Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol.
To speed weaning and free physicians for other duties, we changed from a physician-directed to a respiratory therapist (RT)-directed protocol for weaning cardiac surgery patients from mechanical ventilation. Eligible patients were identified by physicians after which RTs initiated and directed an intermittent mandatory ventilation weaning in accordance with a written weaning protocol. Eligibility criteria for entry into the weaning protocol (Phase 1) were expanded at the end of 4 months to include more complicated and unstable patients to be weaned by the RT-directed protocol (Phase 2). Total ventilation time and the duration of weaning were recorded for all patients during both phases and during the 2-months prior to implementing RT-directed weaning (control period). All patients were physician weaned during the control period. No complications were associated with the introduction of RT-directed weaning. The percentage of all cardiac surgery patients weaned by the RTs increased progressively from 41 to 90% over the 7-month study period. When compared to a similar group of physician-weaned patients in the control period, the RT-weaned patients in Phase 1 and Phase 2 of the study had a significantly shorter median total ventilation time (18.6 vs 16.8 hours [p = 0.02, chi 2.95,1] for Phase 1 and 19.7 vs 17.8 hours [p = 0.04] for Phase 2). We have demonstrated that respiratory therapists can safely and efficiently wean cardiac surgery patients from mechanical ventilation.