title: The effect of a mechanical ventilation discontinuation protocol in patients with simple and difficult weaning: impact on clinical outcomes.
abstract: OBJECTIVE
  We sought to determine whether the utilization of a respiratory therapist (RT) driven mechanical ventilation weaning protocol is associated with improvement in clinical outcomes in subjects with simple versus difficult weaning.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data obtained during a quality improvement project. We collected data on 803 consecutive mechanically ventilated patients admitted to the ICU of an academic tertiary care hospital. We compared an RT-driven weaning protocol to a physician-driven weaning strategy.
  
  
  RESULTS
  Of the 803 patients, 651 with simple weaning and 131 with difficult weaning were included in the analysis. In the subjects with simple weaning, 514 (79%) were weaned with the RT-driven protocol. Among the difficult weaning subjects, 101(77.1%) were liberated with the RT-driven protocol. A multivariate analysis, which included Acute Physiology and Chronic Health Evaluation II, body mass index, and type of primary ICU team under which the subjects were admitted, revealed a significant difference in ventilator-free days at 28-days, which supports the RT-driven protocol over the physician-driven strategy. Specifically, the RT-driven protocol increased ventilator-free days by 20.92% and 68.2% among subjects with simple and difficult weaning, respectively. A multivariate analysis of ICU mortality and extubation failure found no significant difference between the RT-driven protocol and the physician-driven strategy.
  
  
  CONCLUSIONS
  The RT-driven weaning protocol increased ventilator-free days among subjects with simple and difficult weaning, with no significant differences in ICU mortality or extubation failure.
authors.affiliation: Pulmonary, Sleep, and Critical Care Medicine Division, Department of Medicine.
authors.forename: Pooja
authors.initials: P
authors.lastname: Gupta
authors.forename: Katherine
authors.initials: K
authors.lastname: Giehler
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Walters
authors.forename: Katherine
authors.initials: K
authors.lastname: Meyerink
authors.forename: Ariel M
authors.initials: AM
authors.lastname: Modrykamien
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002985:Clinical Protocols; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods* / Q000401:mortality / Q000592:standards
keywords: extubation; mechanical ventilation; protocols; respiratory failure; respiratory therapist; weaning