Abstract

MIRANDA GONZALEZ, Isabel Mayré et al. Implementation of a Protocol for Separation of Mechanical Ventilation in Critically Ill Patients Managed by Intensive Care Nurses. CCM [online]. 2014, vol.18, n.3, pp. 430-443. ISSN 1560-4381.

Introduction: the implementation of protocols for weaning from mechanical ventilation (MV) seems to be advantageous although results are contradictories. Objective: to introduce and evaluate a weaning from MV protocol directed by for intensive care nurses to decrease lethality and MV duration. Methods: a quasi-experimental research with the patients admitted at Intensive Care Unit from V. I. Lenin General University Hospital between November 2009 and April 2010 was performed. One hundred and five consecutive invasive ventilated patients for more than 24 hours were evaluated. Patients with medullary lesion above C4 and those in terminal stage were excluded. A protocol based on rapid-shallow-breathing index measured one hour after the patient had been removed from MV was evaluated. Categorical variables were compared with Chi squared test and continuous variables with t-Student. Results: of 135 evaluated patients, 66 were included. 65.2 % were males with a mean age of 59.4±16.9 years and lower APACHE II (19.9±8.0 vs. 25.4±7.1, p<0.001). The first cause of MV was coma. Successful weaning using the protocol was observed in 81.1 % (p=<0.001). Rapid-shallow-breathing index did not show significant differences between the successful weaned patients and the rest ones. Although the duration of MV was lower (6.8±5.9 vs. 5.4±4.5 days, p=0.035) during the protocol implementation period compared with the six previous months, lethality showed no significant differences (66.9% vs. 57.8 %, p=0.18). Conclusions: the introduction of this protocol allowed to diminish the duration of MV but did not improve lethality between ventilated patients

Keywords : mechanical ventilation; intensive care; weaning; lethality; rapid-shallow breathing index.

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