Dimens Crit Care Nurs. 2021;40(2):67-74. doi: 10.1097/DCC.0000000000000462.
Prolonged duration of mechanical ventilation is associated with higher mortality and increased patient complications; conventional physician-directed weaning methods are highly variable and permit significant time that weaning is inefficient and ineffective.
The primary objective of this quality improvement project was to implement a registered nurse (RN)- and respiratory therapist (RT)-driven mechanical ventilation weaning protocol in a medical intensive care unit (ICU) at a tertiary care academic medical center.
This quality improvement project used a quasi-experimental design with a retrospective usual care group who underwent physician-directed (conventional) weaning (n = 51) and a prospective intervention group who underwent protocol-directed weaning (n = 54). Outcomes included duration of mechanical ventilation, ICU length of stay, reintubation rates, and RN and RT satisfaction with the weaning protocol.
Patients in the RN- and RT-driven mechanical ventilation weaning protocol group had significantly lower duration of mechanical ventilation (74 vs 152 hours; P = .002) and ICU length of stay (6.7 vs 10.2 days; P = .031). There was no significant difference in reintubation rates between groups. Staff surveys indicate that both RN and RTs were satisfied with the process change.
Implementation of a multidisciplinary mechanical ventilation weaning protocol is a safe and effective way to improve patient outcomes and empower ICU staff.
机械通气时间延长与死亡率升高和患者并发症增加有关；传统的医生主导的撤机方法差异很大，允许撤机效率低下和无效的大量时间。
本质量改进项目的主要目的是在一家三级保健学术医疗中心的重症监护病房（ICU）实施注册护士（RN）和呼吸治疗师（RT）驱动的机械通气撤机方案。
本质量改进项目采用准实验设计，回顾性地将接受医生指导（常规）撤机的患者作为对照组（n=51），前瞻性地将接受方案指导撤机的患者作为干预组（n=54）。结果包括机械通气时间、ICU 住院时间、再插管率以及 RN 和 RT 对撤机方案的满意度。
接受 RN 和 RT 驱动的机械通气撤机方案的患者机械通气时间明显缩短（74 小时对 152 小时；P=0.002），ICU 住院时间也明显缩短（6.7 天对 10.2 天；P=0.031）。两组再插管率无显著差异。工作人员调查表明，RN 和 RT 都对流程改变感到满意。
实施多学科机械通气撤机方案是改善患者预后和增强 ICU 工作人员能力的安全有效的方法。
