Decrease in ventilation time with a standardized weaning process

Objective: To test the hypothesis that standardizing the process of weaning from mechanical ventilation would decrease ventilation times and length of stay in a surgical intensive care unit. Design: Comparison of historic ventilation times with physician-directed weaning with those obtained with protocol-guided weaning by respiratory therapists. Setting: Urban, teaching surgical intensive care unit with open admission policy and no dominant diagnosis related group. Results: From January 1, 1995, through December 31, 1995, 378 patients who underwent physician-directed weaning from a ventilator had 64 488 hours of ventilation, compared with 57 796 ventilation hours in 515 patients with protocol-guided weaning (April 1, 1996, through May 31, 1997). The mean hours of ventilation decreased by 58 hours, a 46% decrease (P<.001). The length of hospital stay decreased by 1.77 days (29% change), while the Acute Physiology and Chronic Health Evaluation III score remained at 50 to 51. The number of reintubations did not change. The marginal cost savings was $603 580. Conclusion: Protocol-guided weaning from mechanical ventilation leads to more rapid extubation than physician-directed weaning and has great potential for cost savings.