Weaning from Mechanical Ventilator in a Long-term Acute Care Hospital: A Retrospective Analysis
Salim Surani1, *, Munish Sharma2, Kevin Middagh2, Hector Bernal2, Joseph Varon3, Iqbal Ratnani4, Humayun Anjum5, Alamgir Khan5
Identifiers and Pagination:Year: 2020
First Page: 62
Last Page: 66
Publisher Id: TORMJ-14-62
Article History:Received Date: 08/7/2020
Revision Received Date: 18/9/2020
Acceptance Date: 30/9/2020
Electronic publication date: 18/12/2020
Collection year: 2020
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Prolonged Mechanical Ventilation (PMV) is associated with a higher cost of care and increased morbidity and mortality. Patients requiring PMV are referred mostly to Long-Term Acute Care (LTAC) facilities.
To determine if protocol-driven weaning from mechanical ventilator by Respiratory Therapist (RT) would result in quicker weaning from mechanical ventilation, cost-effectiveness, and decreased mortality.
A retrospective case-control study was conducted that utilized protocol-driven ventilator weaning by respiratory therapist (RT) as a part of the Respiratory Disease Certification Program (RDCP).
51 patients on mechanical ventilation before initiation of protocol-based ventilator weaning formed the control group. 111 patients on mechanical ventilation after implementation of the protocol formed the study group. Time to wean from the mechanical ventilation before the implementation of protocol-driven weaning by RT was 16.76 +/- 18.91 days, while that after the implementation of protocol was 7.67 +/- 6.58 days (p < 0.0001). Mortality proportion in patients after implementation of protocol-based ventilator weaning was 0.21 as compared to 0.37 in the control group (p=0.0153). The daily cost of patient care for the LTAC while on mechanical ventilation was $2200/day per patient while it was $ 1400/day per patient while not on mechanical ventilation leading to significant cost savings.
Protocol-driven liberation from mechanical ventilation in LTAC by RT can significantly decrease the duration of a mechanical ventilator, leading to decreased mortality and cost savings.