Mechanical ventilation is a life-saving supportive therapy, but it can also cause lung injury, diaphragmatic dysfunction, and lung infection. Ventilator liberation should be attempted as soon as clinically indicated, to minimize morbidity and mortality. The most effective method of liberation follows a systematic approach that includes a daily assessment of weaning readiness, in conjunction with interruption of sedation infusions and spontaneous breathing trials. Protocols and checklists are decision support tools that help ensure consistent application of key elements of evidence-based practice. A majority of studies of weaning protocols applied by non-physician healthcare providers suggest faster weaning and shorter duration of ventilation and ICU stay, and some suggest reduced failed extubation and ventilator-associated pneumonia rates. Checklists can be used to reinforce application of the protocol, or possibly in lieu of one, particularly in environments where the caregiver-to-patient ratio is high and clinicians are well versed in and dedicated to applying evidence-based care. There is support for integrating best-evidence rules for weaning into the mechanical ventilator so that a substantial portion of the weaning process can be automated, which may be most effective in environments with low caregiver-to-patient ratios or those in which it is challenging to consistently apply evidence-based care. This paper reviews evidence for ventilator liberation protocols and discusses issues of implementation and ongoing monitoring.

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Cardiac surgery patients ICU length of stay(LOS) had increased since moving to a larger, 24 bed unit in the Cardiovascular building. This resulted in a reduction from 45% to 26% of patients being weaned post‐op in a 6 hour period. Longer delays in weaning post cardiac surgery patients off the ventilator, particularly routine Cardiac bypass and valve replacement/repair patients was found to increase overall LOS and a reduced ability to perform more surgeries. After collecting data indentifying the sources of these delays, we set out to reduce the time these patients were vented. Nursing staff and Respiratory therapists developed protocols and guidelines and then educated and trained staff to initiate these protocols with a 6 hour goal for each patient. Using these education tools and this new RT/RN extubation protocol we have been able to reduce ventilator time to pre‐CVC levels, opening more beds and availabilty to perform more surgeries.