Spontaneous ventilation test in ventilated patients

an assessment of fulfillment of protocol guidelines vs the analysis by the health team

Abstract

Introduction: Ideal duration of mechanical ventilation is a source of debate and uncertainty. Early weaning attempts result in failure and increased mortality rates, while a late discontinuation of ventilation increases the patients’ risks. The use of the spontaneous ventilation test is safe and results in a fair identification of patients who are ready for weaning. However, adherence to protocol guidelines varies and scientific evidence fails to be implemented in the clinical practice.
Objective: to analyze the interaction between mechanical ventilation discontinuation guidelines and medical assessment for the making of a decision.
Method: descriptive, prospective study which involved interviewing physicians in the Intensive Care Unit on their assessment of the patient’s condition to perform a spontaneous ventilation test. The physicians´ opinion was compared to the assessment carried out as per the Intensive Care Unit Protocol, in order to analyze agreements and discrepancies.
Results: 27 patients and 46 physicians were included in the study. Agreements represented 85.4% of opinions, although there were a few confusing elements confusing as to the medical decision to be made, both in terms of agreements and discrepancies, the most frequent of which was the patient’s level of consciousness.
Discussion and conclusions: assessing the level of consciousness of patients is essential in the daily practice of medicine, although not for the spontaneous ventilation test. It was included in almost one third of the responses obtained and delayed the performance of a spontaneous ventilation test. This fact needs to be considered both in the context of training instances and at the time of optimizing times for the spontaneous ventilation test and the discontinuation of mechanical ventilation.