Protocol-Directed vs. Physician-Directed Weaning from Ventilator in Intra-Abdominal Surgical Patients†
Onuma Chaiwat MD*, Niyomporn Sarima MD*, Kussama Niyompanitpattana MD*, Chulaluk Komoltri DrPH**, Yuthana Udomphorn MD*, Suneerat Kongsayreepong MD*
Affiliation : † This work has been presented at the 2008 American Society of Anesthesiology Annual Meeting, Orlando, Florida on 10/21/08 in the critical care section * Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Research Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Previous studies have demonstrated that protocol-directed weaning is better than physician-directed weaning
in terms of shorter duration of mechanical ventilation in general critically ill patients. In this prospective, randomized
controlled trial, the authors compared duration of mechanical ventilation between protocol based nurse-directed weaning
and physician-directed weaning in patients following intra-abdominal surgery.
Material and Method: One hundred intra-abdominal surgical patients requiring mechanical ventilation for more than 24
hours were randomly assigned to receive either protocol-directed (n = 51) or physician-directed (n = 49) weaning from
mechanical ventilation. Patients assigned to the protocol-directed weaning group underwent daily screening and a spontaneous
breathing trial by nursing staff.
Outcomes: The primary outcome was the duration of mechanical ventilation.
Results : The median duration of mechanical ventilation was 40 and 72 hrs in protocol-directed and physician-directed
groups, respectively (p < 0.001). Two patients in the protocol-directed group and three patients in the physician directed
group were re-intubated within the first 72 hours after extubation (p = 0.61).
Conclusion : Daily screening of respiratory function in intra-abdominal surgical patients followed by trials of spontaneous
breathing performed by nurses resulted in a shorter duration of mechanical ventilation when compared to traditional
physician-directed weaning.
Keywords : Mechanical ventilation, Weaning, Intensive care unit, Outcomes, Protocol-directed weaning, Nursing
