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Dual Treatment Helps Wean Patients From Ventilators
Date:1/11/2008

'Wake up-and-breathe' protocol appears to improve results, study says

FRIDAY, Jan. 11 (HealthDay News) -- Periodically stopping sedatives and allowing for spontaneous breathing -- the so-called "wake up-and-breathe" protocol -- improves results for patients on mechanical ventilators in intensive care units, a new study finds.

This practice helps wean patients from ventilators and should become common practice, the study authors said.

"Our results show that a paired sedation and ventilator weaning protocol resulted in patients spending more time off mechanical ventilation, less time in coma, and less time in intensive care and the hospital, and the protocol improved one-year survival compared with usual care," said lead researcher Dr. Timothy Girard, an instructor in medicine at Vanderbilt University School of Medicine.

About one-third of patients in intensive care are mechanically ventilated, in which a machine generates a controlled flow of air to the patient's respiratory system. Ventilation is often accompanied by large doses of sedatives. But the use of ventilators is associated with significant adverse effects, such as infection, collapsed lungs and lung damage. The sedatives can also produce unwanted side effects, including sleeping for days.

To try to improve outcomes, various weaning programs have been tried, but there has so far been little evidence that they actually improve results, according to background information for the study.

To test its hypothesis, Girard's team assigned 336 patients to either a daily wake up-and-breathe program -- breathing on one's own and stopping sedatives for a short period of time -- or standard care.

Patients in the wake up-and-breathe group were able to breathe without assistance for three days more than patients in the standard care group over the 28 days of the trial, the researchers found.

Also, patients in the wake up-and-breathe group left the hospital four days earlier than patients receiving standard care. And, wake up-and-breathe patients remained in a coma two days less than patients in the standard care group, the study found.

What's more, wake up-and-breathe patients were about a third less likely to die during the year after the trial than were patients given usual care, Girard's team found.

The study is published in the Jan. 12 issue of The Lancet.

"We believe the implications of these results are that the wake up-and-breathe protocol should be routine practice in the management of mechanically ventilated medical intensive care unit patients," Girard said.

"Because the protocol involves the discontinuation of sedation and mechanical ventilation, instead of the addition of potentially risky new procedures or medications, we anticipate that the protocol will be widely adopted," he added.

One expert thinks this protocol is an advance in critical care.

"This is a tremendous finding. It's an important advance in critical care," said Dr. J. Randall Curtis, vice president of the American Thoracic Society and a professor of medicine at the University of Washington.

"Instituting this protocol in most intensive care units would improve outcomes by getting patients off the ventilator faster, reducing sedation, and, it appears, it would also improve survival," he said.

Curtis noted that in his hospital they do breathing tests and reduced sedation, but they haven't linked the two as was done in the study. "Linking the two in a more formal way is something I would try in my hospital," he said.

More information

To learn more about critical care, visit the U.S. National Library of Medicine.



SOURCES: Timothy Girard, M.D., instructor of medicine, Vanderbilt University School of Medicine, Nashville, Tenn.; J. Randall Curtis, M.D., M.P.H., vice president, American Thoracic Society, professor of medicine, University of Washington, Seattle; Jan. 12, 2008, The Lancet


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