Protocol-directed weaning from mechanical ventilation in neurological patients: a randomised controlled trial and subgroup analyses based on consciousness. (November 2015)

• Record Type: Journal Article
• Authors: Fan, Linlin; Su, Yingying; Elmadhoun, Omar A.; Zhang, Yan; Zhang, Yunzhou; Gao, Daiquan; Ye, Hong; Chen, Weibi
• Is Part Of: Neurological research. Volume 37:Number 11(2015)
• Page Start: 1006
• Page End: 1014
• Publication Date: 2015-11
• Subjects: Neurocritical care, -- Ventilator weaning, -- Protocol, -- Neurology, -- Randomised controlled trial; Neurology -- Periodicals; Neurosciences -- Periodicals; 616.8005
• DOI: 10.1179/1743132815Y.0000000092
• Languages: English
• ISSNs: 0161-6412

Abstract

Abstract : Objectives: To assess whether a weaning protocol reduces the mechanical ventilation (MV) duration compared to physician's judgement-based weaning in neurological patients and to determine whether patient consciousness influences this reduction. Methods: A randomised controlled trial was conducted in a neurological intensive care unit (NCU) of a tertiary hospital; 144 patients requiring MV for more than 24 hours were randomly allocated to protocol-directed (intervention) ( n = 71) or physician-directed (control) group ( n = 73). Results: The intervention group displayed a significantly shorter median weaning time than the control group (2.00 vs 5.07 days, P < 0.05). The median MV duration tended to be shorter in the intervention group (10.8 vs 14.2 days, P = 0.106). The median length of NCU stay was 19.0 and 26.1 days in the intervention and control groups, respectively ( P = 0.063). The median NCU cost was 9.26 × 10 4 and 12.24 × 10 4 ¥ in the intervention and control groups, respectively ( P = 0.059). The unsuccessful weaning, ventilator-associated pneumonia (VAP) and mortality rates were similar between the groups. Among conscious patients, the median weaning time (2.00 vs 7.00 days, P < 0.05) and the median MV duration (8.8 vs 18.0 days, P = 0.017) were significantly reduced in the intervention group. Among unconscious patients, the intervention group displayed a reduced median weaning time (1.00 vs 3.10 days, P < 0.05), but not median MV duration (11.6 vs 11.1 days, P = 0.702), compared to the control group. Conclusion: Protocol-directed weaning reduces weaning time, MV duration, length of NCU stay and NCU cost in neurological patients, and these effects are more significant in conscious patients than in unconscious patients.