Pulmonary, Sleep, and Critical Care Medicine Division, Department of Medicine.
Respir Care. 2014 Feb;59(2):170-7. doi: 10.4187/respcare.02558. Epub 2013 Jul 23.
We sought to determine whether the utilization of a respiratory therapist (RT) driven mechanical ventilation weaning protocol is associated with improvement in clinical outcomes in subjects with simple versus difficult weaning.
This was a retrospective analysis of prospectively collected data obtained during a quality improvement project. We collected data on 803 consecutive mechanically ventilated patients admitted to the ICU of an academic tertiary care hospital. We compared an RT-driven weaning protocol to a physician-driven weaning strategy.
Of the 803 patients, 651 with simple weaning and 131 with difficult weaning were included in the analysis. In the subjects with simple weaning, 514 (79%) were weaned with the RT-driven protocol. Among the difficult weaning subjects, 101(77.1%) were liberated with the RT-driven protocol. A multivariate analysis, which included Acute Physiology and Chronic Health Evaluation II, body mass index, and type of primary ICU team under which the subjects were admitted, revealed a significant difference in ventilator-free days at 28-days, which supports the RT-driven protocol over the physician-driven strategy. Specifically, the RT-driven protocol increased ventilator-free days by 20.92% and 68.2% among subjects with simple and difficult weaning, respectively. A multivariate analysis of ICU mortality and extubation failure found no significant difference between the RT-driven protocol and the physician-driven strategy.
The RT-driven weaning protocol increased ventilator-free days among subjects with simple and difficult weaning, with no significant differences in ICU mortality or extubation failure.
我们旨在确定呼吸治疗师（RT）驱动的机械通气撤机方案的使用是否与简单撤机与困难撤机患者的临床结局改善相关。
这是一项回顾性分析，对一项质量改进项目中前瞻性收集的数据进行分析。我们收集了 803 例连续机械通气患者入住学术性三级护理医院 ICU 的数据。我们比较了 RT 驱动的撤机方案与医生驱动的撤机策略。
在 803 例患者中，纳入了 651 例简单撤机和 131 例困难撤机患者进行分析。在简单撤机患者中，514 例（79%）采用 RT 驱动方案撤机。在困难撤机患者中，101 例（77.1%）采用 RT 驱动方案撤机。多变量分析包括急性生理学和慢性健康评估 II、体重指数以及患者入住的主要 ICU 团队类型，结果显示 28 天无呼吸机天数存在显著差异，这支持 RT 驱动方案优于医生驱动策略。具体而言，RT 驱动方案使简单撤机和困难撤机患者的无呼吸机天数分别增加了 20.92%和 68.2%。对 ICU 死亡率和拔管失败的多变量分析发现，RT 驱动方案与医生驱动策略之间无显著差异。
RT 驱动的撤机方案增加了简单和困难撤机患者的无呼吸机天数，而在 ICU 死亡率或拔管失败方面无显著差异。
