title: Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians.
abstract: OBJECTIVE
  Ventilator weaning protocols can improve clinical outcomes, but their impact may vary depending on intensive care unit (ICU) structure, staffing, and acceptability by ICU physicians. This study was undertaken to examine their relationship.
  
  
  METHODS
  We prospectively examined outcomes of 102 mechanically ventilated patients for more than 24 hours and weaned using nurse-driven protocol-directed approach (nurse-driven group) in an intensivist-led ICU with low respiratory therapist staffing and compared them with a historic control of 100 patients who received conventional physician-driven weaning (physician-driven group). We administered a survey to assess ICU physicians' attitude.
  
  
  RESULTS
  Median durations of mechanical ventilation (MV) in the nurse-driven and physician-driven groups were 2 and 4 days, respectively (P = .001). Median durations of ICU length of stay (LOS) in the nurse-driven and physician-driven groups were 5 and 7 days, respectively (P = .01). Time of extubation was 2 hours and 13 minutes earlier in the nurse-driven group (P < .001). There was no difference in hospital LOS, hospital mortality, rates of ventilator-associated pneumonia, or reintubation rates between the 2 groups. We identified 4 independent predictors of weaning duration: nurse-driven weaning, Acute Physiology and Chronic Health Evaluation II score, vasoactive medications use, and blood transfusion. Intensive care unit physicians viewed this protocol implementation positively (mean scores, 1.59-1.87 on a 5-point Likert scale).
  
  
  CONCLUSIONS
  A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients for more than 24 hours without adverse effects and was well accepted by ICU physicians.
authors.affiliation: Critical Care Section, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10019, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Danckers
authors.forename: Horiana
authors.initials: H
authors.lastname: Grosu
authors.forename: Raymonde
authors.initials: R
authors.lastname: Jean
authors.forename: Raul B
authors.initials: RB
authors.lastname: Cruz
authors.forename: Amelita
authors.initials: A
authors.lastname: Fidellaga
authors.forename: Qifa
authors.initials: Q
authors.lastname: Han
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Awerbuch
authors.forename: Nagesh
authors.initials: N
authors.lastname: Jadhav
authors.forename: Keith
authors.initials: K
authors.lastname: Rose
authors.forename: Hassan
authors.initials: H
authors.lastname: Khouli
mesh_terms: D018806:APACHE; D000368:Aged; D001291:Attitude of Health Personnel; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010820:Physicians / Q000523:psychology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D015300:Ventilator Weaning / Q000379:methods* / Q000451:nursing*