Critical Care Section, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10019, USA.
J Crit Care. 2013 Aug;28(4):433-41. doi: 10.1016/j.jcrc.2012.10.012. Epub 2012 Dec 21.
Ventilator weaning protocols can improve clinical outcomes, but their impact may vary depending on intensive care unit (ICU) structure, staffing, and acceptability by ICU physicians. This study was undertaken to examine their relationship.
DESIGN/METHODS: We prospectively examined outcomes of 102 mechanically ventilated patients for more than 24 hours and weaned using nurse-driven protocol-directed approach (nurse-driven group) in an intensivist-led ICU with low respiratory therapist staffing and compared them with a historic control of 100 patients who received conventional physician-driven weaning (physician-driven group). We administered a survey to assess ICU physicians' attitude.
Median durations of mechanical ventilation (MV) in the nurse-driven and physician-driven groups were 2 and 4 days, respectively (P = .001). Median durations of ICU length of stay (LOS) in the nurse-driven and physician-driven groups were 5 and 7 days, respectively (P = .01). Time of extubation was 2 hours and 13 minutes earlier in the nurse-driven group (P < .001). There was no difference in hospital LOS, hospital mortality, rates of ventilator-associated pneumonia, or reintubation rates between the 2 groups. We identified 4 independent predictors of weaning duration: nurse-driven weaning, Acute Physiology and Chronic Health Evaluation II score, vasoactive medications use, and blood transfusion. Intensive care unit physicians viewed this protocol implementation positively (mean scores, 1.59-1.87 on a 5-point Likert scale).
A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients for more than 24 hours without adverse effects and was well accepted by ICU physicians.
呼吸机脱机方案可以改善临床结果，但它们的影响可能因重症监护病房（ICU）的结构、人员配备以及 ICU 医生的接受程度而异。本研究旨在探讨它们之间的关系。
方法/设计：我们前瞻性地检查了 102 例机械通气超过 24 小时的患者的结局，并在以重症监护医生为主导、呼吸治疗师人员配备低的 ICU 中使用护士驱动的协议指导方法（护士驱动组）进行脱机，然后将其与接受传统医生驱动脱机的 100 例历史对照患者（医生驱动组）进行比较。我们进行了一项调查，以评估 ICU 医生的态度。
护士驱动组和医生驱动组的机械通气（MV）中位持续时间分别为 2 天和 4 天（P=0.001）。护士驱动组和医生驱动组的 ICU 住院时间（LOS）中位数分别为 5 天和 7 天（P=0.01）。护士驱动组拔管时间提前了 2 小时 13 分钟（P<0.001）。两组间住院 LOS、医院死亡率、呼吸机相关性肺炎发生率或再插管率均无差异。我们确定了 4 个脱机持续时间的独立预测因素：护士驱动脱机、急性生理学和慢性健康评估 II 评分、血管活性药物使用和输血。重症监护病房医生对该方案的实施持积极态度（5 分制评分，1.59-1.87 分）。
由 ICU 护士驱动的 MV 解脱方案可缩短机械通气超过 24 小时的患者的 MV 和 ICU LOS 持续时间，且无不良影响，并得到 ICU 医生的认可。
