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Volume 15 Supplement 1

31st International Symposium on Intensive Care and Emergency Medicine

Efficacy of implementation strategies of an evidenced-based awakening and breathing protocol

Critical Care volume 15, Article number: P163 (2011) Cite this article

Introduction

A protocol that paired spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT) decreased duration of mechanical ventilation (DMV), ICU length of stay (LOS) and mortality [1]. We studied the efficacy of multifaceted implementation strategies (MIS) of an evidenced-based protocol at a tertiary academic center.

Methods

This was a prospective observational cohort study with historical control. The cohort consisted of consecutive patients who were extubated at least once during the ICU stay. The intervention was MIS of a quality improvement (QI) protocol pairing SAT and SBT. These strategies included: preprinted daily order sheets, structured daily multidisciplinary rounds, QI monitoring and regular feedback to the ICU staff. The outcomes: DMV, ICU LOS, reintubation and hospital mortality. Chi-square and t tests, adjusted logistic and Cox regressions were used.

Results

Total patients n = 120 (2009, n = 40; 2010, n = 80). The baseline characteristics were imbalance for age and APACHE II. The 2010 group (after QI) had less DMV, ICU LOS and hospital mortality (Table 1). The adjusted hazard ratio in reducing time to extubation = 0.57 (95% CI = 0.37 to 0.88) and adjusted odds ratio for hospital mortality = 0.27 (95% CI = 0.12 to 0.67) in the 2010 group. See Figure 1.

Table 1 Main outcomes
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Figure 1
figure 1

Time to extubation KM curve.

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Conclusions

MIS of a paired SAT and SBT protocol reduced duration of MV, ICU LOS and hospital mortality.

References

  1. Girard T, et al.: Lancet. 2008, 371: 126-134. 10.1016/S0140-6736(08)60105-1

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Authors and Affiliations

  1. King Fahad Specialist Hospital - Dammam, Saudi Arabia

    O Almuslim, M Rezk & N Hassan

Authors
  1. O Almuslim
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  2. M Rezk
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  3. N Hassan
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Almuslim, O., Rezk, M. & Hassan, N. Efficacy of implementation strategies of an evidenced-based awakening and breathing protocol. Crit Care 15 (Suppl 1), P163 (2011). https://doi.org/10.1186/cc9583

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  • DOI: https://doi.org/10.1186/cc9583

Keywords

  • Quality Improvement
  • Adjust Odds Ratio
  • Hospital Mortality
  • Adjusted Hazard Ratio
  • Observational Cohort Study

Critical Care

ISSN: 1364-8535