Compared with specialist registrars, experienced staff nurses shorten the duration of weaning neonates from mechanical ventilation*

Abstract

Objective To compare the overall performance of specially trained neonatal nurses acting autonomously, unsupervised, and without a protocol with specialist registrars when weaning neonates from mechanical ventilation. Design Prospective, randomized, controlled trial. Setting A single neonatal intensive care unit. Patients Neonates requiring conventional mechanical ventilation (n = 50). Interventions Infants on conventional ventilation were randomly assigned to receive either nurse-led (n = 25) or registrar-led (n = 23) weaning. A total of 48 infants completed the study (two infants in the registrar group were excluded when their parents withdrew consent). Measurements and Main Results The main outcome measure, median weaning time, was 1200 mins (95% confidence interval [CI], 621–1779 mins) in the nurse group and 3015 mins (95% CI, 2650–3380 mins) in the registrar group (p = .0458). The median time from treatment assignment to the first ventilator change was 60 mins (95% CI, 52–68 mins) in the nurse group and 120 mins (95% CI, 103–137 mins) in the registrar group (p = .35). On average, the nurses made ventilator changes every 4.5 hrs (95% CI, 2.9–6 hrs) and the registrars every 7.2 hrs (95% CI, 5.4–9 hrs;p = .003). The median number (range) of backward steps taken per infant was 0 (0–5 steps) in the nurse group and 1 (0–5 steps) in the registrar group (p = .019). Conclusions The findings of this study suggest that additional domains of neonatal critical care could be reviewed for their potential transfer to appropriately prepared nurses.