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Variations in the Measurement of Weaning Parameters^*

A Survey of Respiratory Therapists

^* From the Pulmonary and Critical Care Section, West Los Angeles Veterans Affairs Medical Center, and Department of Medicine, UCLA School of Medicine, Los Angeles, CA.

Correspondence to: Guy W. Soo Hoo, MD, MPH, FCCP, West Los Angeles VAMC, Pulmonary and Critical Care (111Q), 11301 Wilshire Blvd, Los Angeles, CA 90073;

Objectives: Respiratory therapists differ in the methods used to obtain weaning parameters. A questionnaire survey was conducted to better characterize those differences.

Design: A questionnaire survey was conducted among respiratory therapists from nine hospitals in the Los Angeles area. The four-page, 32-question instrument was self-administered and anonymous. Responses were tabulated for analysis.

Setting: Respondents from nine hospitals, three hospitals with residency training programs and six community hospitals without training programs in the Los Angeles area.

Participants: One hundred two respiratory therapists.

Results: There was no universally acknowledged group of weaning parameters, although four parameters were named by > 90%. There was wide variation in methods used to obtaining weaning parameters. Almost all (91%) obtained measurements with the patients breathing their current fraction of inspired oxygen, but there was great variability in the ventilator mode used to collect these parameters (T-tube, continuous positive airway pressure, pressure support), with an equally wide range of pressures added to each mode (0 to 10 cm H₂O). There was great variation in the time (< 1 to > 15 min) before recording weaning parameters. Measurement of parameters was done either with bedside instruments or read from the ventilator display. The maximal inspiratory pressure had great variation in the duration of airway occlusion (< 1 to 20 s), with the most frequent time frame being 2 to 4 s. Differences were noted between therapists from the same hospital as well as between hospitals.

Conclusions: There is great variation among respiratory therapists when obtaining weaning parameters. This calls for further standardization of the measurement of weaning parameters.

Key Words: mechanical ventilation • respiratory therapists • weaning parameters

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