{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:09:24Z","timestamp":1792084164042,"version":"4.4.0"},"reference-count":27,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,5,1]]},"abstract":"<jats:p>OBJECTIVE. The purpose of this work was to evaluate the impact of the implementation of a ventilation protocol driven by registered respiratory therapists on respiratory outcomes of premature infants with birth weight \u22641250 g.<\/jats:p>\n               <jats:p>METHODS. A ventilation protocol driven by a registered respiratory therapist was developed by a multidisciplinary group and implemented in our unit in July 2004. A retrospective review of 301 inborn infants with birth weight \u22641250 g who were mechanically ventilated was performed. Ninety-three infants were ventilated before the ventilation protocol (before), 109 in the first year (after 1) and 99 during the second year (after 2) after the ventilation protocol implementation. Data were collected with a predefined form.<\/jats:p>\n               <jats:p>RESULTS. The baseline characteristics of the population were similar among the 3 groups, except for a significant smaller number of male infants in the first year after the protocol implementation. The significant differences among the 3 periods were as follows: (1) time of first extubation attempt; (2) duration of mechanical ventilation; and (3) rate of extubation failure (40%, 26%, and 20%). There was no difference in the rate of air leaks, patent ductus arteriosus ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, or death. There was a significant decrease in the combined rates of intraventricular hemorrhage grades III to IV and\/or periventricular leukomalacia (31%, 18%, and 4%) after the protocol implementation.<\/jats:p>\n               <jats:p>CONCLUSIONS. In this study, we were able to demonstrate for the first time a significant improvement on the weaning time and duration of mechanical ventilation with the implementation of a ventilation protocol driven by a registered respiratory therapist in the premature population. Based on our experience, other institutions can customize ventilation protocols to their local practice. However, a prospective, randomized, controlled study should be planned to evaluate long-term outcomes such as BPD and neurodevelopment.<\/jats:p>","DOI":"10.1542\/peds.2008-1647","type":"journal-article","created":{"date-parts":[[2009,4,21]],"date-time":"2009-04-21T00:49:53Z","timestamp":1240274993000},"page":"e907-e916","source":"Crossref","is-referenced-by-count":52,"title":["Implementation of a Respiratory Therapist-Driven Protocol for Neonatal Ventilation: Impact on the Premature Population"],"prefix":"10.1542","volume":"123","author":[{"given":"Fernanda","family":"Hermeto","sequence":"first","affiliation":[{"name":"Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcela Nosralla","family":"Bottino","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Vaillancourt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Mendes","family":"Sant'Anna","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,5,1]]},"reference":[{"key":"2021120902373393900_R1","doi-asserted-by":"crossref","unstructured":"Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest.\u20082001;120(6 suppl):400S\u2013424S","DOI":"10.1378\/chest.120.6_suppl.400S"},{"key":"2021120902373393900_R2","doi-asserted-by":"crossref","unstructured":"MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest.\u20082001;120(6 suppl):375S\u2013395S","DOI":"10.1378\/chest.120.6_suppl.375S"},{"key":"2021120902373393900_R3","doi-asserted-by":"crossref","unstructured":"Ely EW, Meade MO, Haponik EF, et al. Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines. Chest.\u20082001;120(6 suppl):454S\u2013463S","DOI":"10.1378\/chest.120.6_suppl.454S"},{"key":"2021120902373393900_R4","doi-asserted-by":"crossref","unstructured":"Randolph AG, Wypij D, Venkataraman ST, et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. JAMA.\u20082002;288(20):2561\u20132568","DOI":"10.1001\/jama.288.20.2561"},{"key":"2021120902373393900_R5","unstructured":"Schultz TR, Lin RJ, Watzman HM, et al. Weaning children from mechanical ventilation: a prospective randomized trial of protocol-directed versus physician-directed weaning. Respir Care.\u20082001;46(8):772\u2013782"},{"key":"2021120902373393900_R6","doi-asserted-by":"crossref","unstructured":"Restrepo RD, Fortenberry JD, Spainhour C, Stockwell J, Goodfellow LT. Protocol-driven ventilator management in children: comparison to nonprotocol care. J Intensive Care Med.\u20082004;19(5):274\u2013284","DOI":"10.1177\/0885066604267646"},{"key":"2021120902373393900_R7","doi-asserted-by":"crossref","unstructured":"Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg.\u20081978;187(1):1\u20137","DOI":"10.1097\/00000658-197801000-00001"},{"key":"2021120902373393900_R8","doi-asserted-by":"crossref","unstructured":"Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr.\u20081978;92(4):529\u2013534","DOI":"10.1016\/S0022-3476(78)80282-0"},{"key":"2021120902373393900_R9","doi-asserted-by":"crossref","unstructured":"Danan C, Durrmeyer X, Brochard L, Decobert F, Benani M, Dassieu G. A randomized trial of delayed extubation for the reduction of reintubation in extremely preterm infants. Pediatr Pulmonol.\u20082008;43(2):117\u2013124","DOI":"10.1002\/ppul.20726"},{"key":"2021120902373393900_R10","doi-asserted-by":"crossref","unstructured":"Thomson MA, Yoder BA, Winter VT, Giavedoni L, Chang LY, Coalson JJ. Delayed extubation to nasal continuous positive airway pressure in the immature baboon model of bronchopulmonary dysplasia: lung clinical and pathological findings. Pediatrics.\u20082006;118(5):2038\u20132050","DOI":"10.1542\/peds.2006-0622"},{"key":"2021120902373393900_R11","doi-asserted-by":"crossref","unstructured":"Rothaar RC, Epstein SK. Extubation failure: magnitude of the problem, impact on outcomes, and prevention. Curr Opin Crit Care.\u20082003;9(1):59\u201366","DOI":"10.1097\/00075198-200302000-00011"},{"key":"2021120902373393900_R12","doi-asserted-by":"crossref","unstructured":"Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med.\u20081998;158(2):489\u2013493","DOI":"10.1164\/ajrccm.158.2.9711045"},{"key":"2021120902373393900_R13","doi-asserted-by":"crossref","unstructured":"Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics.\u20082001;107(4):638\u2013641","DOI":"10.1542\/peds.107.4.638"},{"key":"2021120902373393900_R14","doi-asserted-by":"crossref","unstructured":"Khalaf MN, Brodsky N, Hurley J, Bhandari V. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics.\u20082001;108(1):13\u201317","DOI":"10.1542\/peds.108.1.13"},{"key":"2021120902373393900_R15","doi-asserted-by":"crossref","unstructured":"Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev.\u20082003;(2):CD000143","DOI":"10.1002\/14651858.CD000143"},{"key":"2021120902373393900_R16","doi-asserted-by":"crossref","unstructured":"Carlo WA, Stark AR, Wright LL, et al. Minimal ventilation to prevent bronchopulmonary dysplasia in extremely-low-birth-weight infants. J Pediatr.\u20082002;141(3):370\u2013374","DOI":"10.1067\/mpd.2002.127507"},{"key":"2021120902373393900_R17","doi-asserted-by":"crossref","unstructured":"Walsh MC, Morris BH, Wrage LA, et al. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr.\u20082005;146(6):798\u2013804","DOI":"10.1016\/j.jpeds.2005.01.047"},{"key":"2021120902373393900_R18","doi-asserted-by":"crossref","unstructured":"St John EB, Carlo WA. Respiratory distress syndrome in VLBW infants: changes in management and outcomes observed by the NICHD Neonatal Research Network. Semin Perinatol.\u20082003;27(4):288\u2013292","DOI":"10.1016\/S0146-0005(03)00056-9"},{"key":"2021120902373393900_R19","doi-asserted-by":"crossref","unstructured":"Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med.\u20082008;358(7):700\u2013708","DOI":"10.1056\/NEJMoa072788"},{"key":"2021120902373393900_R20","doi-asserted-by":"crossref","unstructured":"Kamlin CO, Davis PG, Morley CJ. Predicting successful extubation of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed.\u20082006;91(3):F180\u2013F183","DOI":"10.1136\/adc.2005.081083"},{"key":"2021120902373393900_R21","doi-asserted-by":"crossref","unstructured":"Mariani G, Cifuentes J, Carlo WA. Randomized trial of permissive hypercapnia in preterm infants. Pediatrics.\u20081999;104(5 pt 1):1082\u20131088","DOI":"10.1542\/peds.104.5.1082"},{"key":"2021120902373393900_R22","doi-asserted-by":"crossref","unstructured":"Fabres J, Carlo WA, Phillips V, Howard G, Ambalavanan N. Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants. Pediatrics.\u20082007;119(2):299\u2013305","DOI":"10.1542\/peds.2006-2434"},{"key":"2021120902373393900_R23","doi-asserted-by":"crossref","unstructured":"Geary C, Caskey M, Fonseca R, Malloy M. Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid administration: a historical cohort study. Pediatrics.\u20082008;121(1):89\u201396","DOI":"10.1542\/peds.2007-0225"},{"key":"2021120902373393900_R24","doi-asserted-by":"crossref","unstructured":"Schmidt B, Roberts R, Millar D, Kirpalani H. Evidence-based neonatal drug therapy for prevention of bronchopulmonary dysplasia in very-low-birth-weight infants. Neonatology.\u20082008;93(4):284\u2013287","DOI":"10.1159\/000121453"},{"key":"2021120902373393900_R25","doi-asserted-by":"crossref","unstructured":"Schmidt B, Roberts RS, Davis P, et al. Caffeine therapy for apnea of prematurity. N Engl J Med.\u20082006;354(20):2112\u20132121","DOI":"10.1056\/NEJMoa054065"},{"key":"2021120902373393900_R26","doi-asserted-by":"crossref","unstructured":"Hagen EW, Sadek-Badawi M, Carlton DP, Palta M. Permissive hypercapnia and risk for brain injury and developmental impairment. Pediatrics.\u20082008;122(3). Available at: www.pediatrics.org\/cgi\/content\/full\/122\/3\/e583","DOI":"10.1542\/peds.2008-1016"},{"key":"2021120902373393900_R27","unstructured":"Stoller JK. The effectiveness of respiratory care protocols. Respir Care.\u20082004;49(7):761\u2013765"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/123\/5\/e907\/1103157\/zpe0050900e907.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/123\/5\/e907\/1103157\/zpe0050900e907.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T14:15:33Z","timestamp":1639059333000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/123\/5\/e907\/71436\/Implementation-of-a-Respiratory-Therapist-Driven"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,5,1]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2009,5,1]]},"published-print":{"date-parts":[[2009,5,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-1647","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,5,1]]}}}