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Critical Care |

Utilization of Spontaneous Awakening Trials in Mechanically Ventilated Patients

Margaret Ragland, MD; Shayna Weiner, MPH; Curtis Weiss, MD
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Northwestern University Feinberg School of Medicine, Chicago, IL


Chest. 2015;148(4_MeetingAbstracts):308A. doi:10.1378/chest.2265943
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Abstract

SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of this study is to establish current duration of time from intubation to first spontaneous awakening trial (SAT) and variables that may be associated with decreased likelihood of implementation of this intervention. These results will inform a clinical trial designed to increase adherence to daily spontaneous awakening and spontaneous breathing trials in patients with acute respiratory failure.

METHODS: Patients from Northwestern Memorial Hospital (NMH), a tertiary academic medical center in Chicago, Illinois, and Northwestern Lake Forest Hospital, a community hospital affiliated with NMH located in an affluent suburb of Chicago, were included. Patients were excluded if they were less than 18 years of age at intubation, on the ventilator less than 12 hours, had a tracheostomy at time of hospital admission, suffered cardiac arrest immediately prior to or during their admission, were transitioned to comfort-focused care, or were managed on continuous intravenous sedation for alcohol withdrawal or delirium tremens. Based on power calculations, we collected data from the first 377 patients who were intubated in the intensive care units and met our inclusion criteria from June 23, 2013, to October 11, 2013.

RESULTS: In our sample, mean age at intubation was 60.6 years, 153 (40.6%) were women, and 214 (56.8%) self-identified as white or Caucasian, 100 (26.5%) as black or African-American. Out of the 377 patients included in the analysis, 39 (10.3%) were never started on sedative infusions and of those who were started on infusions of sedatives (narcotics, benzodiazepines, and/or propofol), median time to first SAT (defined as at least 4 hours off all sedative infusions) was 40.6 hours. Of the patients started on sedative infusions, 270 (79.9%) did not receive an SAT within the first 24 hours of intubation.

CONCLUSIONS: Median time to first SAT was substantially longer than recommended by most professional organizations and only a small number of patients had an SAT within the first 24 hours of intubation.

CLINICAL IMPLICATIONS: Daily SATs are associated with reduced duration of mechanical ventilation and intensive care unit stay, and this data gives us evidence that adherence to this best practice is low and helps inform the design of a novel intervention to improve these rates.

DISCLOSURE: The following authors have nothing to disclose: Margaret Ragland, Shayna Weiner, Curtis Weiss

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