title: Protocol-directed weaning from mechanical ventilation in neurological patients: a randomised controlled trial and subgroup analyses based on consciousness.
abstract: OBJECTIVE
  To assess whether a weaning protocol reduces the mechanical ventilation (MV) duration compared to physician's judgement-based weaning in neurological patients and to determine whether patient consciousness influences this reduction.
  
  
  METHODS
  A randomised controlled trial was conducted in a neurological intensive care unit (NCU) of a tertiary hospital; 144 patients requiring MV for more than 24 hours were randomly allocated to protocol-directed (intervention) (n = 71) or physician-directed (control) group (n = 73).
  
  
  RESULTS
  The intervention group displayed a significantly shorter median weaning time than the control group (2.00 vs 5.07 days, P < 0.05). The median MV duration tended to be shorter in the intervention group (10.8 vs 14.2 days, P = 0.106). The median length of NCU stay was 19.0 and 26.1 days in the intervention and control groups, respectively (P = 0.063). The median NCU cost was 9.26 × 10(4) and 12.24 × 10(4) ¥ in the intervention and control groups, respectively (P = 0.059). The unsuccessful weaning, ventilator-associated pneumonia (VAP) and mortality rates were similar between the groups. Among conscious patients, the median weaning time (2.00 vs 7.00 days, P < 0.05) and the median MV duration (8.8 vs 18.0 days, P = 0.017) were significantly reduced in the intervention group. Among unconscious patients, the intervention group displayed a reduced median weaning time (1.00 vs 3.10 days, P < 0.05), but not median MV duration (11.6 vs 11.1 days, P = 0.702), compared to the control group.
  
  
  CONCLUSIONS
  Protocol-directed weaning reduces weaning time, MV duration, length of NCU stay and NCU cost in neurological patients, and these effects are more significant in conscious patients than in unconscious patients.
authors: Linlin
authors: L
authors: Fan
authors: Yingying
authors: Y
authors: Su
authors: Omar A
authors: OA
authors: Elmadhoun
authors: Yan
authors: Y
authors: Zhang
authors: Yunzhou
authors: Y
authors: Zhang
authors: Daiquan
authors: D
authors: Gao
authors: Hong
authors: H
authors: Ye
authors: Weibi
authors: W
authors: Chen
mesh_terms: D003244:Consciousness Disorders / Q000150:complications*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D013997:Time Factors
keywords: Neurocritical care,; Neurology,; Protocol,; Randomised controlled trial; Ventilator weaning,