COMPARISON
OF AUTONOMOUS NURSE VERSUS SPECIALIST REGISTRAR WEANING FROM MECHANICAL
VENTILATION: A RANDOMISED CONTROLLED STUDY
Luyt K,
Boyle B, Petros A
Neonatal Intensive Care Unit, Great Ormond Street Hospital for
Children NHS Trust, London WC1N 3JH
Background:
Nurses
involved in this study completed an advanced respiratory module which
enabled them to make autonomous decisions when altering mechanical
ventilation without adhering to any protocol.
Aim: To compare the duration
of weaning with specialist registrars and determine whether specially
trained nurses could safely wean neonates to extubation.
Method: Infants up to 44 weeks
corrected gestation on conventional ventilation were eligible. Informed
consent was obtained. Infants were randomly allocated to receive either
nurse or registrar led weaning, when the consultant considered weaning to
be appropriate. The consultant remained blinded to the treatment
allocation. The main outcome measure, weaning time, was assessed with
Kaplan-Meier survival analysis. P<0.05 was considered significant.
Results: 50 infants were
randomised to two groups. 2 infants in the registrar group were excluded
when their parents withdrew consent. The ventilatory index at the time of
randomisation and baseline demographic data was similar in the two groups
(p>0.05). The median weaning time (interquartile range) was 20h (12-36.75h) in the nurse
group and 50.25h (23.5-66.25h) in the doctor group (p<0.05). The nurses
made fewer backward steps and more ventilator changes per hour during the
weaning period (p<0.02). One infant in the nurse group was reintubated
within 24 hours; the subsequent diagnosis of tracheomalacia was made.
Conclusion: Autonomous nurse
management of weaning resulted in a significantly shorter weaning period. Safety
was not compromised in either group. The 30.25 hours reduction in time to
extubation when weaning is nurse led has significant implications for
medical and financial resource allocation.