Weaning Protocols

Test lengths of stay and complications rates of your institution Design evidence-based protocols that are reviewed by local experts Change the weaning culture  

Create a team approach to include physicians, nonphysician health professionals, managers, and ethicists 

Define local goals Promote dedicated personnel 

Educate through feedback, monitoring of appropriate outcomes, and ongoing protocol review. Avoid rigid interpretation Preserve clinical judgment 

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Scheinhom DJ, Chao DC, Steam-Hassenpflug M, et al. Outcomes in post-ICU mechanical ventilation a therapist-implemented weaning protocol. Chest 2001 119(l) 236-242. 

Table 1 Tips for Implementation of Therapist-Driven Weaning Protocols Identify the patient-care issues...

Table 3 Simimary of For and Against Opinions on Using a Weaning Protocol...

IV. Weaning Protocols with Noninvasive Mechanical Ventilation... 

An early SB or PSV trial should be repeated daily in difficult-to-wean patients. Weaning protocols are necessary to assist junior physicians, especially in ICUs where staff turnover is high. 

Saura P, Blanch L, Mestre J, et al. Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 1996 22 1052-1056. 

McLean SE, Jensen LA, Schroeder DG, et al. Improving adherence to a mechanical ventilation weaning protocol for critically ill adults outcomes after an implementation program. Am J Crit Care 2006 15 299-309. 

Grap MJ, Strickland D, Tormey L, et al. Collaborative practice development, implementation, and evaluation of a weaning protocol for patients receiving mechanical ventilation. Am J Crit Care 2003 12 454-460. 

Randolph AG, Wypij D, Venkataraman ST, et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children. A randomized controlled trial, JAMA 2002 288 2561-2568. 

Ely EW. The utility of weaning protocols to expedite liberation from mechanical ventilation. Respir Care Clin N Am 2000 6 303-319. 

Standardized weaning protocols are useful approaches for the difficult-to-wean patients (9-13). Therapist-driven protocols (TDPs) are daily care plans, which are drawn up by experienced staff and designed to be responsive to changes in the patient s condition, the latter being measured objectively by tracking physiological and clinical variables. 

Ely EW, Baker AM, Dunagan DP, et al. Effect of the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996 335 1864-1869. Kollef MH, Shapiro SD, Silver P, et al. A randomized controlled trial of protocol-directed versus physician directed weaning from mechanical ventilation. Crit Care Med 1997 25 567-574. Saura P, Blanch L, Mestre L, et al. Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 1996 22 1052-1056. 

Certified, registered therapist, competent in all equipment procedures associated with ventilation and airway care, assesses patients for dyspnea, gas exchange, comfort and anxiety, manages weaning protocols, and communicates with patient and team... 

Walsh TS, Dodds S, McArdle F. Evaluation of simple criteria to predict successful weaning from mechanical ventilation in intensive care patients. Br J Anaesth 2004 92(6) 793-799. Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M, et al. Outcomes of post-ICU mechanical ventilation a therapist-implemented weaning protocol. Chest 2001 119(l) 236-242, 19. 

These kind of breathing control exercises like ACBT and autogenic drainage are not indicated in severe ventilatory dependent patient that are in an assist-controlled mechanical ventilation mode, however it may be used during weaning protocols. 

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