Article

Many patients who have suffered traumatic injuries require mechanical
ventilation (MV). Weaning is the transition from ventilatory support to
spontaneous breathing.
The purpose of this study was to determine whether the use
of a nurse and a physiotherapist-driven protocol to wean and extubate patients
from MV resulted in decreased MV days and intensive care unit (ICU) length of
stay (LOS). METHODS: A prospective cohort of 28 patients (Phase I), weaned
according to the protocol developed for the Union Hospital Trauma Unit, was
matched retrospectively with a historical cohort of 28 patients (Phase II),
weaned according to physician preference. Pairs in the two groups were matched
for gender, age, type, and severity of injury. RESULTS: For mean MV days, the
groups did not differ statistically significantly (p 0.3; 14.4 days vs. 16.3
days), although the reduction in MV is clinically significant in view of the
complications of additional MV days. The difference of 0.2 days for ICU LOS was
not statistically significant (p = 0.9; 20.8 days vs. 21.0 days) demonstrating
that the reduction in MV days may not result in the reduction of ICU LOS. The
rate of re-intubation was similar between the groups (Phase I = 3/28 vs. Phase II
= 4/24). CONCLUSION: The use of a weaning and extubation protocol led by nursing
staff and physiotherapists resulted in a clinically significant reduction in MV
time, reducing risk of ventilator-associated complications.
The role of
physiotherapists and nursing staff in weaning and extubation from MV could be
greatly expanded in South African ICUs.

Langue : ANGLAIS