• Elizabeth Henneman, Kathleen Dracup, Tomas Ganz, Orna Molayeme, and Christopher B Cooper.
• University of California, Los Angeles, Medical Center, USA.
• Am. J. Crit. Care. 2002 Mar 1;11(2):132-40.

BackgroundPatients requiring mechanical ventilation for prolonged periods typically are sicker and have more comorbid illnesses than do patients who can be weaned more rapidly. As a result, the weaning process is often complex, requiring shared decision making by a skilled, multidisciplinary team. Unfortunately, many of the structures used in critical care units to plan and evaluate care do not lend themselves to collaborative management of patients.ObjectiveTo evaluate the effect of a collaborative weaning plan on outcomes, including duration of mechanical ventilation, for patients treated with mechanical ventilation for 7 days or more.MethodsA collaborative weaning plan (weaning board and flow sheet) was introduced into the medical intensive care unit at the University of California Los Angeles, Medical Center. A historical design was used to compare outcomes before and after the plan was used. The primary outcome variable was duration of mechanical ventilation. Other outcomes studied included length of stay in the unit, cost, prevalence of complications (ie, reventilation, readmission to the intensive care unit), and mortality rate.ResultsThe collaborative weaning plan decreased duration of ventilation by 4.9 days (P=.02) and decreased median length of stay in the unit by 4.5 days (P=.004). The median cost per stay in the unit decreased from $50462 to $37330 (P=.004). The prevalence of complications did not differ significantly between groups.ConclusionsCollaborative structures (eg, weaning boards, flow sheets) are useful in decreasing duration of mechanical ventilation for patients receiving long-term ventilation.

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