Abstract:
Introduction: Prolonged mechanical ventilation may be
associated with various complications. Checklists and protocols have
been made to increase the success of weaning from ventilation and reduce
the complications; however, adherence to same and outcomes are not well
documented in resource-limited, high burden settings. This study was
conducted to assess the current weaning practices and impact of
implementation of evidence-based weaning protocol in a high-burden
tertiary care ICU setting.
Materials and methods: A quasi experimental (pre-test,
post-test design) study was carried out in the medical ICU of a tertiary
care centre between January 2016 and June 2017.The study was done in
three phases, in which 50 patients were recruited in phase one and phase
three. Phase two involved training and education of residents in
protocol-based weaning. The compliance to various steps of the
protocol-based weaning was assessed and outcome parameters were assessed
and compared between phases one and three.
Results : The baseline demographic profile and comorbidities of
the patients in both the groups were comparable. The compliance to
weaning protocol was low in various steps. There was a significant
improvement assessment of readiness criteria, post-SBT assessment and
pre-extubation screening in the post-intervention as compared to the
pre-intervention phase. There was an increase in the proportion of
patients who were successfully extubated from 50% to 66% (p=0.10).
There was no significant difference in duration of mechanical
ventilation (10 days vs 7.3 days, p= 0.61), ICU stay (9.2 vs 8.2 days,
p= 0.57), as well as hospital stay between the two groups (16.1 vs 17.1
days, p= 0.45).Frequency of re-intubations decreased from 14% to 6%
and ventilator associated pneumonia decreased from 34% to 18%.
Conclusion: The study revealed low compliance to various
parameters assessed as a part of weaning; however, training of resident
doctors was successful in improving compliance with protocol-based
weaning.
Key words: weaning; mechanical ventilation; extubation;
intensive care unit