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Do any hospitals out there have a decent ventilator protocol. If so, how did you implement it and is your medical director supportive?
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JJ,
we use a simple weaning protocol at my hospital, but honestly we use the Draegers in MMV or Smart Care and let the vents do the weaning while we concentrate on sicker patients.
Greg
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I wish our hospital had a vent protocol. Just give me gas parameters and let me adjust. We deal with a lot of fellows who "him and haw" not wanting to approach the attending with an idea about changing the vent. So let me do it!
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There is so much documentation that protocols decrease times and events! I think people have an ability to choose what evidence based medicine they think is worthwhile. I was so fortunate to work in a facility where the attendings had a lot of trust in the RT's and the fellows were instructed to listen to what we had to say! AH! those days!
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I know this is a bit late since you posted but we have a good solid protocol. We do "sedation vacation" each night to assess patients ability to wean (part of our VAP bundle). We take sedation off, nursing does a neuro check and we to a spontaneous breathing trial (3 minutes), do RSBI, VC and NIF. Then the patient goes back on their settings till the am rounds and this information is passed on to the day shift. When we get an order to "wean per protocol", we take the patient to zero peep, zero psv and again do a 3 min spontaneous breathing trial. If their RSBI is less than 100,we go on Cpap +7 for 30 mins then ABG. If all is good we get orders to extubate. We do not have residents or med students. Just Pulmonary Docs and RT.
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 1 user thanked andrea.macdonald for this useful post.
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mburakof on 10/3/2012(UTC)
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Andrea's post seems like a perfect example of how uncomplicated yet effective a weaning protocol can be. It appears to contain the important features of a weaning protocol, such as sedation vacations and neuro checks before the spontaneous breathing trials and then probably basic steps to decrease support to 0/0 and then proceed to extubation. Thanks Andrea!
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We have a great weaning protocol and vent management protocol. Once we receive a vent order, we make adjustments, including modes and breath types, to meet patient needs. We begin the wean process immediately and wean very similarly to what Andrea posted with the exception of Vc. If you are using RSBI, it's a better indicator of endurance than VC. Our vent hours have dropped to below national standards, from > 110 hrs to 60. We have had periods as low as 40 hrs. Needless to say, the protocols work, and the physicians are delighted with the results.
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Greg and Andrea, can you share you protocols?
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Sure Sandra, I would be happy to share. What is your email adress?
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hi andrea, with this protocol you have in your hospital, is it applicable to all your patients or does it varies or altered slightly on case to case bases?
thanks!
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Hi Stephan,
We do not apply this protocol to any patients who are on A/C, Bilevel, or other definitions of full support. Also if they are unable to come off sedation we do not apply this either. After the decision is made to wean the protocol it is the same process for every patient.
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