Background:
The Successful wean & extubation of ventilated patients decreases hospital length of stay and reduces morbidity and mortality. One tool utilized to facilitate this process is “wean predictors” incorporated into RCP driven protocols to determine whether a patient may advance to a spontaneous breathing trial (SBT).
Hypothesis: Patients are less probable to be placed on a SBT due to weaning predictors that are not within the RCP’s scope of practice vs. predictors, which can be manipulated/controlled, by the RCP.
Design: Single center, nonrandomized, prospective, convenience cohort.
Setting- 18 bed general ICU. Patients- 91 adult patients requiring mechanical ventilation > 24 hours, admitted to the ICU between June 2006 and March 2007.
Interventions:
All patients where screened for “readiness to wean” based on the following parameters: heart rate, blood pressure, level of sedation, P/F ratio, minute ventilation, dyspnea on current ventilator support, and pH & base excess (P/F ratio, minute ventilation, & dyspnea were considered predictors the RCP could manipulate).
Data was collected on ventilator day “two” for patients that failed wean screen criteria. The paired two-sample t-test was used to evaluate differences between weaning predictors.
Results:
The level of sedation was the foremost reason why patients did not proceed to a SBT, with a prevalence of 48%. However, when comparing predictors that the RCP could manipulate with predictors influenced by other practitioners there was no relevance between the two groups (p = 0.10).
Conclusion:
By identifying why patients failed wean screen criteria, we may be able to better explore appropriate interventions to augment wean readiness. Currently, at are facility the ICU RN evaluates the level of sedation based on a modified “Ramsey” score, this sedation assessment may be too subjective among many health care providers. Further investigation of comparing the current sedation assessment to processed EEG technology/Bi-spectral index (a objective tool) may prove beneficial in are mechanically ventilated patient population.
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