Outcomes of the Implementation of the Weaning Guidelines for Patients with Cervical Spinal Cord Injuries at Phrapokklao Hospital
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Abstract
Background: In patients with cervical spinal cord injuries, weaning from mechanical ventilation is particularly challenging and often takes longer compared to other groups of patients. To respond to this issue, the research team developed ventilator weaning guidelines that have been specifically designed for patients with cervical spinal cord injuries, which have been implemented since 2022.
Objective: To study the outcomes related to the implementation of the ventilator weaning guidelines with patients with cervical spinal cord injuries in terms of the following: 1) the patient outcomes, which consist of the initiation time of ventilator weaning, as well as the duration of the weaning process before and after the implementation of the guideline; and 2) the nursing outcomes, which consist of the challenges when facing nursing practice-related problems and the degree of happiness that was experienced by the nurses based on the PERMA model, before and after the implementation of the weaning guidelines for patients with cervical spinal cord injuries.
Methods: This quasi-experimental study compared ventilator weaning outcomes in patients with cervical spinal cord injuries at the levels of C3–C5 with the injury severity classified as Grades C–E. All the patients had been able to be successfully weaned from the ventilator after passing the spinal shock phase. The comparison group consisted of patients, who had been treated according to the pre-guideline implementation, while the experimental group consisted of those treated after the implementation of the weaning guidelines had commenced during the period from January 2022 to May 2024. Moreover, each group was composed of 19 patients. Furthermore, the study collected opinions and compared the work-related challenges and the degree of job satisfaction from 13 registered nurses, who had experience in caring for these types of patients both before and after the implementation of the guidelines. The data was collected using a structured data recording form and a questionnaire that had been validated by experts. Statistical analyses consisted of frequencies, percentages, medians, Fisher’s Exact Test, the Mann-Whitney U Test, and the Wilcoxon signed-rank.
Results: Implementation of the guidelines had significantly led to earlier initiations of the ventilator weaning process (p=0.006), had shortened the overall weaning duration (p=0.005), had significantly reduced the challenges that were faced by the professional nurses (p=0.001), and had increased the degree of happiness that the nurses experienced at work based on the PERMA model (p=0.001).
Conclusion: The developed ventilator weaning guidelines for patients with cervical spinal cord injuries can result in earlier and more efficient weaning from mechanical ventilation. Furthermore, they have a positive impact on healthcare staff members by reducing operational problems and increasing job satisfaction.
Thaiclinicaltrials.org number, TCTR20250314001
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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