The Effect of using a Weaning Assessment Guideline in the Intensive Care Unit at Sanpatong Hospital, Chiang Mai
Keywords:
ventilator weaning, weaning guideline, nurse role, intensive care, patient outcomeAbstract
Mechanical ventilators: MVs are essential for sustaining life in critically ill patients; however, prolonged use may result in serious complications. Therefore, timely and successful ventilator weaning is crucial. This quasi-experimental study aimed to: (1) compare weaning duration, (2) compare weaning success rates, and (3) evaluate nursing practice performance and nurse satisfaction at Sanpatong Hospital. The sample comprised 10 registered nurses and 30 adult patients (≥18 years) with respiratory failure who required mechanical ventilation. Patients were assigned to either a pre-implementation group (n=15), which received conventional care, or a post-implementation group (n=15), which received care based on a newly developed three-phase ventilator weaning assessment guideline. Data were collected sequentially, beginning with the pre-implementation group followed by the post-implementation group. Four research instruments were utilized: (1) the three-phase weaning assessment guideline developed by the researcher, (2) a demographic and clinical data record form, (3) a nursing practice evaluation tool, and (4) a nurse satisfaction questionnaire. All instruments demonstrated excellent content validity (CVI = 1.00). The reliability coefficients were 0.90 for the outcome recording form, 0.80 for the nursing practice evaluation tool, and 0.87 for the satisfaction questionnaire. Data were analyzed using descriptive statistics, the Mann–Whitney U test, and Fisher’s exact test. The results showed that: (1) the post-implementation group had a significantly shorter weaning duration compared with the pre-implementation group (p<.001); (2) although the difference in weaning success rates was not statistically significant (p=.068), a positive trend favoring the post-implementation group was observed; and (3) nurses reported high adherence to the guideline (mean score 23.20±0.79 out of 24) and very high satisfaction (mean 4.76±0.21 out of 5). In conclusion, the newly developed ventilator weaning assessment guideline effectively reduced weaning duration and enhanced nursing practice quality, while also increasing nurse satisfaction.
References
Arayasukawat, P., So-Ngern, A., Reechaipichitkul, W., Chumpangern, W., Arunsurat, I., Ratanawatkul, P., & Chuennok, W. (2021). Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand. BMC pulmonary medicine, 21(1), 47. https://doi.org/10.1186/s12890-021-01415-8
Awang, S., Alias, N., DeWitt, D., Jamaludin, K. A., & Abdul Rahman, M. N. (2021). Design of a clinical practice guideline in nurse-led ventilator-weaning for nursing training. Frontiers in public health, 9, 726647. https://doi.org/10.3389/fpubh.2021.726647
Bianquis, C., De Leo, G., Morana, G., Duarte-Silva, M., Nolasco, S., Vilde, R., Tripipitsiriwat, A., Viegas, P., Purenkovs, M., Duiverman, M., Karagiannids, C., & Fisser, C. (2024). Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2024. Breathe (Sheffield, England), 20(3), 240105. https://doi.org/10.1183/20734735.0105-2024
Blackwood, B., Alderdice, F., Burns, K. E., Cardwell, C. R., Lavery, G., & O’Halloran, P. (2011). Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. The Cochrane database of systematic reviews, 5, CD006904. https://doi.org/10.1002/14651858.CD006904.pub2
Cantero, C., Adler, D., Pasquina, P., Uldry, C., Egger, B., Prella, M., Younossian, A. B., Soccal, P. M., Pépin, J. L., & Janssens, J. P. (2020). Long-term noninvasive ventilation in the Geneva Lake Area: Indications, prevalence, and modalities. Chest, 158(1), 279–291. https://doi.org/10.1016/j.chest.2020.02.064
Carteaux, G., Parfait, M., Combet, M., Haudebourg, A. F., Tuffet, S., & Mekontso Dessap, A. (2021). Patient-self inflicted lung injury: A practical review. Journal of clinical medicine, 10(12), 2738. https://doi.org/10.3390/jcm10122738
Chung, W. C., Sheu, C. C., Hung, J. Y., Hsu, T. J., Yang, S. H., & Tsai, J. R. (2020). Novel mechanical ventilator weaning predictive model. The Kaohsiung journal of medical sciences, 36(10), 841–849. https://doi.org/10.1002/kjm2.12269
Duyndam, A., Houmes, R. J., van Rosmalen, J., Tibboel, D., van Dijk, M., & Ista, E. (2020). Implementation of a nurse-driven ventilation weaning protocol in critically ill children: Can it improve patient outcome?. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 33(1), 80–88. https://doi.org/10.1016/j.aucc.2019.01.005
Fradkin, M., Elyashiv, M., Camel, A., Agay, N., Brik, M., Singer, P., & Dankner, R. (2024). A historical cohort study on predictors for successful weaning from prolonged mechanical ventilation and up to 3-year survival follow-up in a rehabilitation center. Respiratory medicine, 227, 107636. https://doi.org/10.1016/j.rmed.2024.107636
Gray, J. R., Grove, S. K., & Sutherland, S. (2017). The practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). Elsevie.
Gunther, I., Pradhan, D., Lubinsky, A., Urquhart, A., Thompson, J. A., & Reynolds, S. (2021). Use of a multidisciplinary mechanical ventilation weaning protocol to improve patient outcomes and empower staff in a medical intensive care unit. Dimensions of critical care nursing: DCCN, 40(2), 67–74. https://doi.org/10.1097/DCC.0000000000000462
Hanneman, S. K. (2004). Weaning from short-term mechanical ventilation. Critical Care Nurse, 24(1), 70–73. https://doi.org/10.4037/ccn2004.24.1.70
Hasegawa, D., Sato, R., Lee, Y. I., Wang, H. Y., Nishida, K., & Steiger, D. (2024). The prevalence, risk factors, and outcomes of acute pulmonary embolism complicating sepsis and septic shock: A national inpatient sample analysis. Scientific reports, 14(1), 16049. https://doi.org/10.1038/s41598-024-67105-7
Hirzallah, F. M., Alkaissi, A., & do Céu Barbieri-Figueiredo, M. (2019). A systematic review of nurse-led weaning protocol for mechanically ventilated adult patients. Nursing in critical care, 24(2), 89–96. https://doi.org/10.1111/nicc.12404
Huang, H. Y., Huang, C. Y., & Li, L. F. (2022). Prolonged mechanical ventilation: Outcomes and management. Journal of clinical medicine, 11(9), 2451. https://doi.org/10.3390/jcm11092451
Jhou, H. J., Chen, P. H., Ou-Yang, L. J., Lin, C., Tang, S. E., & Lee, C. H. (2021). Methods of weaning from mechanical ventilation in adult: A network meta-analysis. Frontiers in medicine, 8, 752984. https://doi.org/10.3389/fmed.2021.752984
Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E. C., Greene, L. R., Lee, G., Maragakis, L. L., Powell, K., Priebe, G. P., Speck, K., Yokoe, D. S., & Berenholtz, S. M. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection control and hospital epidemiology, 43(6), 687–713. https://doi.org/10.1017/ice.2022.88
Leung, C. H. C., Lee, A., Arabi, Y. M., Phua, J., Divatia, J. V., Koh, Y., Du, B., Tan, C. C., Palo, J. E. M., Burns, K. E. A., Kim, T. H., Egi, M., Faruq, M. O., Shrestha, B. R., Liu, S. F., Nguyen, T. D., Wahjuprajitno, B., Hashmi, M., Patjanasoontorn, B., Latif, Z., & Gomersall, C. D. (2021). Mechanical ventilation discontinuation practices in asia: A multinational survey. Annals of the American Thoracic Society, 18(8), 1352–1359. https://doi.org/10.1513/AnnalsATS.202008-968OC
Lin, Y. C., Chang, R. L., & Tang, C. C. (2025). Safety and efficacy of nurse-led weaning protocols on ICU patients: A systematic review and meta-analysis of randomized controlled trials. Worldviews on evidence-based nursing, 22(2), e70015. https://doi.org/10.1111/wvn.70015
Medical Records and Statistics Section, Sanpatong Hospital. (2025). Statistics of patients admitted to the Medical Intensive Care Unit, 2025 [In Thai]. Sanpatong Hospital, Chiang Mai, Thailand.
Morton, P. G., & Fontaine, D. K. (2018). Critical care nursing: A holistic approach (11th ed.). Wolters Kluwer.
Powers, S. K. (2024). Ventilator-induced diaphragm dysfunction: phenomenology and mechanism(s) of pathogenesis. The Journal of physiology, 602(19), 4729–4752. https://doi.org/10.1113/JP283860
Sison, S. M., Sivakumar, G. K., Caufield-Noll, C., Greenough, W. B., 3rd, Oh, E. S., & Galiatsatos, P. (2021). Mortality outcomes of patients on chronic mechanical ventilation in different care settings: A systematic review. Heliyon, 7(2), e06230. https://doi.org/10.1016/j.heliyon.2021.e06230
Tongtem, E., Tomon, S., & Tanadkar, N. (2023). The weaning protocol from mechanical ventilation for adult and older adult patients requiring prolonged mechanical ventilation: A systematic review [In Thai]. Nursing Research and Innovation Journal, 29(2), 236 - 250. https://he02.tci-thaijo.org/index.php/RNJ/article/view/258025
Vahedian-Azimi, A., Bashar, F. R., Jafarabadi, M. A., Stahl, J., Miller, A. C., & MORZAK Collaborative. (2020). Protocolized ventilator weaning verses usual care: A randomized controlled trial. International Journal of Critical Illness and Injury Science, 10(4), 206–212. https://doi.org/10.4103/IJCIIS.IJCIIS_29_20
