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

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Abstract
To evaluate the impact of a handheld computer containing a unit-specific weaning protocol on the efficiency of weaning patients from mechanical ventilation. A prospective before-after study design with consecutive control and intervention time periods. A medical intensive care unit of an urban teaching hospital. All patients receiving mechanical ventilation in the medical intensive care unit were eligible for study enrollment. 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). 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). 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.