Reduction of ventilatory time using the multidisciplinary disconnection protocol. Pilot study.

OBJECTIVE: compare ventilatory time between patients with the application of a disconnection protocol, managed in a coordinated way between doctor and nurse, with patients managed exclusively by the doctor. METHOD: experimental pilot study before and after. Twenty-five patients requiring invasive mechanical ventilation for 24 hours or more were included, and the protocol-guided group was compared with the protocol-free group managed according to usual practice. RESULTS: by means of the multidisciplinary protocol, the time of invasive mechanical ventilation was reduced (141.94 ± 114.50 vs 113.18 ± 55.14; overall decrease of almost 29 hours), the time spent on weaning (24 hours vs 7.40 hours) and the numbers of reintubation (13% vs 0%) in comparison with the group in which the nurse did not participate. The time to weaning was shorter in the retrospective cohort (2 days vs. 5 days), as was the hospital stay (7 days vs. 9 days). CONCLUSION: the use of a multidisciplinary protocol reduces the duration of weaning, the total time of invasive mechanical ventilation and reintubations. The more active role of the nurse is a fundamental tool to obtain better results.

Diseño e implantación de un protocolo de destete de ventilación mecánica invasiva en pacientes posquirúrgicos / Design and implementation of protocolized weaning from invasive mechanical ventilation in postquirurgical patients

Objetivo. Estandarizar el proceso de destete de ventilación mecánica invasiva a través de la construcción de un protocolo de destete y su algoritmo para pacientes posquirúrgicos consensuado por un equipo multidisciplinar. Método. Se realizó una revisión de la literatura comprendida desde el 1 de enero de 2010 hasta el 31 de diciembre de 2015 en las bases de datos Pub- Med, LILACS, Cochrane Library, SciELO y Science Direct. Resultados. Protocolo de destete de ventilación mecánica invasiva. Conclusiones. Los protocolos son herramientas de trabajo efectivas para disminuir el tiempo de destete en el paciente conectado a la ventilación mecánica invasiva y capaces de influir en la morbimortalidad, en la estancia y costes hospitalarios. La evidencia es confusa en el acuerdo sobre qué modo ventilatorio es superior a la hora de iniciar el destete, aunque la prueba de oxígeno en T y la prueba de respiración espontánea son indicadores con altas probabilidades de éxito a la hora de conocer si el paciente podrá ser extubado. Se recomienda la utilización de ventilación de protección pulmonar con volúmenes bajos. Si el paciente falla el proceso de destete, es aconsejable la espera de 24 horas antes de volver a intentarlo, y que el paciente permanezca con un soporte ventilatorio cómodo. Los predictores de destete y las recomendaciones basadas en la evidencia son de gran utilidad. La participación de la enfermera en la creación, implantación y ejecución de los protocolos de destete es de gran relevancia (AU)

Objective. To determine the relevance of de ventilación mecánica invasiva en pacientes posquirúrgicos Diseño e implantación de un protocolo de destete developing a standardize weaning protocol from invasive mechanical ventilation, based on an agreed protocol and algorithm for postsurgical patients by a multidisciplinary professional team. Method. A literature review in the following databases was performed between January, 1st 2010 and December, 31st 2015: PubMed, LILACS, Cochrane Library, SciELO and Science Direct. Results. Several weaning protocols from invasive mechanical ventilation were found. Conclusions. Protocols are effective tools that help reduce weaning time for patients connected to invasive mechanical ventilation. They have an effect on morbidity, mortality, hospital stay and costs. Evidence about which ventilation method is superior to the others when it comes to weaning processes is unclear. However, we found T-piece trials and spontaneous breathing trials (SBT) to be high probability success indicators to determine whether patients were ready for extubation. The use of lung-protective ventilation with low tidal volumes is recommended. If a patient fails during weaning process, it is advisable to wait 24 hours before trying weaning again, keeping the patient stable with a comfortable ventilation support. Successful weaning predictors and evidence-based recommendations are very useful. Nurse involvement in the creation, implementation and execution of weaning protocols is of great importance (AU)