RT Journal Article SR Electronic T1 The Effect of a Mechanical Ventilation Discontinuation Protocol in Patients with Simple and Difficult Weaning: Impact on Clinical Outcomes JF Respiratory Care FD American Association for Respiratory Care SP 170 OP 177 DO 10.4187/respcare.02558 VO 59 IS 2 A1 Pooja Gupta A1 Katherine Giehler A1 Ryan W Walters A1 Katherine Meyerink A1 Ariel M Modrykamien YR 2014 UL http://rc.rcjournal.com/content/59/2/170.abstract AB OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.