Impact of a mechanical ventilation weaning protocol on the extubation failure rate in difficult-to-wean patients.
OBJECTIVE
To determine whether the predictive accuracy of clinical judgment alone can be improved by supplementing it with an objective weaning protocol as a decision support tool.


METHODS
This was a multicenter prospective cohort study carried out at three medical/surgical ICUs. The study involved all consecutive difficult-to-wean ICU patients (failure in the first spontaneous breathing trial [SBT]), on mechanical ventilation (MV) for more than 48 h, admitted between January of 2002 and December of 2005. The patients in the protocol group (PG) were extubated after a T-piece weaning trial and were compared with patients who were otherwise extubated (non-protocol group, NPG). The primary outcome measure was reintubation within 48 h after extubation.


RESULTS
We included 731 patients-533 (72.9%) and 198 (27.1%) in the PG and NPG, respectively. The overall reintubation rate was 17.9%. The extubation success rates in the PG and NPG were 86.7% and 69.6%, respectively (p < 0.001). There were no significant differences between the groups in terms of age, gender, severity score, or pre-inclusion time on MV. However, COPD was more common in the NPG than in the PG (44.4% vs. 17.6%; p < 0.001), whereas sepsis and being a post-operative patient were more common in the PG (23.8% vs. 11.6% and 42.4% vs. 26.4%, respectively; p < 0.001 for both). The time on MV after the failure in the first SBT was higher in the PG than in the NPG (9 ± 5 days vs. 7 ± 2 days; p < 0.001).


CONCLUSIONS
In this sample of difficult-to-wean patients, the use of a weaning protocol improved the decision-making process, decreasing the possibility of extubation failure.
CTI-Adulto, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Porto Alegre, RS, Brazil.
Cassiano
C
Teixeira
Juçara Gasparetto
JG
Maccari
Silvia Regina Rios
SR
Vieira
Roselaine Pinheiro
RP
Oliveira
Augusto
A
Savi
André Sant'Ana
AS
Machado
Túlio Frederico
TF
Tonietto
Ricardo Viegas
RV
Cremonese
Ricardo
R
Wickert
Kamile Borba
KB
Pinto
Fernanda
F
Callefe
Fernanda
F
Gehm
Luis Guilherme
LG
Borges
Eubrando Silvestre
ES
Oliveira
D060666:Airway Extubation / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D002985:Clinical Protocols / Q000592:standards*; D003657:Decision Making; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D017211:Treatment Failure; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*