BACKGROUND: We developed a comprehensive ventilatory management protocol that enables the respiratory therapist to adjust ventilator settings without physician orders. METHODS: We conducted a retrospective review of 50 ventilated patients from the preprotocol period and 57 patients from the postprotocol period. Variables measured included the ability to rest patients totally, number of tachypneic events, the time to respond to abnormal arterial blood gas values or oxygen saturations by pulse oximetry (SpO2) and the subsequent change in ventilator settings, and the duration of mechanical ventilation. These were evaluated before and after the introduction of the protocol. RESULTS: When the goal of mechanical ventilation was to rest patients completely, we observed 282.3 episodes of spontaneous breathing in every 1,000 patient assessments during the preprotocol period but only 218.3 episodes during the postprotocol period. This difference was not statistically significant. However, during weaning; we observed a significant reduction in the number of tachypneic events (respiratory rate greater than 30/min, expressed as rate/1,000) from 186.3 in the preprotocol group, to 102.6 in the postprotocol group (rate/1,000). The median response time was more than 3 times faster in the postprotocol group (10 min) than in the preprotocol group (31 min) (p = 0.0001). There were no statistically significant differences in the duration of mechanical ventilation between the preprotocol group (3.18 days) and the postprotocol group (3.89 days) (median, p = 0.39). CONCLUSION: Although the duration of ventilation was not altered, the introduction of this protocol has significantly improved patient comfort as evaluated by the reduction in tachypneic events and has led to an important reduction in the time to respond to abnormal blood gas and pulse oximetry values. Furthermore, it has formalised a method to totally rest patients in acute respiratory failure.
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