Material 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 primary objective was to study the current practices being followed for weaning of mechanically ventilated patients and the effect of introduction of evidence-based weaning protocols. Patient outcomes were assessed as secondary objective.
All mechanically ventilated patients admitted in medical ICU with age more than 18 years and Glasgow coma scale score greater than 8 were included in the study. Patients with expected duration of mechanical ventilation less than 48 hours, who had neuromuscular disorders, a history of high cervical cord injury and pregnant patients were excluded from the study.
The study was carried out in three phases, each of six months duration. In the first phase (pre-intervention), the existing practices in the ICU was assessed daily. Patients were weaned on the basis of the judgement of the physician in-charge and no stringent protocol was applied. In this phase, compliance to various steps which were later introduced as a part of evidence-based protocol was assessed. During the second phase, the physicians posted in the ICU were educated regarding the steps of weaning and components of evidence-based protocol (Box1). Multiple modalities like posters, group interactions, didactic lectures, social media were used to spread awareness and improve the compliance to the protocol on a regular basis. During the third phase (post-intervention), compliance to various steps of the protocol-based weaning was assessed and outcome parameters were assessed and later on compared between phases one and three. The ethical clearance of the study was obtained from the Institute ethics committee.
Statistical analysis: Data analysis was done using STATA 12 software. For discrete variables, the two groups were compared using Fischer’s exact t-test and continuous variables were compared using two sample t-test.