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Addition of a spontaneous awakening trial improves outcome in mechanically ventilated medical ICU patients
Critical Care volume 12, Article number: P330 (2008)
Delayed discontinuation of mechanical ventilation is associated with increased mortality. The Sixth International Consensus Conference on Intensive Care Medicine recommends spontaneous breathing trials (SBT) as best practice for mechanical ventilation weaning. Daily spontaneous awakening trials (SAT) are also correlated with reduced ventilation duration and ICU length of stay. The aim of our study was to implement the SBT and SAT as best practices in the ICU and to assess the outcome of using the SAT and SBT combined.
We collected information on medical ICU patients for 12 weeks in 2006 after implementing a SBT protocol and in 2007 after adding a SAT protocol to the SBT. We compared the likelihood of passing the SBT, extubation after a complete SBT, reasons for not extubating after a passed SBT, and the median ventilator days. Statistical comparison included the chi-square test and Mann–Whitney test (two-tailed with P < 0.05 considered significant).
Fifty-three patients were enrolled in the SBT-only group and 44 patients were included in the SAT + SBT group. In the SAT + SBT group the likelihood of passing both a safety screen (38% vs 47%; P < 0.05) and 30-minute SBT (73% vs 85%, P < 0.05) were lower than in the SBT-only group. The decreased likelihood of passing the safety screen in the SAT + SBT group was associated with an increased incidence of physician override to the protocol. The number of SBT trials performed decreased from 6.1 to 5.7 per patient with the addition of the SAT. The likelihood of extubation following a complete SBT increased in the SAT + SBT group versus the SBT-only group (42% versus 29%, P = 0.143). The likelihood of not extubating following a passed SBT due to sedation is decreased in the SAT + SBT group (10% vs 36%, P = 0.002). The median ventilator days was reduced in the SAT + SBT group versus the SBT-only group (5 days versus 6 days, P = 0.18).
Implementation of a best practice protocol for SAT to an SBT in the medical ICU improved patient outcome by decreasing the days on the ventilator and increasing the likelihood of extubation.
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Mann, H., Lupei, M. & Weinert, C. Addition of a spontaneous awakening trial improves outcome in mechanically ventilated medical ICU patients. Crit Care 12, P330 (2008). https://doi.org/10.1186/cc6551
- Mechanical Ventilation
- Emergency Medicine
- Whitney Test
- Good Practice
- Improve Patient Outcome