University of Virginia Health System, Charlottesville, 22903-3395, USA.
Am J Crit Care. 2012 Jan;21(1):52-8; quiz 59. doi: 10.4037/ajcc2012425.
The Burns Wean Assessment Program (BWAP) assessment checklist is designed to assist clinicians in the systematic evaluation of 26 clinical factors important to weaning. The authors recently described the relationship of the BWAP score (derived from the checklist) to weaning trial outcomes (weaning success or failure) in patients receiving mechanical ventilation for 3 days or longer in 5 adult critical care units. A BWAP score of 50 or higher was significantly associated with weaning success regardless of the specific category of patient (surgical, medical, cardiovascular, etc). This secondary analysis extends the evaluation of the BWAP checklist as it focuses on the importance of each individual BWAP factor to weaning outcomes in 5 different populations of patients.
To identify the relative importance of the 26 BWAP factors to weaning success in patients undergoing mechanical ventilation for 3 days or longer in 5 adult critical care units.
BWAP checklists were completed within 24 hours of a weaning attempt in surgical-trauma, medical, neurological, thoracic-cardiovascular, and coronary care units in a 5-year period. Advanced practice nurses using a multidisciplinary pathway, the BWAP checklist, protocols for weaning trials, and sedation guidelines managed the patients similarly.
A total of 20 BWAP factors were significantly associated with successful weaning in all units combined (P ≤ .02). However, some differences in the importance of the BWAP factors to weaning outcome exist between units, with the neuroscience intensive care unit deviating the most from the other units.
Although not all BWAP factors are significantly associated with weaning success, most are predictive. Restructuring the BWAP as a unit-specific weaning checklist and potential predictor may assist clinicians to address factors that may impede weaning more efficiently and effectively.
烧伤脱机评估计划（BWAP）评估检查表旨在帮助临床医生系统评估 26 个对脱机重要的临床因素。作者最近描述了 BWAP 评分（源自检查表）与机械通气 3 天或以上的 5 个成人重症监护病房患者脱机试验结局（脱机成功或失败）的关系。BWAP 评分≥50 与脱机成功显著相关，无论患者的具体类别（手术、内科、心血管等）如何。这项二次分析扩展了 BWAP 检查表的评估，因为它侧重于 5 个不同患者群体中每个 BWAP 因素对脱机结局的重要性。
确定在 5 个成人重症监护病房中，机械通气 3 天或以上的患者中，26 个 BWAP 因素对脱机成功的相对重要性。
在 5 年内，在外科创伤、内科、神经科、胸心血管和冠心病监护病房中，在尝试脱机后 24 小时内完成 BWAP 检查表。使用多学科途径、BWAP 检查表、脱机试验方案和镇静指南的高级执业护士对患者进行类似的管理。
在所有单位中，共有 20 个 BWAP 因素与成功脱机显著相关（P≤0.02）。然而，BWAP 因素对脱机结局的重要性在不同单位之间存在差异，神经重症监护病房与其他单位的差异最大。
尽管并非所有 BWAP 因素都与脱机成功显著相关，但大多数因素具有预测性。将 BWAP 重新构建为特定单位的脱机检查表和潜在预测因子可能有助于临床医生更有效地解决可能阻碍脱机的因素。
