To test the hypothesis that standardizing the process of weaning from mechanical ventilation would decrease ventilation times and length of stay in a surgical intensive care unit.
Comparison of historic ventilation times with physician-directed weaning with those obtained with protocol-guided weaning by respiratory therapists.
Urban, teaching surgical intensive care unit with open admission policy and no dominant diagnosis related group.
From January 1, 1995, through December 31, 1995, 378 patients who underwent physician-directed weaning from a ventilator had 64488 hours of ventilation, compared with 57796 ventilation hours in 515 patients with protocol-guided weaning (April 1, 1996, through May 31, 1997). The mean hours of ventilation decreased by 58 hours, a 46% decrease (P<.001). The length of hospital stay decreased by 1.77 days (29% change), while the Acute Physiology and Chronic Health Evaluation III score remained at 50 to 51. The number of reintubations did not change. The marginal cost savings was $603580.
Protocol-guided weaning from mechanical ventilation leads to more rapid extubation than physician-directed weaning and has great potential for cost savings.