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. 2012 Sep;67(9):995-1000.
doi: 10.6061/clinics/2012(09)02.

Low mechanical ventilation times and reintubation rates associated with a specific weaning protocol in an intensive care unit setting: a retrospective study

Cilene Saghabi de Medeiros Silva  1 , Karina T Timenetsky, Corinne Taniguchi, Sedila Calegaro, Carolina Sant'anna A Azevedo, Ricardo Stus, Gustavo Faissol Janot de Matos, Raquel A C Eid, Carmen Silvia Valente Barbas
Affiliations

Low mechanical ventilation times and reintubation rates associated with a specific weaning protocol in an intensive care unit setting: a retrospective study

Cilene Saghabi de Medeiros Silva et al. Clinics (Sao Paulo). 2012 Sep.

Abstract

Objectives: A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and its results.

Methods: Patients who required invasive mechanical ventilation for more than 24 hours were included and assessed daily to identify individuals who were ready to begin the weaning process.

Results: We studied 252 patients with a median mechanical ventilation time of 3.7 days (interquartile range of 1 to 23 days), a rapid shallow breathing index value of 48 (median), a maximum inspiratory pressure of 40 cmH(2)0, and a maximum expiratory pressure of 40 cm H(2)0 (median). Of these 252 patients, 32 (12.7%) had to be reintubated, which represented weaning failure. Noninvasive ventilation was used postextubation in 170 (73%) patients, and 15% of these patients were reintubated, which also represented weaning failure. The mortality rate of the 252 patients studied was 8.73% (22), and there was no significant difference in the age, gender, mechanical ventilation time, and maximum inspiratory pressure between the survivors and nonsurvivors.

Conclusions: The use of a specific weaning protocol resulted in a lower mechanical ventilation time and an acceptable reintubation rate. This protocol can be used as a comparative index in hospitals to improve the weaning system, its monitoring and the informative reporting of patient outcomes and may represent a future tool and source of quality markers for patient care.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Causes of orotracheal intubation for 252 mechanically ventilated patients. ARF: acute respiratory failure.
Figure 2
Figure 2
Reasons for reintubation of the 32 patients who failed extubation during a period of up to 48 hours after treatment at Albert Einstein Hospital in São Paulo, Brazil from cases collected over a 15-month period.
See this image and copyright information in PMC

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