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.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
Project #
Application #
Study Section
Nursing Research Study Section (NURS)
Program Officer
Bryan, Yvonne E
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Other Health Professions
Schools of Nursing
United States
Zip Code
Choi, JiYeon; Donahoe, Michael P; Zullo, Thomas G et al. (2011) Caregivers of the chronically critically ill after discharge from the intensive care unit: six months' experience. Am J Crit Care 20:12-22; quiz 23
Kim, Yookyung; Hoffman, Leslie A; Choi, JiYeon et al. (2006) Characteristics associated with discharge to home following prolonged mechanical ventilation: a signal detection analysis. Res Nurs Health 29:510-20
Hoffman, Leslie A; Miller, Thomas H; Zullo, Thomas G et al. (2006) Comparison of 2 models for managing tracheotomized patients in a subacute medical intensive care unit. Respir Care 51:1230-6
Hoffman, Leslie A; Tasota, Frederick J; Zullo, Thomas G et al. (2005) Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. Am J Crit Care 14:121-30; quiz 131-2
Hoffman, Leslie A; Happ, Mary Beth; Scharfenberg, Carmella et al. (2004) Perceptions of physicians, nurses, and respiratory therapists about the role of acute care nurse practitioners. Am J Crit Care 13:480-8
Hoffman, Leslie A; Tasota, Frederick J; Scharfenberg, Carmella et al. (2003) Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training. Am J Crit Care 12:436-43