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Length of stay in the intensive care unit (ICU) and hospital are important factors when you’re looking at cost-effectiveness and quality. "The length of ventilation is a small piece of the puzzle," says Michael Gentile, RRT, extracorporeal life support coordinator and pediatric research assistant at Duke University Medical Center in Durham, NC. "Important, but small."
A New England Journal of Medicine editorial accompanying a study on mechanical ventilation in the ICU (N Engl J Med 1996; 335:1,864-1,869) pointed out that physicians in ICUs have practiced as they wished for many years. This approach is now being challenged, however. New algorithms and guidelines exist that standardize patient care in an effort to decrease errors, improve effectiveness, and increase accountability.
The editorial says ICU nurses and respiratory care practitioners are becoming more familiar with protocols because the expensive and often invasive techniques in ICUs are increasingly being subjected to scrutiny by quality overseers.
Gentile says his facility uses weaning protocols established by the ICU medical director.
"Guidelines allow us the latitude to act on our own to a certain extent, so we don’t have to consult unnecessarily with the physicians," says Gentile. "We don’t make decisions, but we follow safe, strict protocols to wean the patients as quickly as possible. For example, if a patient’s arterial oxygen level is above 60 and the oxygen saturation is above 90, we can wean that patient’s fraction of inspired oxygen."