Implementation Of Respiratory Therapist Driven Protocol To Decrease The Weaning Time Of Intubated Patients In Medical Icu: A Post-Intervention Analysis

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Weaning is described as a gradual process of decreasing ventilator support and is estimated to be 40% of the duration of mechanical ventilation. Based on the previous evidence, it is recommended that the duration of weaning should be at least 30 minutes and not longer than 120 minutes. Longer weaning time is associated with a higher risk of ventilator-associated complications and longer length of intensive care unit (ICU) stay. We aimed to decrease the weaning time in our medical ICU by implementing a respiratory therapist driven protocol and study the effect of this intervention on the re-intubation rate. METHODS: The medical intensive care unit (MICU) was divided into side-1 (MICU-1) and side-2 (MICU-2) to broaden the comparison. The intervention was only done in the MICU-1. 250 mechanically ventilated patients from Jan 1st, 2019 to June 30th, 2019, were included in the pre-intervention group. Additional 330 patients were studied in the post-intervention group for the next six months. We studied the average weaning time in ventilated patients of medical ICU in the pre-intervention period to set a baseline and then attempted to decrease the weaning time with educational awareness and respiratory therapist (RT) driven protocol. RT protocol included independent assessment of patients at the start of day shift to determine the readiness for weaning, calling critical care attending before placing the patient on weaning mode and aiming to extubate the patient within 2 hours, if weaning is successful. RESULTS: In the medical ICU side -1 (MICU-1), during the pre-intervention period, the average weaning time was 4.31 hours. The post-intervention analysis showed a significant reduction in weaning time (2.5 hours, p= 0.00043). To broaden the comparison, weaning time in MICU-1 during the post-intervention period was compared to weaning time in MICU-2. Data showed significantly short weaning duration in MICU-1 compared to MICU-2 (Mean weaning time in hours: 2.5 vs. 3.21, p = 0.00042). Extubation failure rates were compared between the pre and post-intervention periods to see the effect of the intervention. There was no significant difference in the rate of re-intubations between pre and post-intervention periods (Pre=5 events, post= 7 events, p = 0.062). The difference in the number of subjects can account for this small difference (330 vs. 250). CONCLUSIONS: Simple respiratory therapist driven intervention in medical ICU side 1 (MICU-1) resulted in a significantly shorter duration of weaning time compared to control groups. Shorter weaning time did not result in a significant increase in failed extubations. CLINICAL IMPLICATIONS: Respiratory therapist (RT) driven protocol can be utilized in intensive care units to decrease the weaning time on mechanically ventilated patients, and it may result in a decrease in days spent on a mechanical ventilator and subsequently earlier discharge from the hospital. DISCLOSURES: No relevant relationships by Ahmad Arslan, source=Web Response No relevant relationships by Vincent Chan, source=Web Response No relevant relationships by Bilal Lashari, source=Web Response No relevant relationships by nayab Nadeem, source=Web Response No relevant relationships by Rajesh Patel, source=Web Response No relevant relationships by Ahmad Raza, source=Web Response No relevant relationships by Umer Shoukat, source=Web Response