The provision of critical care has changed markedly since its inception. Intensive care units (ICUs), developed to provide highly skilled care during a brief illness, now also provide care for substantial numbers of patients who require extended support due to inability to wean from mechanical ventilation (MV). ACUTE Care Nurse Practitioners (ACNP) are prepared to perform a wide range of nursing functions, as well as certain functions traditionally performed by physicians, including diagnosis, management, and interpreting diagnostic studies. These competencies make the ACNP an excellent candidate to test an intervention designed to facilitate recovery from critical illness. The primary aim of this study is to test ability of an ICU and in the post discharge period. The secondary aim is to identify factors which promote weaning progression and weaning success in this population. The study will use a 2 X 2 non-randomized, repeated measures, equivalent time- samples design. During the intervention, an ACNP will management subjects admitted to a SD-ICU, and provide consultation to these patients and their families for one month after discharge. Usual care subjects will be managed by physicians-in-training and followed for the same time period, but will not receive post discharge consultation. Dependent variables will be: 1) weaning progress (hours off full MV support); 2) recovery trajectory (rapid, shallow breathing ratio [f/Vt], pulmonary capillary wedge pressure estimated non-invasively [ePCWP], acute physiology and chronic health evaluation [APACHE] III scores; 4) information needs (Patient/Family Information Needs Scale); 5) ICU resource consumption (ratio of cost to charges); 6) health-related quality of life (Health Assessment questionnaire, Medical Outcomes Study SF- 36); 7) medical record documentation, and 8) disposition. Measures will be obtained at SD-ICU admission, when weaning occurs or the subject is discharged from the SD-ICU and 1, 6, and 12 months after discharge. During weaning trials, f/Vt and ePCWP will be also measured at 3-day intervals. Data will be analyzed using logistic regression, analysis of covariance, proportional hazards regression, and linear mixed effect models. To accomplish our Secondary Aims, we will construct weaning patterns for each subject, identify the proportion of weaning patterns which can be reliably differentiated as consistent weaning progress, and use stepwise multiple logistic regression to identify variables which predict weaning consistent progress, irrespective of group.
