New MCH-RVH protocol helps wean infants from ventilators sooner

In an effort to reduce the number of days that infants need mechanical ventilation, the respiratory therapists (RT) and neonatologists at both the MCH and RVH have developed a protocol which aims to harmonize ventilator weaning practices of premature and term infants in the neonatal intensive care units (NICU). This is the first inter-site RT-driven protocol, and it is an important step in preparation for the move to the Glen.
Evidence shows that the sooner an infant is removed from ventilation, the better the outcome. So to improve the opportunities for this, the respiratory therapists from the MCH and RVH worked with neonatologists from both sites to develop a weaning protocol. The ultimate goal is to reduce the number of days an infant requires mechanical ventilation, thus reducing risk of infection, lung damage and the number of days the infant spends in the NICU.
The NICU nursing teams also participated in the development of the protocol to ensure all aspects of patient care were included. The protocol is essentially an algorithm that allows for a methodical step-by-step approach to weaning the infant. The project received uniform approval from neonatologists at both sites, and after various hospital committees reviewed it, the RTs received the go-ahead.
Not every infant in the NICU is placed on the protocol. The RT notifies the neonatalogists once a patient has met the criteria and is ready to begin being weaned. Ventilation may be required for any number of reasons, and as soon as a baby is brought into the NICU, the immediate concern is to stabilize the infant. Once that is done, the neonatologist and RTs then decide if the child is ready to begin weaning and eventually come off the ventilator. 
A major advantage of the protocol is that it gives clear directives to the RTs and allows them to quickly scale back ventilatory support without having to get medical orders from the neonatalogist for every change on the ventilator, which can help reduce the remaining time that the infant is on a ventilator. In effect, if the infant successfully completes a stage of the protocol, the RT can proceed right away to the next step according to the algorithm.
The RTs say the protocol is running well. It is in its infancy stage and with all things new there is a learning curve and adaptation. They plan to monitor the long-term effects and patient outcomes, as well as assess the impact of having this type of protocol in place and how it might play a role in decreasing airway damage and extubation failure rate.

Marisa Leone
, Assistant Chief Respiratory Therapist at the MCH and Linda Levesque, Respiratory Therapist at the RVH both worked diligently with the neonatologists to get the protocol under way. Neonatologists Dr. Nabeel Ali and Dr. Sophie Nadeau represented both the MCH and RVH neonatal units in helping to develop the protocol.