Weaning protocols can improve outcomes, but their efficacy may vary
with patient and staff characteristics. In this prospective, controlled
trial, we compared protocol-based weaning to usual, physiciandirected
weaning in a closed medical intensive care unit (ICU) with
high physician staffing levels and structured, system-based rounds.
Adult patients requiring mechanical ventilation for more than 24
hours were assigned to usual care (UC) or protocol weaning based
on their hospital identification number. Patients assigned to UC
(n 145) were managed at their physicians’ discretion. Patients
assigned to protocol (n 154) underwent daily screening and a
spontaneous breathing trial by respiratory and nursing staff without
physician intervention. There were no significant baseline differences
in patient characteristics between groups. The proportion of
patients (protocol vs. UC) who successfully discontinued mechanical
ventilation (74.7% vs. 75.2%, p 0.92), duration of mechanical
ventilation (median [interquartile range]: 60.4 hours [28.6–167.0
hours] vs. 68.0 hours [27.1–169.3 hours], p 0.61), ICU (25.3% vs.
28.3%) and hospital mortality (36.4% vs. 33.1%), ICU length of stay
(115 vs. 146 hours), and rates of reinstituting mechanical ventilation
(10.3% vs. 9.0%) was similar. We conclude that protocol-directed
weaning may be unnecessary in a closed ICU with generous physician
staffing and structured rounds.