• Mary Jo Grap, Dale Strickland, Laura Tormey, Kim Keane, Shannon Lubin, Joanne Emerson, Suzanne Winfield, Paul Dalby, Regina Townes, and Curtis N Sessler.
• Virginia Commonwealth University, Richmond, Va., USA.
• Am. J. Crit. Care. 2003 Sep 1;12(5):454-60.

BackgroundUse of protocols to reduce weaning time for patients receiving mechanical ventilation helps reduce cost and length of stay. However, implementation of this type of protocol is not easy and requires a consistent collaborative effort.ObjectiveTo provide a systematic approach to the weaning process by developing, implementing, and evaluating a protocol for weaning patients from mechanical ventilation in a medical respiratory intensive care unit.MethodsThe weaning protocol used was a modification of a protocol developed by Ely et al. Modifications included a more aggressive approach in proceeding to the spontaneous breathing trial, inclusion of the Richmond Agitation-Sedation Scale, and documentation of the production of secretions.ResultsImplementation of the protocol significantly reduced the duration of mechanical ventilation as measured by 8-hour shifts and ventilator days. Although length of stay in the intensive care unit was not significantly reduced (P = .29), a continuing downward trend occurred, from a mean of 8.6 days before the protocol was implemented to 7.9 days during the last 6 months of data collection (P = .07).ConclusionsThe need to provide efficient care requires the collaboration of all disciplines involved in providing patients' care. The weaning protocol introduced in this study demonstrates the benefits of using a collaborative team to identify best practices and implement them in a practice setting.

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