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Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease

Thorens, Jean-Benoit MD; Kaelin, Rainer Maria MD; Jolliet, Philippe MD; Chevrolet, Jean-Claude MD

Clinical Investigation
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Objective  To evaluate the influence of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease.

Design  Data were collected prospectively over a 1-yr period (study year) and compared with previously collected prospective data recorded in our chronic obstructive pulmonary disease database during a 5-yr period.

Setting  The medical intensive care unit (ICU) of a university hospital.

Patients  Eighty-seven patients with chronic obstructive pulmonary disease. Fifteen patients had chronic obstructive pulmonary disease that required mechanical ventilation for acute exacerbation of their disease (study year), and 72 were patients with chronic obstructive pulmonary disease from the previously collected data.

Interventions  The ICU course (duration of mechanical ventilation, mortality) was recorded, as well as several respiratory parameters (pulmonary function tests and arterial blood gases in stable conditions, and nutritional status), and they were compared with an ``index of nursing.''

Measurements and Main Results  We developed an ``index of nursing'', comparing the effective workforce of the nurses (number and qualifications) with the ideal workforce required by the number of patients and the severity of their diseases. A value of 1.0 represented a perfect match between the needed and the effectively present nurses, whereas a lesser value signified a diminished available workforce. This index was compared with the complications and duration of weaning from mechanical ventilation.

During the first 5 yrs, the duration of mechanical ventilation increased progressively from 7.3 plus minus 8.0 to 38.2 plus minus 25.8 days (p equals .006). A significant inverse correlation between the duration of mechanical ventilation and the nursing index (p equals .025) was found. In the sixth comparative year, the number of nurses increased (nursing index equals 1.05) and the duration of mechanical ventilation decreased to 9.9 plus minus 13 days (p less than .001, yr 5 vs. yr 6).

Conclusions  The quality of nursing appears to be a measurable and critical factor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease. Below a threshold in the available workforce of ICU nurses, the weaning duration of patients with chronic obstructive pulmonary disease increases dramatically. Therefore, very close attention should be given to the education and number of ICU nurses.

(Crit Care Med 1995; 23:1807-1815)

From the Medical Intensive Care Unit (Drs. Thorens, Jolliet, and Chevrolet), and the Division of Pneumology (Drs. Thorens and Kaelin), University Hospital, Geneva, Switzerland.

This study was supported by the Department of Internal Medicine, University Hopital, Geneva, Switzerland.

© Williams & Wilkins 1995. All Rights Reserved.