Protocol directed weaning reduced time spent on mechanical ventilation
To compare protocol directed weaning from mechanical ventilation by nurses and respiratory therapists with physician directed weaning.
Randomised controlled trial with follow up to discharge.
4 medical and surgical intensive care units in 2 university teaching hospitals in the USA.
357 patients (50% surgical, median age 66 y, 53% women) who were age > 18 years and required mechanical ventilation. Exclusion criteria were head or facial burns or trauma, previous mechanical ventilation in another hospital, or mechanical ventilation needed for organ retrieval.
Patients were stratified by intensive care unit site, and allocated to protocol directed weaning (n=179) or physician directed weaning (n=178). Protocol directed weaning was done by nurses and respiratory therapists when the underlying conditions for mechanical ventilation had resolved or substantially improved. Physicians were notified about the start of weaning, and could change the criteria based procedures. The criteria …