Major Journal Publishes Study on RT-Driven Protocol

April 29, 2009

A new study in this month’s Pediatrics demonstrates the value of the respiratory therapist protocols in the NICU.

Canadian researchers compared outcomes for preterm infants born before the implementation of a ventilation protocol driven by registered respiratory therapists with those for infants born both before and after the protocol. This therapist-driven weaning protocol produced some significant improvements in patient outcomes that were sustained over time. Specifically:

• The median age for the first extubation attempt decreased from 5.0 days before implementation of the protocol to 1.5 days in the first year after implementation and1.2 days in the second year after implementation.
• Median duration of mechanical ventilation went from 18 days to 5 days after implementation and held steady at 6 days in year 2.
• The exbutation failure rate went from a pre-protocol rate of 40% to 26% in year 1 and continue to fall to 20%.
• The combined intraventricular hemorrhage/periventricular leukomalacia rate significantly decreased from 31% to 18% (year 1) to 4% (year 2).
• Despite the fact that oxygen levels were decreased significantly in the first 24 hours from preprotocol levels, there was an overall increase in retinopathy of prematurity in both year 1 and 2 (15 and 28% respectively).

No differences were seen in mortality rates, pulmonary hemorrhage, air leaks, or bronchopulmonary dysplasia at either 28 days or 36 weeks postconception age.

“In this study, we were able to demonstrate for the first time a significant improvement on the weaning time and duration of mechanical ventilation with the implementation of a ventilation protocol driven by a registered respiratory therapist in the premature population,” write the McMaster University researchers. “Based on our experience, other institutions can customize ventilation protocols to their local practice.”

Read the full paper on the Pediatrics web site.