Efficacy of Weaning Protocol in Medical Intensive Care Unit of Tertiary Care Center
Chaiwat Bumroongkit, MD*, Chalerm Liwsrisakun, MD*, Athavudh Deesomchok, MD*, Theerakorn Theerakittikul MD*, Chaicharn Pothirat, MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : To evaluate the efficacy of the protocol-directed weaning from a mechanical ventilator compared
to physician-directed weaning.
Materials and Methods : A comparative study between retrospective studies of physician-directed weaning as
controls (N = 198) reviewed from July 2000 to July 2002 and the prospective studies of protocol-directed
weaning as intervention (N = 196) enrolled from October 2002 to October 2003 in the medical ICU of
Maharaj Nakorn Chiang Mai Hospital, tertiary care center of northern Thailand. Study results were con-
cluded by Fisher’s exact test.
Results : Baseline characteristics data of both groups including sex, age, illness severity which demonstrated
by APACHE II score and PaO2/FiO2 ratio, causes of respiratory failure and mode of mechanical ventilation
used were similar. The duration of mechanical ventilation before weaning was 5.89 + 3.71 days in the
protocol-directed group and 7.41 + 5.54 days in the physician-directed group (p < 0.05). Weaning duration
in the protocol-directed group was significantly shorter than the physician-directed group (14.58 + 16.98
hours VS 47.09 + 38.23 hours; p < 0.05). Kaplan-Meire analysis demonstrated that patients in the protocol-
directed group had significantly shorter durations of mechanical ventilation compared to patients in the
physician-directed group (p = 0.001, log-rank test). The ICU LOS was significantly shorter in the protocol-
directed group (7.91 + 4.71 vs 11.53 + 7.80 days; p < 0.05). The 28 days mortality rate and the incidence of
hospital acquired pneumonia seemed to be less in the protocol-directed group (4.60% vs 6.10% and 5.60%
vs 10.10% consecutively) and reintubation rate seemed to be higher in the protocol-directed group (6.1% vs
4.5%) than the physician-directed group but differences were not significant (p > 0.05).
Conclusion : Protocol-directed weaning proved to have more efficacy in weaning patients from a ventilator
than physician-directed weaning in terms of weaning duration and ICU length of stay without a deteriorat-
ing effect to the patients.
Keywords : Protocol-directed weaning, Physician-directed weaning
