Use of a Noninvasive Ventilation Respiratory Therapist-Driven Weaning Protocol Decreases Patient Time on Noninvasive Ventilation

Abstract

Background:

Protocol driven care has been well documented to provide effective and efficient care for patient needs. There has been scarce data documenting the value of a noninvasive (NIV) weaning protocol with the goal of decreasing hours (h) patients are on NIV. In order to validate the hypothesis that patients with acute respiratory or cardiac decompensation an evidenced based RT driven weaning protocol would decrease total NIV h.

Methods:

An IRB approved Quality Improvement Project conducted in a Medical Intensive Care Unit. Data from a pre-intervention period of physician directed weaning was compared to prospective data obtained during post-intervention of RT protocol directed use. The Mann-Whitney U test was used to analyze the continuous variables of NIV hours (h) and ICU hours.

Results:

A total of 24 non-OSA diagnosed patients’ who experienced acute decompensation due to pulmonary or cardiac reasons NIV hours were compared. Review of 11 randomly selected patients in the pre-protocol physician directed NIV period was compared to 13 consecutive patients in the post-protocol period when placed on a three day RT directed NIV wean. Pre-intervention period median NIV h for the physician directed NIV wean: Day One 8.44 h, Day Two 4.34 h, and Day Three 0.0 h. Median overall ICU hours were 179.5 in the pre-intervention period. Post intervention Protocol managed median NIV hours; Day One 4.5 h, Day Two 0.0 h, and Day Three 0.0 h. Median overall ICU hours during the post period was 73.1. Mann-Whitney Test η1 = η2 vs η1 ≠ η2 was used for analysis of significance of change for both NIV and ICU hours. The decrease in NIV hours was statistically significant at 0.035. The decrease in ICU hours was not statistically significant at 0.271, No complications or adverse events occurred for any of the patients in the pre or post period.

Conclusions:

The statistically significantly decrease in NIV hours validates the hypothesis that use of a RT driven protocol is effective in decreasing time on NIV. Although ICU hours decreased for the RT protocol group, it was not statistically significant. In conclusion the RT Protocol directed NIV wean is safe and led to a statistically significant decrease in median hours of NIV with RT driven protocol use. Additionally, RT labor hours and ICU bed availability may be gained by implementation of a RT directed NIV weaning protocol.