Protocolized Weaning

Weaning protocols usually consist of three parts: 1) objective criteria to judge readiness to wean; 2) guidelines to decrease support gradually; and 3) criteria to assess readiness for extubation.([FOOTNOTE= McConville, J. F., & Kress, J. P. Weaning patients from the ventilator. N Engl J Med. 2012;367(23):2233-2239.],[ANCHOR=],[LINK=])

Improved Outcomes Associated with Protocolized Weaning

In ventilated patients, using effective protocols to better identify patients who are ready for weaning and to better manage the weaning process itself can significantly reduce the duration of ventilation and number of complications.1,([FOOTNOTE=Burns, K. E., Meade, M. O., Lessard, M. R., et al. Wean earlier and automatically with new technology (the WEAN study). A multicenter, pilot randomized controlled trial. Am J Respir Crit Care Med. 2013;187(11):1203-1211.],[ANCHOR=],[LINK=]),([FOOTNOTE=Cook, D. J., Walter, S. D., Cook, R. J., et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433-440.],[ANCHOR=],[LINK=])

Weaning Adherence

While weaning protocols have been shown to improve outcomes, adherence to these protocols remains relatively poor and highly variable across ICUs.

Multiple studies have demonstrated that even in the highly structured environment of clinical trials adherence to weaning protocols is low, ranging from 21-66%.11,15 These low rates may be a product of healthcare professionals perceiving protocols as removing clinical judgment from clinical decision making.11 In order to overcome this obstacle, McLean et al. demonstrated that a process improvement intervention program designed to improve weaning protocol adherence resulted in a 13-fold increase in adherence rates accompanied by a 4-fold decrease in reintubation.11

Guidelines Supporting Protocolized Weaning

Numerous critical and respiratory care societies have developed guidelines to support the weaning process.

Weaning guidelines typically include strategies to reduce the duration of mechanical ventilation once intubated, earlier appreciation of readiness for an SBT, and a shorter process of discontinuation of mechanical ventilation after passing an SBT.

Recommendations supporting the utilization of protocolized weaning to improve clinical outcomes in mechanically ventilated patients

  • 16. MacIntyre, N. R., Cook, D. J., Ely, E. W., Jr., et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S-395S.

  • 17. Greene, L. R., & Kathleen Sposato. Guide to the Elimination of Ventilator-Associated Pneumonia. www.apic.org/Resource_/EliminationGuideForm/18e326ad-b484.../VAP_09.pdf. 2009.

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  • 18. Institute for Healthcare Improvement. How to Guide: Prevent Ventilator-Associated Pneumonia. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventVAP.aspx. 2012.

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