Multifactor clinical score and outcome of mechanical ventilation weaning trials: Burns Wean Assessment Program.
BACKGROUND
The Burns Wean Assessment Program is a 26-factor weaning assessment worksheet and scoring instrument used to reduce practice variability in the clinical management of patients receiving mechanical ventilation. The instrument has been tested in patients in a medical-surgical intensive care unit, but further testing in different populations of adult patients is needed.


OBJECTIVE
To determine the relationship between Burns Wean Assessment Program scores and outcomes of weaning trials in patients treated with mechanical ventilation for 3 or more days.


METHODS
For 5 years in 5 adult critical care units (surgical, medical, neurological, thoracic-cardiovascular, and coronary care), advanced practice nurses collected scores within 24 hours of a weaning attempt. All patients were managed similarly by using a multidisciplinary pathway, the Burns Wean Assessment Program checklist, protocols for weaning trials, and sedation guidelines.


RESULTS
Of 1889 weaning attempts, 1669 (88%) were successful, and 220 (12%) were unsuccessful. Weaning outcomes did not differ according to sex, but significantly more trials were successful in younger patients than in older patients (P = .002) and in patients in different units (P = .01). Regardless of unit, patients with Burns Wean Assessment Program scores greater than 50 were significantly more likely to be weaned successfully (P = .001) than were patients with lower scores.


CONCLUSIONS
Systematic tracking of the factors and scores on the Burns Wean Assessment Program may be helpful in care planning and management and in determining weaning potential.
Burns
Suzanne M
SM
School of Nursing at the University of Virginia Health System, Charlottesville, Virginia 22903-3395, USA. smb4h@virginia.edu
Fisher
Charles
C
Earven Tribble
Sidenia S
SS
Lewis
Rose
R
Merrel
Paul
P
Conaway
Mark R
MR
Bleck
Thomas P
TP
D000328:Adult; D057179:Advanced Practice Nursing; D000368:Aged; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012372:ROC Curve; D012720:Severity of Illness Index; D015300:Ventilator Weaning / Q000379:methods* / Q000451:nursing / Q000592:standards