title: Low mechanical ventilation times and reintubation rates associated with a specific weaning protocol in an intensive care unit setting: a retrospective study.
abstract: OBJECTIVE
  A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and its results.
  
  
  METHODS
  Patients who required invasive mechanical ventilation for more than 24 hours were included and assessed daily to identify individuals who were ready to begin the weaning process.
  
  
  RESULTS
  We studied 252 patients with a median mechanical ventilation time of 3.7 days (interquartile range of 1 to 23 days), a rapid shallow breathing index value of 48 (median), a maximum inspiratory pressure of 40 cmH(2)0, and a maximum expiratory pressure of 40 cm H(2)0 (median). Of these 252 patients, 32 (12.7%) had to be reintubated, which represented weaning failure. Noninvasive ventilation was used postextubation in 170 (73%) patients, and 15% of these patients were reintubated, which also represented weaning failure. The mortality rate of the 252 patients studied was 8.73% (22), and there was no significant difference in the age, gender, mechanical ventilation time, and maximum inspiratory pressure between the survivors and nonsurvivors.
  
  
  CONCLUSIONS
  The use of a specific weaning protocol resulted in a lower mechanical ventilation time and an acceptable reintubation rate. This protocol can be used as a comparative index in hospitals to improve the weaning system, its monitoring and the informative reporting of patient outcomes and may represent a future tool and source of quality markers for patient care.
authors.affiliation: Intensive Care Unit, Critically III Patients Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. cilene@einstein.br
authors.forename: Cilene Saghabi de Medeiros
authors.initials: CS
authors.lastname: Silva
authors.forename: Karina T
authors.initials: KT
authors.lastname: Timenetsky
authors.forename: Corinne
authors.initials: C
authors.lastname: Taniguchi
authors.forename: Sedila
authors.initials: S
authors.lastname: Calegaro
authors.forename: Carolina Sant'anna A
authors.initials: CS
authors.lastname: Azevedo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Stus
authors.forename: Gustavo Faissol Janot de
authors.initials: GF
authors.lastname: Matos
authors.forename: Raquel A C
authors.initials: RA
authors.lastname: Eid
authors.forename: Carmen Silvia Valente
authors.initials: CS
authors.lastname: Barbas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods* / Q000592:standards