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Antoni Torres - One of the best experts on this subject based on the ideXlab platform.
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influence of spontaneous breathing on systemic oxidative stress during Ventilator Weaning
European Respiratory Journal, 2013Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Monica Vilaubach, Esther Barreiro, Antoni TorresAbstract:Rationale As the spontaneous breathing trial (SBT) could represent a major cardiopulmonar stress that could be associated with an increased oxidative stress, we assessed the imbalance of systemic oxidants and antioxidants during a SBT in a mixed populaton of ventilated patients and compare those with SBT failure and success. Methods A prospective clinical study was conducted in 89 patients under mechanical ventilation (MV). During the first SBT, blood samples were drawn before, at the end and 24 hours after the SBT. An additional sample from a control group of patients (n=31) who presented respiratory failure without requirement of Ventilator support was also obtained. Samples were processed for the assessment of oxidative stress as measured using several markers: oxidized and nitrated proteins, malondialdehyde (MDA), and oxidized DNA (8-OHdG), and the reduced antioxidant glutathione (GSH). Results Baseline levels of oxidative stress markers were similar in SBT failure (n= 33) and success (n= 56). Systemic levels of protein carbonylation and nitration, and 8-OHdG significantly decreased during SBT in both failure and success groups of patients. MDA levels were increased in SBT failure (p = 0.04) patients, but not in the SBT success group (p=0.29). Protein tyrosine nitration and 8-OHdG levels were higher during MV than those observed in patients non-exposed to MV. Conclusions The liberation of MV during SBT was associated with a decrease in oxidative stress markers, except for MDA, which increased in SBT failure patients. These results suggest that systemic oxidative stress seems to be influenced by MV rather than by the outcome of the SBT during Ventilator Weaning.
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the effect of spontaneous breathing on systemic interleukin 6 during Ventilator Weaning
European Respiratory Journal, 2012Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Rosanel Amaro, Ramon Farre, Antoni TorresAbstract:During the Weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure. 49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n = 39). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined. IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p = 0.02) and in the chronic obstructive pulmonary disease (COPD) population (p = 0.05) with SBT failure compared with success, but not in non-COPD patients (p = 0.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p = 0.02) and those with Weaning success (p = 0.04). No changes were observed in the remaining inflammatory mediators. Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate Weaning, together with the potential clinical implications.
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Predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory ICU
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Esteban Cano, Mauricio Valencia, Antoni TorresAbstract:Purpose An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival.
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predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory icu
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Antoni Torres, Esteban Cano, Mauricio ValenciaAbstract:An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival. We prospectively studied 181 mechanically ventilated patients (131, 72% with chronic respiratory disorders) in whom Weaning had been initiated, divided into simple (78, 43%), difficult (70, 39%), and prolonged (33, 18%) Weaning. We compared the characteristics and outcomes among the three groups and determined the factors associated with prolonged Weaning and survival in multivariate analysis. Patients with simple and difficult Weaning had similar characteristics and outcomes. A higher proportion of patients with prolonged Weaning had chronic obstructive pulmonary disease, and these patients also had more complications, a longer stay and lower survival. Increased heart rate (≥105 min−1, p < 0.001) and PaCO2 (≥54 mmHg, p = 0.001) during the spontaneous breathing trial independently predicted prolonged Weaning. In addition, the need for reintubation (p < 0.001) and hypercapnia during the spontaneous breathing trial (p = 0.003) independently predicted a decreased 90-day survival. Because of the similar characteristics and outcomes, the differentiation between simple and difficult Weaning had no relevant clinical consequences in a respiratory ICU. Patients with prolonged Weaning had the worst outcomes. For the overall population, hypercapnia at the end of spontaneous breathing predicts prolonged Weaning and a worse survival, and clinicians should implement measures aimed at improving Weaning outcome.
Jacobo Sellares - One of the best experts on this subject based on the ideXlab platform.
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influence of spontaneous breathing on systemic oxidative stress during Ventilator Weaning
European Respiratory Journal, 2013Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Monica Vilaubach, Esther Barreiro, Antoni TorresAbstract:Rationale As the spontaneous breathing trial (SBT) could represent a major cardiopulmonar stress that could be associated with an increased oxidative stress, we assessed the imbalance of systemic oxidants and antioxidants during a SBT in a mixed populaton of ventilated patients and compare those with SBT failure and success. Methods A prospective clinical study was conducted in 89 patients under mechanical ventilation (MV). During the first SBT, blood samples were drawn before, at the end and 24 hours after the SBT. An additional sample from a control group of patients (n=31) who presented respiratory failure without requirement of Ventilator support was also obtained. Samples were processed for the assessment of oxidative stress as measured using several markers: oxidized and nitrated proteins, malondialdehyde (MDA), and oxidized DNA (8-OHdG), and the reduced antioxidant glutathione (GSH). Results Baseline levels of oxidative stress markers were similar in SBT failure (n= 33) and success (n= 56). Systemic levels of protein carbonylation and nitration, and 8-OHdG significantly decreased during SBT in both failure and success groups of patients. MDA levels were increased in SBT failure (p = 0.04) patients, but not in the SBT success group (p=0.29). Protein tyrosine nitration and 8-OHdG levels were higher during MV than those observed in patients non-exposed to MV. Conclusions The liberation of MV during SBT was associated with a decrease in oxidative stress markers, except for MDA, which increased in SBT failure patients. These results suggest that systemic oxidative stress seems to be influenced by MV rather than by the outcome of the SBT during Ventilator Weaning.
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the effect of spontaneous breathing on systemic interleukin 6 during Ventilator Weaning
European Respiratory Journal, 2012Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Rosanel Amaro, Ramon Farre, Antoni TorresAbstract:During the Weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure. 49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n = 39). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined. IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p = 0.02) and in the chronic obstructive pulmonary disease (COPD) population (p = 0.05) with SBT failure compared with success, but not in non-COPD patients (p = 0.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p = 0.02) and those with Weaning success (p = 0.04). No changes were observed in the remaining inflammatory mediators. Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate Weaning, together with the potential clinical implications.
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Predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory ICU
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Esteban Cano, Mauricio Valencia, Antoni TorresAbstract:Purpose An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival.
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predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory icu
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Antoni Torres, Esteban Cano, Mauricio ValenciaAbstract:An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival. We prospectively studied 181 mechanically ventilated patients (131, 72% with chronic respiratory disorders) in whom Weaning had been initiated, divided into simple (78, 43%), difficult (70, 39%), and prolonged (33, 18%) Weaning. We compared the characteristics and outcomes among the three groups and determined the factors associated with prolonged Weaning and survival in multivariate analysis. Patients with simple and difficult Weaning had similar characteristics and outcomes. A higher proportion of patients with prolonged Weaning had chronic obstructive pulmonary disease, and these patients also had more complications, a longer stay and lower survival. Increased heart rate (≥105 min−1, p < 0.001) and PaCO2 (≥54 mmHg, p = 0.001) during the spontaneous breathing trial independently predicted prolonged Weaning. In addition, the need for reintubation (p < 0.001) and hypercapnia during the spontaneous breathing trial (p = 0.003) independently predicted a decreased 90-day survival. Because of the similar characteristics and outcomes, the differentiation between simple and difficult Weaning had no relevant clinical consequences in a respiratory ICU. Patients with prolonged Weaning had the worst outcomes. For the overall population, hypercapnia at the end of spontaneous breathing predicts prolonged Weaning and a worse survival, and clinicians should implement measures aimed at improving Weaning outcome.
Hugo Loureiro - One of the best experts on this subject based on the ideXlab platform.
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influence of spontaneous breathing on systemic oxidative stress during Ventilator Weaning
European Respiratory Journal, 2013Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Monica Vilaubach, Esther Barreiro, Antoni TorresAbstract:Rationale As the spontaneous breathing trial (SBT) could represent a major cardiopulmonar stress that could be associated with an increased oxidative stress, we assessed the imbalance of systemic oxidants and antioxidants during a SBT in a mixed populaton of ventilated patients and compare those with SBT failure and success. Methods A prospective clinical study was conducted in 89 patients under mechanical ventilation (MV). During the first SBT, blood samples were drawn before, at the end and 24 hours after the SBT. An additional sample from a control group of patients (n=31) who presented respiratory failure without requirement of Ventilator support was also obtained. Samples were processed for the assessment of oxidative stress as measured using several markers: oxidized and nitrated proteins, malondialdehyde (MDA), and oxidized DNA (8-OHdG), and the reduced antioxidant glutathione (GSH). Results Baseline levels of oxidative stress markers were similar in SBT failure (n= 33) and success (n= 56). Systemic levels of protein carbonylation and nitration, and 8-OHdG significantly decreased during SBT in both failure and success groups of patients. MDA levels were increased in SBT failure (p = 0.04) patients, but not in the SBT success group (p=0.29). Protein tyrosine nitration and 8-OHdG levels were higher during MV than those observed in patients non-exposed to MV. Conclusions The liberation of MV during SBT was associated with a decrease in oxidative stress markers, except for MDA, which increased in SBT failure patients. These results suggest that systemic oxidative stress seems to be influenced by MV rather than by the outcome of the SBT during Ventilator Weaning.
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the effect of spontaneous breathing on systemic interleukin 6 during Ventilator Weaning
European Respiratory Journal, 2012Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Rosanel Amaro, Ramon Farre, Antoni TorresAbstract:During the Weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure. 49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n = 39). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined. IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p = 0.02) and in the chronic obstructive pulmonary disease (COPD) population (p = 0.05) with SBT failure compared with success, but not in non-COPD patients (p = 0.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p = 0.02) and those with Weaning success (p = 0.04). No changes were observed in the remaining inflammatory mediators. Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate Weaning, together with the potential clinical implications.
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Predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory ICU
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Esteban Cano, Mauricio Valencia, Antoni TorresAbstract:Purpose An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival.
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predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory icu
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Antoni Torres, Esteban Cano, Mauricio ValenciaAbstract:An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival. We prospectively studied 181 mechanically ventilated patients (131, 72% with chronic respiratory disorders) in whom Weaning had been initiated, divided into simple (78, 43%), difficult (70, 39%), and prolonged (33, 18%) Weaning. We compared the characteristics and outcomes among the three groups and determined the factors associated with prolonged Weaning and survival in multivariate analysis. Patients with simple and difficult Weaning had similar characteristics and outcomes. A higher proportion of patients with prolonged Weaning had chronic obstructive pulmonary disease, and these patients also had more complications, a longer stay and lower survival. Increased heart rate (≥105 min−1, p < 0.001) and PaCO2 (≥54 mmHg, p = 0.001) during the spontaneous breathing trial independently predicted prolonged Weaning. In addition, the need for reintubation (p < 0.001) and hypercapnia during the spontaneous breathing trial (p = 0.003) independently predicted a decreased 90-day survival. Because of the similar characteristics and outcomes, the differentiation between simple and difficult Weaning had no relevant clinical consequences in a respiratory ICU. Patients with prolonged Weaning had the worst outcomes. For the overall population, hypercapnia at the end of spontaneous breathing predicts prolonged Weaning and a worse survival, and clinicians should implement measures aimed at improving Weaning outcome.
Miquel Ferrer - One of the best experts on this subject based on the ideXlab platform.
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influence of spontaneous breathing on systemic oxidative stress during Ventilator Weaning
European Respiratory Journal, 2013Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Monica Vilaubach, Esther Barreiro, Antoni TorresAbstract:Rationale As the spontaneous breathing trial (SBT) could represent a major cardiopulmonar stress that could be associated with an increased oxidative stress, we assessed the imbalance of systemic oxidants and antioxidants during a SBT in a mixed populaton of ventilated patients and compare those with SBT failure and success. Methods A prospective clinical study was conducted in 89 patients under mechanical ventilation (MV). During the first SBT, blood samples were drawn before, at the end and 24 hours after the SBT. An additional sample from a control group of patients (n=31) who presented respiratory failure without requirement of Ventilator support was also obtained. Samples were processed for the assessment of oxidative stress as measured using several markers: oxidized and nitrated proteins, malondialdehyde (MDA), and oxidized DNA (8-OHdG), and the reduced antioxidant glutathione (GSH). Results Baseline levels of oxidative stress markers were similar in SBT failure (n= 33) and success (n= 56). Systemic levels of protein carbonylation and nitration, and 8-OHdG significantly decreased during SBT in both failure and success groups of patients. MDA levels were increased in SBT failure (p = 0.04) patients, but not in the SBT success group (p=0.29). Protein tyrosine nitration and 8-OHdG levels were higher during MV than those observed in patients non-exposed to MV. Conclusions The liberation of MV during SBT was associated with a decrease in oxidative stress markers, except for MDA, which increased in SBT failure patients. These results suggest that systemic oxidative stress seems to be influenced by MV rather than by the outcome of the SBT during Ventilator Weaning.
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the effect of spontaneous breathing on systemic interleukin 6 during Ventilator Weaning
European Respiratory Journal, 2012Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Rosanel Amaro, Ramon Farre, Antoni TorresAbstract:During the Weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure. 49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n = 39). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined. IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p = 0.02) and in the chronic obstructive pulmonary disease (COPD) population (p = 0.05) with SBT failure compared with success, but not in non-COPD patients (p = 0.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p = 0.02) and those with Weaning success (p = 0.04). No changes were observed in the remaining inflammatory mediators. Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate Weaning, together with the potential clinical implications.
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Predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory ICU
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Esteban Cano, Mauricio Valencia, Antoni TorresAbstract:Purpose An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival.
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predictors of prolonged Weaning and survival during Ventilator Weaning in a respiratory icu
Intensive Care Medicine, 2011Co-Authors: Jacobo Sellares, Hugo Loureiro, Miquel Ferrer, Antoni Torres, Esteban Cano, Mauricio ValenciaAbstract:An International Consensus Conference proposed classifying Weaning into simple, difficult, and prolonged Weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three Weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged Weaning and survival. We prospectively studied 181 mechanically ventilated patients (131, 72% with chronic respiratory disorders) in whom Weaning had been initiated, divided into simple (78, 43%), difficult (70, 39%), and prolonged (33, 18%) Weaning. We compared the characteristics and outcomes among the three groups and determined the factors associated with prolonged Weaning and survival in multivariate analysis. Patients with simple and difficult Weaning had similar characteristics and outcomes. A higher proportion of patients with prolonged Weaning had chronic obstructive pulmonary disease, and these patients also had more complications, a longer stay and lower survival. Increased heart rate (≥105 min−1, p < 0.001) and PaCO2 (≥54 mmHg, p = 0.001) during the spontaneous breathing trial independently predicted prolonged Weaning. In addition, the need for reintubation (p < 0.001) and hypercapnia during the spontaneous breathing trial (p = 0.003) independently predicted a decreased 90-day survival. Because of the similar characteristics and outcomes, the differentiation between simple and difficult Weaning had no relevant clinical consequences in a respiratory ICU. Patients with prolonged Weaning had the worst outcomes. For the overall population, hypercapnia at the end of spontaneous breathing predicts prolonged Weaning and a worse survival, and clinicians should implement measures aimed at improving Weaning outcome.
Wesley E Ely - One of the best experts on this subject based on the ideXlab platform.
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protocol driven Ventilator Weaning reviewing the evidence
Clinics in Chest Medicine, 2008Co-Authors: Timothy D Girard, Wesley E ElyAbstract:Though seminal clinical trials have identified efficacious methods of liberating patients from mechanical ventilation (ie, Weaning), this knowledge is not applied often by physicians in routine practice. Weaning protocols are a strategies by which research results can be translated effectively and efficiently into clinical practice, but results of clinical trials evaluating Weaning protocols have not been uniform, and controversy continues to surround this important area in critical care medicine. This article reviews the rationale for and against the routine use of Weaning protocols and highlights informative details of many clinical trials that have evaluated such protocols.
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mechanical Ventilator Weaning protocols driven by nonphysician health care professionals evidence based clinical practice guidelines
Chest, 2001Co-Authors: Wesley E Ely, Edward F Haponik, Deborah J Cook, Maureen O Meade, Marin H Kollef, Gordon H Guyatt, James K StollerAbstract:Health-care professionals (HCPs) can provide protocol-based care that has a measurable impact on critically ill patients beyond their liberation from mechanical ventilation (MV). Randomized controlled trials have demonstrated that protocols for liberating patients from MV driven by nonphysician HCPs can reduce the duration of MV. The structure and features of protocols should be adapted from published protocols to incorporate patient-specific needs, clinician preferences, and institutional resources. As a general approach, shortly after patients demonstrate that their condition has been stabilized on the Ventilator, a spontaneous breathing trial (SBT) is safe to perform and is indicated. Ventilator management strategies for patients who fail a trial of spontaneous breathing include the following: (1) consideration of all remediable factors (such as electrolyte derangements, bronchospasm, malnutrition, patient positioning, and excess secretions) to enhance the prospects of successful liberation from MV; (2) use of a comfortable, safe, and well-monitored mode of MV (such as pressure support ventilation); and (3) repeating a trial of spontaneous breathing on the following day. For patients who pass the SBT, the decision to extubate must be guided by clinical judgment and objective data to minimize the risk of unnecessary reintubations and self-extubations. Protocols should not represent rigid rules but, rather, guides to patient care. Moreover, the protocols may evolve over time as clinical and institutional experience with them increases. Useful protocols aim to safely and efficiently liberate patients from MV, reducing unnecessary or harmful variations in approach.
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large scale implementation of a respiratory therapist driven protocol for Ventilator Weaning
American Journal of Respiratory and Critical Care Medicine, 1999Co-Authors: Wesley E Ely, Patricia A Bennett, David L Bowton, Sean M Murphy, Allison M Florance, Edward F HaponikAbstract:We prospectively investigated the large-scale implementation of a respiratory-therapist–driven protocol (TDP) that included 117 respiratory care practitioners (RCPs) managing 1,067 patients with respiratory failure over 9,048 patient days of mechanical ventilation. During a 12-mo period, we reintroduced a previously validated protocol that included a daily screen (DS) coupled with spontaneous breathing trials (SBTs) and physician prompt, as a TDP without daily input from a physician or “Weaning team.” With graded, staged educational interventions at 2-mo intervals, RCPs had a 97% completion rate and a 95% correct interpretation rate for the DS. The frequency with which patients who passed the DS underwent SBTs increased throughout the implementation process (p < 0.001). As the year progressed, RCPs more often considered SBTs once patients had passed a DS (p < 0.001), and physicians ordered more SBTs (46 versus 65%, p = 0.004). Overall, SBTs were ordered more often on the medicine than on the surgical serv...
