Protocol-driven ventilator management in a trauma intensive care unit population

Abstract

Hypothesis: The use of weaning and sedation protocols affects the intensive care unit (ICU) course of a trauma population.

Design: Nonrandomized before-after trial.

Setting: A level I trauma center.

Patients: Three hundred twenty-eight consecutive trauma patients receiving mechanical ventilation treated in the ICU between October 1, 1997, and November 1, 1999.

Intervention: Sedation and weaning protocols were used to treat patients receiving mechanical ventilation during the second year of this study.

Main outcome measures: Self-extubation rates, ventilator days, number of ICU days, and charges.

Results: There were 168 patients in the preprotocol group (year 1: October 1, 1997, to October 31, 1998) and 160 patients in the postprotocol group (year 2: November 1, 1998, to November 30, 1999). The groups were similar in age (P =.68), Injury Severity Score (P =.06), and Glasgow Coma Scale score (P =.29). There were no differences in self-extubation rates (P =.57), ventilator days (P =.83), ventilator charges (P =.83), number of ICU days (P =.67), or ICU charges (P =.67) between the 2 groups. No statistical difference was identified in any of these categories when long-term ventilator patients (defined as ventilator length of stay > or =3 SDs above the mean) were excluded.

Conclusions: Use of weaning and sedation protocols did not affect the measured outcomes in this study. These findings may reflect difficulties inherent in the protocols or with their utilization. Further subgroup analysis focusing on ventilator-associated pneumonias and mortality may demonstrate benefits not identified herein.