Reduction of ventilatory time using the multidisciplinary disconnection protocol. Pilot study.
Miriam Sánchez-Maciá, Jaime Miralles-Sancho, María José Castaño-Picó and 2 others
PMID 31826158WHAT IT FOUND
A nurse-doctor weaning protocol lowered total ventilator time by almost 29 hours compared with doctor-led care; weaning time was 7.40 versus 24 hours in 25 surgical ICU patients.
Reintubations were 0% with the protocol and 13% without it. This was a small before-after pilot.
Key findings
01Patients managed with the multidisciplinary protocol had shorter total mechanical ventilation time than those managed by doctor-only standard care (113.18±55.14 vs 141.94±114.50 hours; p=0.011).
02Weaning duration was shorter in the protocol group (7.40 hours vs 24 hours; p=0.004).
03Reintubations were lower in the protocol group (0% vs 13%; p=0.004).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a pilot before-after study of 25 patients, with only 9 in the protocol group, and the authors state the sample size limits the conclusions. The protocol group was compared with retrospective records from a different period, not with a concurrent control group. The study was done in a six-bed surgical ICU with high comorbidity and age above 70 years, so it may not apply to other ventilated patients. Different ventilatory modes and T-piece oxygen times were reported between groups. The protocol group had longer stay in the unit, 9 versus 7 days, and the authors say this may be related to the small sample.
The easy way to misread this
Do not conclude that this protocol is proven for all mechanically ventilated patients. It was a small pilot before-after study with 25 patients and only 9 in the protocol group, and the authors state the sample size and retrospective comparison limit the result.