittld@evms.edu
Riblet
Jeffrey L
JL
Golay
David
D
Cole
Frederic J
FJ
Weireter
Leonard J
LJ
Britt
L D
LD
D000328:Adult; D002985:Clinical Protocols / Q000592:standards*; D016292:Procedural Sedation; D003422:Critical Care / Q000592:standards*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods* / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods; D014947:Wounds and Injuries / Q000628:therapy
D006993:Hypnotics and Sedatives; D009294:Narcotics