The relationship of 26 clinical factors to weaning outcome.
BACKGROUND
The Burns Wean Assessment Program (BWAP) assessment checklist is designed to assist clinicians in the systematic evaluation of 26 clinical factors important to weaning. The authors recently described the relationship of the BWAP score (derived from the checklist) to weaning trial outcomes (weaning success or failure) in patients receiving mechanical ventilation for 3 days or longer in 5 adult critical care units. A BWAP score of 50 or higher was significantly associated with weaning success regardless of the specific category of patient (surgical, medical, cardiovascular, etc). This secondary analysis extends the evaluation of the BWAP checklist as it focuses on the importance of each individual BWAP factor to weaning outcomes in 5 different populations of patients.


OBJECTIVE
To identify the relative importance of the 26 BWAP factors to weaning success in patients undergoing mechanical ventilation for 3 days or longer in 5 adult critical care units.


METHODS
BWAP checklists were completed within 24 hours of a weaning attempt in surgical-trauma, medical, neurological, thoracic-cardiovascular, and coronary care units in a 5-year period. Advanced practice nurses using a multidisciplinary pathway, the BWAP checklist, protocols for weaning trials, and sedation guidelines managed the patients similarly.


RESULTS
A total of 20 BWAP factors were significantly associated with successful weaning in all units combined (P ≤ .02). However, some differences in the importance of the BWAP factors to weaning outcome exist between units, with the neuroscience intensive care unit deviating the most from the other units.


CONCLUSIONS
Although not all BWAP factors are significantly associated with weaning success, most are predictive. Restructuring the BWAP as a unit-specific weaning checklist and potential predictor may assist clinicians to address factors that may impede weaning more efficiently and effectively.
University of Virginia Health System, Charlottesville, 22903-3395, USA. smb4h@virginia.edu
Suzanne M
SM
Burns
Charles
C
Fisher
Sidenia Earven S
SE
Tribble
Rose
R
Lewis
Paul
P
Merrel
Mark R
MR
Conaway
Thomas P
TP
Bleck
D000046:Academic Medical Centers; D000328:Adult; D057179:Advanced Practice Nursing; D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods*; D009732:Nursing Care; D010043:Outcome and Process Assessment, Health Care; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*; D055815:Young Adult