PURPOSE: A recent study demonstrated that paired use of spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT) results in a reduction in the number of ventilator days, ICU length of stay, and mortality. We sought to improve outcomes in mechanically ventilated patients at our institution by ensuring our pre-existing SAT and SBT protocols were used sequentially.
METHODS: Retrospective chart review of all patients mechanically ventilated for over 12 hours between 12/21/2008 and 2/7/2009 and prospective intervention on all mechanically ventilated patients from 3/22/2009 through 5/16/2009. Respiratory therapists were instructed to coordinate with nurses so that an SBT was performed directly after the daily SAT by 10:00 am so the physician team had the results on rounds. The primary outcome was the number of ventilator hours in patients who remained extubated for at least 48 hours.
RESULTS: The control and intervention groups had 84 and 113 patients respectively. Equal percentages were successfully extubated in each group (49/84, 58.3% and 65/113, 57.5%, p=0.799). Mean time on the ventilator was reduced by 18.22 hours (99.08 +/- 10.99 versus 117.3 +/- 15.64, p=0.1135) and the mortality for all mechanically ventilated patients was reduced by 10.5% (p=0.144). A number of barriers to successful implementation of this protocol were identified, the most frequent being over sedation, impaired communication, deviance from standard protocols, and variance in physician practice.
CONCLUSION: With a simple intervention to link our standard SAT and SBT protocols, the number of ventilator hours and mortality were both reduced. While these changes did not reach statistical significance, we believe that elimination of the barriers to success that we identified will lead to a significant reduction in the number of ventilator hours and mortality. Interventions to correct these problems and a follow up study are currently underway.
CLINICAL IMPLICATIONS: An easy to perform study lead to identification of a number of quality control issues that can be simply corrected with potential improvement in outcomes and reduction in costs.
DISCLOSURE: David Green, No Financial Disclosure Information; No Product/Research Disclosure Information