Effect of implementation of protocol-based weaning practices in medical
Intensive Care Unit of a high burden resource-limited setting
Abstract
Introduction: Prolonged mechanical ventilation may be associated with
various complications. Checklists and protocols have been made to
increase the success of weaning from ventilation and reduce the
complications; however, adherence to same and outcomes are not well
documented in resource-limited, high burden settings. This study was
conducted to assess the current weaning practices and impact of
implementation of evidence-based weaning protocol in a high-burden
tertiary care ICU setting. Materials 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 study was
done in three phases, in which 50 patients were recruited in phase one
and phase three. Phase two involved training and education of residents
in protocol-based weaning. The compliance to various steps of the
protocol-based weaning was assessed and outcome parameters were assessed
and compared between phases one and three. Results: The baseline
demographic profile and comorbidities of the patients in both the groups
were comparable. The compliance to weaning protocol was low in various
steps. There was a significant improvement assessment of readiness
criteria, post-SBT assessment and pre-extubation screening in the
post-intervention as compared to the pre-intervention phase. There was
an increase in the proportion of patients who were successfully
extubated from 50% to 66% (p=0.10). There was no significant
difference in duration of mechanical ventilation (10 days vs 7.3 days,
p= 0.61), ICU stay (9.2 vs 8.2 days, p= 0.57), as well as hospital stay
between the two groups (16.1 vs 17.1 days, p= 0.45).Frequency of
re-intubations decreased from 14% to 6% and ventilator associated
pneumonia decreased from 34% to 18%. Conclusion: The study revealed
low compliance to various parameters assessed as a part of weaning;
however, training of resident doctors was successful in improving
compliance with protocol-based weaning.