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Effect of implementation of protocol-based weaning practices in medical Intensive Care Unit of a high burden resource-limited setting
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  • Anuj Ajay,
  • Manasvini Bhatt,
  • Manish Soneja,
  • Animesh Ray,
  • Neeraj Nischal,
  • Piyush Ranjan,
  • Naveet Wig
Anuj Ajay

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Manasvini Bhatt
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Manish Soneja
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Animesh Ray
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Neeraj Nischal
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Piyush Ranjan
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Naveet Wig
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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.