Original research

Mechanical ventilation in the ICU- is there a gap between the time available and time used for nurse-led weaning?

Britt Sætre Hansen^1,2 , Wenche Torunn Mathiesen Fjælberg¹ , Odd Bjarte Nilsen^3,4 , Hans Morten Lossius⁵ and Eldar Søreide¹

¹  Departments of Anaesthesia and Intensive Care, Stavanger University Hospital, Stavaner, Norway

²  Faculty of Social Sciences, University of Stavanger, Stavanger, Norway

³  Norwegian Centre for Movement Disorder, Stavanger University Hospital, Stavanger, Norway

⁴  Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway

⁵  Department of Research and Development, Norwegian Air Ambulance, Drøbak, Norway

author email corresponding author email

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2008, 16:17doi:10.1186/1757-7241-16-17

Published:	2 December 2008

Abstract

Background

Mechanical ventilation (MV) is a key component in the care of critically ill and injured patients. Weaning from MV constitutes a major challenge in intensive care units (ICUs). Any delay in weaning may increase the number of complications and leads to greater expense. Nurse-led, protocol-directed weaning has become popular, but it remains underused. The aim of this study was to identify and quantify discrepancies between the time available for weaning and time actually used for weaning. Further, we also wished to analyse patient and systemic factors associated with weaning activity.

Methods

This retrospective study was performed in a 12-bed general ICU at a university hospital. Weaning data were collected from 68 adult patients on MV and recorded in terms of ventilator-shifts. One ventilator-shift was defined as an 8-hour nursing shift for one MV patient.

Results

Of the 2000 ventilator-shifts analysed, 572 ventilator-shifts were available for weaning. We found that only 46% of the ventilator shifts available for weaning were actually used for weaning. While physician prescription of weaning was associated with increased weaning activity (p < 0.001), a large amount (22%) of weaning took place without physician prescription. Both increased nursing workload and night shifts were associated with reduced weaning activity. During the study period there was a significant increase in performed weaning, both when prescribed or not (p < 0.001).

Conclusion

Our study identified a significant gap between the time available and time actually used for weaning. While various patient and systemic factors were linked to weaning activity, the most important factor in our study was whether the intensive care nurses made use of the time available for weaning.