Weaning from Mechanical Ventilation: Physician-Directed vs a Respiratory-Therapist-Directed Protocol

Abstract

Background

To speed weaning and free physicians for other duties, we changed from a physician-directed to a respiratory therapist (RT)-directed protocol for weaning cardiac surgery patients from mechanical ventilation.

Methods

Eligible patients were identified by physicians after which RTs initiated and directed an intermittent mandatory ventilation weaning in accordance with a written weaning protocol. Eligibility criteria for entry into the weaning protocol (Phase 1) were expanded at the end of 4 months to include more complicated and unstable patients to be weaned by the RT-directed protocol (Phase 2). Total ventilation time and the duration of weaning were recorded for all patients during both phases and during the 2-months prior to implementing RT-directed weaning (control period). All patients were physician weaned during the control period.

Results

No complications were associated with the introduction of RT-directed weaning. The percentage of all cardiac surgery patients weaned by the RTs increased progressively from 41 to 90% over the 7-month study period. When compared to a similar group of physician-weaned patients in the control period, the RT-weaned patients in Phase 1 and Phase 2 of the study had a significantly shorter median total ventilation time (18.6 vs 16.8 hours [p = 0.02, χβ.95,1] for Phase 1 and 19.7 vs 17.8 hours [p = 0.04] for Phase 2).

Conclusions

We have demonstrated that respiratory therapists can safely and efficiently wean cardiac surgery patients from mechanical ventilation.