| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
* From the Division of Pulmonary and Critical Care Medicine, Departments of Internal Medicine (Drs. Marelich and Murin), Surgery (Dr. Battistella), Respiratory Care (Mr. Vierra), and Nursing (Mr. Roby), and Center for Health Services Research in Primary Care (Dr. Inciardi), University of California, Davis Medical Center, Sacramento, CA.
Correspondence to: Gregory P. Marelich, MD, FCCP, 6600 Bruceville Rd, Sacramento, CA 95823; e-mail: gregory.p.marelich{at}kp.org
Study objectives: (1) To determine the effect of a single ventilator management protocol (VMP) used in medical and surgical ICUs on the duration of mechanical ventilation. (2) To determine the effect of a VMP on the incidence of ventilator-associated pneumonia (VAP).
Design: Prospective, randomized, controlled study.
Setting: University medical center.
Patients: Three hundred eighty-five patients receiving mechanical ventilation between June 1997 and May 1998.
Interventions: A respiratory care practitioner– and registered nurse–driven VMP.
Results: Intervention and control groups were comparable with respect to age, sex, severity of illness and injury, and duration of respiratory failure at the time of randomization. The duration of mechanical ventilation for patients was decreased from a median of 124 h for the control group to 68 h in the VMP group (p = 0.0001). Thirty-one total instances of VAP were noted. Twelve patients in the surgical control group had VAP, compared with 5 in the surgical VMP group (p = 0.061). The impact of the VMP on VAP frequency was less for medical patients. Mortality and ventilator discontinuation failure rates were similar between control and VMP groups.
Conclusions: A VMP designed for multidisciplinary use was effective in reducing duration of mechanical ventilatory support without any adverse effects on patient outcome. The VMP was also associated with a decrease in incidence of VAP in trauma patients. These results, in conjunction with prior studies, suggest that VMPs are highly effective means of improving care, even in university ICUs.
Key Words: artificial respiration • clinical protocols • ICU • pneumonia • time factors • ventilator weaning
This article has been cited by other articles:
|
|
 |
|
  S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. McLean, L. A. Jensen, D. G. Schroeder, N. R. T. Gibney, and N. M. Skjodt Improving Adherence to a Mechanical Ventilation Weaning Protocol for Critically Ill Adults: Outcomes After an Implementation Program Am. J. Crit. Care., May 1, 2006; 15(3): 299 - 309. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E.A. Burns, N. K.J. Adhikari, and M. O. Meade A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation: [Une meta-analyse d'un sevrage non effractif pour faciliter le retrait de la ventilation mecanique]. Can J Anesth, March 1, 2006; 53(3): 305 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. R. MacIntyre Current Issues in Mechanical Ventilation for Respiratory Failure Chest, November 1, 2005; 128(5_suppl_2): 561S - 567S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Sebat, D. Johnson, A. A. Musthafa, M. Watnik, S. Moore, K. Henry, and M. Saari A Multidisciplinary Community Hospital Program for Early and Rapid Resuscitation of Shock in Nontrauma Patients Chest, May 1, 2005; 127(5): 1729 - 1743. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Hoffman, F. J. Tasota, T. G. Zullo, C. Scharfenberg, and M. P. Donahoe Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit Am. J. Crit. Care., March 1, 2005; 14(2): 121 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 388 - 416. [Full Text] [PDF]
|
|
|
|
|
|
C. A. Manthous, Y. Amoateng-Adjepong, H. E. Fessler, and J. A. Krishnan Weaning by Protocol Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 98 - 100. [Full Text]
|
|
|
|
|
|
J. A. Krishnan, D. Moore, C. Robeson, C. S. Rand, and H. E. Fessler A Prospective, Controlled Trial of a Protocol-based Strategy to Discontinue Mechanical Ventilation Am. J. Respir. Crit. Care Med., March 15, 2004; 169(6): 673 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. O. Meade and E. W. Ely Protocols to Improve the Care of Critically Ill Pediatric and Adult Patients JAMA, November 27, 2002; 288(20): 2601 - 2603. [Full Text] [PDF]
|
|
|
|
 |
|
 J Goldstone The pulmonary physician in critical care * 10: Difficult weaning Thorax, November 1, 2002; 57(11): 986 - 991. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. ARABI, S. VENKATESH, S. HADDAD, A. A. SHIMEMERI, and S. A. MALIK A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization Int. J. Qual. Health Care, October 1, 2002; 14(5): 403 - 410. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. R. MacIntyre Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support : A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine Chest, December 1, 2001; 120(6_suppl): 375S - 396S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. W. Ely, M. O. Meade, E. F. Haponik, M. H. Kollef, D. J. Cook, G. H. Guyatt, and J. K. Stoller Mechanical Ventilator Weaning Protocols Driven by Nonphysician Health-Care Professionals : Evidence-Based Clinical Practice Guidelines Chest, December 1, 2001; 120(6_suppl): 454S - 463S. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
