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Weaning Pathways and Protocols
If traditional predictors of weaning have been less
than successful, how may we improve the process of separation
from the ventilator so that our patients are not exposed
to excess risk? One approach is to use pathways or protocols.
Rather than representing "cookbook" medicine,
these attempt to minimize the variation in the care
delivered by different caregivers. Guidelines should
have clearly defined entry criteria and measures of
when to stop and declare that weaning has failed. The
literature has demonstrated that this approach can lead
to reduced duration of ventilation, fewer complications,
and reduced hospital costs.[6,7] Many factors unrelated
to respiratory function are clinically important during
weaning. These include nutrition, psychological factors,
and sedation use. In the case of sedation, Kress and
colleagues[8] have clearly demonstrated the benefits
of a policy of periodic awakening in ventilation management.
Suzanne Burns, RN, MSN, RRT,[9] of the University of
Virginia School of Nursing, Ruckersville, Virginia,
made the following suggestions for success when incorporating
weaning protocols into clinical practice:
Define criteria for entry to the pathway.
Develop signs of intolerance.
Define work intervals and rest periods.
Keep it simple.
Keep it flexible and adaptable.
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