Skip to main content

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

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
Figure 1
figure1

Time to extubation KM curve.

Conclusions

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

References

  1. 1.

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

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to O Almuslim.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

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

Download citation

Keywords

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