Critical care clinics
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Critical care clinics · Apr 2007
Therapist driven protocols: a look back and moving into the future.
Therapist-driven protocols have been shown to decrease the duration of mechanical ventilation, reduce cost, length of stay, and improve the rate of weaning when compared with physician-directed weaning. This article describes protocols used at the author's institution. It describes how the respiratory therapy service interacts with other services within the hospital to provide the optimal outcome for the patient.
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Approximately 20% of all mechanically ventilated patients fail their first attempt to wean. Prolonged mechanical ventilation increases morbidity, mortality, and costs. No single weaning parameter predicts patient ability to wean. Weaning studies suggest that daily trials of spontaneous breathing for appropriate patients assured by standing protocol and driven by respiratory care practitioners and/or nurses improve the weaning process and patient outcome.
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The primary goal of ventilator support is the maintenance of adequate, but not necessarily normal, gas exchange, which must be achieved with minimal lung injury and the lowest possible degree of hemodynamic impairment, while avoiding injury to distant organs such as the brain. Modes of MV are described by the relationships between the various types of breaths and by the variables that can occur during the inspiratory phase of ventilation. There are two basic modes of ventilation: ventilation limited by a pressure target and ventilation limited to the delivery of a specified volume.