TY - JOUR T1 - The Effect of a Mechanical Ventilation Discontinuation Protocol in Patients with Simple and Difficult Weaning: Impact on Clinical Outcomes JF - Respiratory Care SP - 170 LP - 177 DO - 10.4187/respcare.02558 VL - 59 IS - 2 AU - Pooja Gupta AU - Katherine Giehler AU - Ryan W Walters AU - Katherine Meyerink AU - Ariel M Modrykamien Y1 - 2014/02/01 UR - http://rc.rcjournal.com/content/59/2/170.abstract N2 - 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. ER -