title: The use of a weaning and extubation protocol to facilitate effective weaning and extubation from mechanical ventilation in patients suffering from traumatic injuries: a non-randomized experimental trial comparing a prospective to retrospective cohort.
abstract: OBJECTIVE
  Many patients who have suffered traumatic injuries require mechanical ventilation (MV). Weaning is the transition from ventilatory support to spontaneous breathing. The purpose of this study was to determine whether the use of a nurse and a physiotherapist-driven protocol to wean and extubate patients from MV resulted in decreased MV days and intensive care unit (ICU) length of stay (LOS).
  
  
  METHODS
  A prospective cohort of 28 patients (Phase I), weaned according to the protocol developed for the Union Hospital Trauma Unit, was matched retrospectively with a historical cohort of 28 patients (Phase II), weaned according to physician preference. Pairs in the two groups were matched for gender, age, type, and severity of injury.
  
  
  RESULTS
  For mean MV days, the groups did not differ statistically significantly (p 0.3; 14.4 days vs. 16.3 days), although the reduction in MV is clinically significant in view of the complications of additional MV days. The difference of 0.2 days for ICU LOS was not statistically significant (p = 0.9; 20.8 days vs. 21.0 days) demonstrating that the reduction in MV days may not result in the reduction of ICU LOS. The rate of re-intubation was similar between the groups (Phase I = 3/28 vs. Phase II = 4/24).
  
  
  CONCLUSIONS
  The use of a weaning and extubation protocol led by nursing staff and physiotherapists resulted in a clinically significant reduction in MV time, reducing risk of ventilator-associated complications. The role of physiotherapists and nursing staff in weaning and extubation from MV could be greatly expanded in South African ICUs.
authors.affiliation: Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. taschplani@gmail.com
authors.forename: Natascha
authors.initials: N
authors.lastname: Plani
authors.forename: Piet
authors.initials: P
authors.lastname: Becker
authors.forename: Helena
authors.initials: H
authors.lastname: van Aswegen
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000009:adverse effects / Q000451:nursing; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010348:Patient Care Team; D059825:Physical Therapists; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing; D012189:Retrospective Studies; D013019:South Africa; D013997:Time Factors; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000451:nursing; D014947:Wounds and Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult