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IJPR.2018.116

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Table of Contents

Type of Article:  Review

Volume 6; Issue 3 (May 2018)

Page No.: 2705-2715

DOI: https://dx.doi.org/10.16965/ijpr.2018.116

PHYSICIAN DIRECTED PROTOCOL VERSUS PHYSIOTHERAPIST DIRECTED PROTOCOL FOR WEANING PATIENTS FROM MECHANICAL VENTILATION: A LITERATURE REVIEW

Bhatia Sneha *1,   Narasimman S 2.

Vinayaka Institute of Physiotherapy, Pranami Bhavan, Vidhyanagar-Vadtal Road, Bakrol, Anand, Gujarat, India.

Address for Correspondence: Dr. Sneha Bhatia (PT), MPT in Orthopedics and Sports Rehabilitation, I/C Principal/ Assistant Professor, Vinayaka Institute of Physiotherapy, Pranami Bhavan, Vidhyanagar-Vadtal Road, Bakrol, Anand, Gujarat 388315, India. Mob: 8758881025

E-Mail: snehabhatiapt@gmail.com

ABSTRACT

Introduction: Weaning is a process of reducing or removing ventilator support from mechanically ventilated patients. Weaning from mechanical ventilation can be defined as the process of abruptly or gradually withdrawing ventilator support. Over 90% of critically ill patients require mechanical ventilation and 40% of the time patient is receiving mechanical ventilation is spent in process of weaning from it. Successful weaning from ventilatory support is the ultimate goal for all those involved in the care of mechanically ventilated patients in intensive care units.

Methods: Thorough literature search was done through various databases and total of 25 articles were included for the review.

DISCUSSION: The result of the study shows that the therapist directed protocol can effectively wean patients from mechanical ventilation when compared to physician directed protocol. The length of stay in ICU and the cost of hospitalization was also reduced following the implementation of therapist driven protocol. Therapist driven protocol is safe and can lead to extubation more rapidly than physician directed weaning.

Thus therapist driven protocol can safely and rapidly wean patients from mechanical ventilation. It will have effect on ICU length of days and also on hospitalization cost and therapist driven protocol reduces the both. So it is safe to wean the patients using therapist driven protocol.

Conclusion: Based on the literature search it is concluded that the therapist driven weaning protocols can effectively wean the patients from mechanical ventilation and also reduces length of stay and cost of hospitalization when compared to physician directed protocol. Still more research work is needed in this area. More number of randomized controlled trials should be done to prove the effectiveness of therapist driven protocols. Institution of therapist driven protocols can safely and effectively wean patients from mechanical ventilation and reduce length of stay in ICU and also reduces the cost.

KEY WORDS: Weaning, Mechanical ventilation, Ventilation, Therapist driven protocol.

REFERENCES

  1. Jennifer A Pryor, S Ammani Prasad; Intensive care for critically ill adult, Physiotherapy in respiratory and cardiac problem,ch-11:357.
  2. Review-weaning from mechanical ventilation, critical care 2000.
  3. Introduction to a series of systematic reviews of weaning from mechanical ventilation. Chest 2001;120:396.
  4. Anne bruton, Joy HC, Stephen TH; Weaning adults from mechanical ventilation
  5. Imanculada Alia: Liberation from mechanical ventilation: Critical care 2000:72.
  6. Mancebo; weaning from mechanical ventilation: European resp journal 1996.
  7. Evidence based guidelines for weaning and discontinuing ventilator support: Respiratory care 2002;47:71-72.
  8. Mark J. Rumbak; Significant tracheal obstruction failure to wean in patients requiring prolonged mechanical ventilation: Chest 1999;115:1095.
  9. The MERCK manual medical library; complications resulting from mechanical ventilation
  10. Evidence based guidelines for weaning and discontinuing ventilator support; Respiratory care, Jan 2002;47 :72.
  11. Mohamad FE, Pierre BK. clinical review: liberation from mechanical ventilation. critical care 2008;12.
  12. Vassilakopoulos T, Roussos C, Zakynthinos S. Weaning from mechanical ventilation. Journal of critical care. 1999 Mar 1;14(1):39-62.
  13. Shaikh H, Morales D, Laghi F. Weaning from mechanical ventilation. InSeminars in respiratory and critical care medicine 2014 Aug (Vol. 35, No. 04, pp. 451-468). Thieme Medical Publishers.
  14. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T. Weaning from mechanical ventilation. European Respiratory Journal. 2007 May 1;29(5):1033-56.
  15. Robert L Chatburn; should weaning protocol be used with all patients who receive mechanical ventilation?:Resp care may 2007:vol 52(5).
  16. Kollef MH; A randomized controlled trial of protocol directed versus physician directed weaning from mechanical ventilation
  17. Wesley, Albert MB, Donnie P.D; Effect on duration of mechanical ventilation identifying patients capable of breathing spontaneously: new England journal of medicine 1996;335 no.25.
  18. Maureen meade, Gordon guyatt, Lauren Griffith; Introduction to a series of systematic reviews of weaning from mechanical ventilation: chest 2001;120:398.
  19. Stoller JK. The effectiveness of respiratory care protocols. Respiratory Care. 2004 Jul 1;49(7):761-5.
  20. JM Graybeal CRTT; Utilization of respiratory therapist driven protocols-weaning ventilated patients in SICU: The science journal of American association for Respiratory care 1996 www.rcjournal.com/contents/12.98/12.98.pdf
  21. Fitch ZW, Debesa O, Ohkuma R, Duquaine D, Steppan J, Schneider EB, Whitman GJ. A protocol-driven approach to early extubation after heart surgery. The Journal of thoracic and cardiovascular surgery. 2014 Apr 1;147(4):1344-50.
  22. Frank Miller; Evaluation of pulmonary related hospitalization length of stay: The science journal of American association of Respiratory care 2002 rcjournal.com/contents/05.00/05.00.pdf
  23. Schultz TR. weaning children from mechanical ventilation: A prospective randomized trial of protocol versus physician directed weaning: Respiratory care 2001;46:772-782
  24. Hermeto F, Bottino MN, Vaillancourt K, Sant’Anna GM. Implementation of a respiratory therapist-driven protocol for neonatal ventilation: impact on the premature population. Pediatrics. 2009 May 1;123(5):e907-16.
  25. Patrick J Dunne;benefits of respiratory care protocols presented at 50th internation respiratory congress of AARC. https://www.aarc.org/aarc-meetings/congress-2016/congress-program.pdf
  26. Dries DJ, McGonigal MD, Malian MS, Bor BJ, Sullivan C. Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia. Journal of Trauma and Acute Care Surgery. 2004 May 1;56(5):943-52.
  27. Hemant HR, Chacko J, Singh MK. Weaning from mechanical ventilation-current evidence. Indian J Anaesth. 2006 Dec;50(6):435-8.
  28. Vitacca M. Therapist driven protocols. Monaldi archives for chest disease. 2003;59(4):342-4.
  29. Wood G,MacLeod b; weaning from mechanical ventilation: physician directed versus a respiratory therapist directed protocol:critical care medicine 1997;25:567-74.
  30. Blackwood B, Alderdice F, Burns KE, Cardwell CR, Lavery G, O’Halloran P. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev. 2010 Jan 1;5.
  31. Bumroongkit C, Liwsrisakun C; efficacy of weaning protocol in medical intensive care unit of tertiary care center: J Med Assoc Thai. 2005;88(1):52-7.
  32. Malkoç, Mehtap; The effect of physiotherapy on ventilatory dependency and the length of stay in an intensive care unit: international journal of rehabilitation research. 2009;32:88-85.
  33. Tietsort JA. Therapist-driven protocols and newer models for patient care delivery. Respiratory care clinics of North America. 1996 Mar;2(1):147-55.
  34. David JS. Outcomes on post ICU mechanical ventilation: A therapist implemented weaning protocol: chest 2001;119:236-242.
  35. Koch RL. Therapist driven protocols: critical care clinic. 2007;23(2):149-59.
  36. Hansen BS, Severinsson E. Intensive care nurses’ perceptions of protocol-directed weaning—a qualitative study. Intensive and Critical Care Nursing. 2007 Aug 1;23(4):196-205. 

Cite this article: Bhatia Sneha, Narasimman S. PHYSICIAN DIRECTED PROTOCOL VERSUS PHYSIOTHERAPIST DIRECTED PROTOCOL FOR WEANING PATIENTS FROM MECHANICAL VENTILATION: A LITERATURE REVIEW. Int J Physiother Res 2018;6(3):2705-2715. DOI: 10.16965/ijpr.2018.116
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