Use of a handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation

Objective: To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. Design: A prospective before-after study design with consecutive control and intervention time periods. Setting: A medical intensive care unit of an urban teaching hospital. Participants: All patients receiving mechanical ventilation in the medical intensive care unit were eligible for study enrollment. Interventions: Weaning of mechanical ventilation during the control period was conducted by respiratory care practitioners using a previously published protocol (n = 176). During the intervention period, respiratory care practitioners weaned patients using a handheld computer version of the same protocol (n = 176). Measurements and Results: The time for the first spontaneous breathing trial to occur was significantly shorter during the intervention period compared with the control period (49.9 ± 63.2 hrs vs. 72.5 ± 86.9 hrs, p = .018). The percentage of patients undergoing a spontaneous breathing trial when first meeting established criteria for a spontaneous breathing trial was significantly greater during the intervention period (89.8% vs. 63.6%, p < .001). Length of stay in the intensive care unit was also significantly shorter for patients during the intervention period (6.2 ± 7.1 days vs. 7.7 ± 8.0 days, p = .018). Conclusions: This experience suggests that respiratory care practitioners employing a weaning protocol programmed on a handheld computer can wean patients from mechanical ventilation more efficiently compared with the use of a paper-based weaning protocol.