2.50
Hdl Handle:
http://hdl.handle.net/10755/203261
Type:
Presentation
Title:
Coupling SAT/SBT Protocols Reduce Ventilator Hours
Abstract:
(Summer Institute) PROBLEM/ EVIDENCE: In the 1990’s, spontaneous breathing trials (SBT) were introduced by Wes Ely with the goal of defining ways to wean patients quickly from mechanical ventilation. Over the past 2 decades researchers have studied coupling the SBT with a spontaneous awakening trial (SAT). These trials were successful at weaning patients from mechanical ventilation while decreasing ICU length of stay (LOS), improving survival rates, decreasing hospital acquired infections, and decreasing VAP rates. These trials led to improvements in preventing over-sedation which can be directly associated with long-term cognitive deficits, prolonged mechanical ventilation and the development of delirium. STRATEGY: In 2008, our hospital adopted the “ABC Wake up and Breathe” philosophy. Nursing was concerned with abrupt withdrawal of medications during the SAT. We developed a protocol that included Girard’s screening tool and criteria for implementing daily SAT/SBTs. However, the protocol lacked standard rescue agents for the nurse to easily medicate and re-sedate to the targeted level of sedation when failure occurred. PRACTICE CHANGE: The Girard protocol was distributed to all disciplines involved in care of the mechanically ventilated patients (physicians, nurses and respiratory therapists). Educational offerings were conducted to disseminate education and answer questions regarding the proposed protocol. After tailoring the changes, the protocol has now been implemented since January 2009. EVALUATION/RESULTS: Our success is demonstrated in the graphs below. Average ventilator hours have decreased from 109.7 hours in 2008, to 88.1 hours in 2009, to 87.1 hours in 2010. This correlates with extreme cost savings with no added cost to the healthcare system. RECOMMENDATIONS/LESSONS LEARNED: Daily evaluations and screening criteria must be used to identify mechanically ventilated patients eligible for daily SAT/SBT. Evidence has shown that these measures will improve patient outcomes. This coupling concept will prevent the accumulation of sedative drug effect over time, prevent over-sedation, and maintain the patient in the ordered targeted level of sedation while simultaneously focusing on patient comfort. BIBLIOGRAPHY: Ely, E.W., Baker, M.P.H., Dunagan, D.P., Burke, H.L., Smith, A.C., Kelly, P.T., Johnson, M.M…. Haponik, E.F. (1996) Effect of the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. New England Journal of Medicine 335;1864- 1869. Girard, TD, Kress, JP, Fuchs, BD, Thomason, JWW, Schweickert, WD, Pun, BT, Taichman, DB, Dunn, JG, Pholman, AS, Kinniry PA, Jackson, J.C., Canonico, A.E., Light, R.W., Shintani, A.K., Thompson, J.L., Gordon, S.M…. Ely, E.W. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 2008;371:126-34. Devlin, JW, Tanios, MA, Epstein, SK. Intensive care unit sedation: waking up clinicians to the gap between research and practice. Critical Care Medicine 2006. 34(2):556-7. Brook, A.D., Ahrens, T.S., Schaiff, R., Prentice, D., Sherman, G., Shannon, W., & Kollef, M.H. (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Critical Care Medicine, 27(12), 2609-2615. Chanques, G., Jaber, S., Barbotte, E., Violet, S., Sebbane, M., Perrigault, P.F.… Ededjam, J.J. (2006). Impact of systemic evaluation of pain and agitation in an intensive care unit. Critical Care Medicine, 34(6):1691-1699. Mehta, S., Burry, L., Fischer, S., Martinez-Motta, J.C., Hallett, D., Bowman, D.… Cook, DJ. (2006). Canadian survey of the use of sedatives, ananlgesica, and neuromuscular blocking agents in critically ill patients. Critical Care Medicine. 34: 374-380. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Protocols; Ventilator
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCoupling SAT/SBT Protocols Reduce Ventilator Hoursen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203261-
dc.description.abstract(Summer Institute) PROBLEM/ EVIDENCE: In the 1990’s, spontaneous breathing trials (SBT) were introduced by Wes Ely with the goal of defining ways to wean patients quickly from mechanical ventilation. Over the past 2 decades researchers have studied coupling the SBT with a spontaneous awakening trial (SAT). These trials were successful at weaning patients from mechanical ventilation while decreasing ICU length of stay (LOS), improving survival rates, decreasing hospital acquired infections, and decreasing VAP rates. These trials led to improvements in preventing over-sedation which can be directly associated with long-term cognitive deficits, prolonged mechanical ventilation and the development of delirium. STRATEGY: In 2008, our hospital adopted the “ABC Wake up and Breathe” philosophy. Nursing was concerned with abrupt withdrawal of medications during the SAT. We developed a protocol that included Girard’s screening tool and criteria for implementing daily SAT/SBTs. However, the protocol lacked standard rescue agents for the nurse to easily medicate and re-sedate to the targeted level of sedation when failure occurred. PRACTICE CHANGE: The Girard protocol was distributed to all disciplines involved in care of the mechanically ventilated patients (physicians, nurses and respiratory therapists). Educational offerings were conducted to disseminate education and answer questions regarding the proposed protocol. After tailoring the changes, the protocol has now been implemented since January 2009. EVALUATION/RESULTS: Our success is demonstrated in the graphs below. Average ventilator hours have decreased from 109.7 hours in 2008, to 88.1 hours in 2009, to 87.1 hours in 2010. This correlates with extreme cost savings with no added cost to the healthcare system. RECOMMENDATIONS/LESSONS LEARNED: Daily evaluations and screening criteria must be used to identify mechanically ventilated patients eligible for daily SAT/SBT. Evidence has shown that these measures will improve patient outcomes. This coupling concept will prevent the accumulation of sedative drug effect over time, prevent over-sedation, and maintain the patient in the ordered targeted level of sedation while simultaneously focusing on patient comfort. BIBLIOGRAPHY: Ely, E.W., Baker, M.P.H., Dunagan, D.P., Burke, H.L., Smith, A.C., Kelly, P.T., Johnson, M.M…. Haponik, E.F. (1996) Effect of the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. New England Journal of Medicine 335;1864- 1869. Girard, TD, Kress, JP, Fuchs, BD, Thomason, JWW, Schweickert, WD, Pun, BT, Taichman, DB, Dunn, JG, Pholman, AS, Kinniry PA, Jackson, J.C., Canonico, A.E., Light, R.W., Shintani, A.K., Thompson, J.L., Gordon, S.M…. Ely, E.W. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 2008;371:126-34. Devlin, JW, Tanios, MA, Epstein, SK. Intensive care unit sedation: waking up clinicians to the gap between research and practice. Critical Care Medicine 2006. 34(2):556-7. Brook, A.D., Ahrens, T.S., Schaiff, R., Prentice, D., Sherman, G., Shannon, W., & Kollef, M.H. (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Critical Care Medicine, 27(12), 2609-2615. Chanques, G., Jaber, S., Barbotte, E., Violet, S., Sebbane, M., Perrigault, P.F.… Ededjam, J.J. (2006). Impact of systemic evaluation of pain and agitation in an intensive care unit. Critical Care Medicine, 34(6):1691-1699. Mehta, S., Burry, L., Fischer, S., Martinez-Motta, J.C., Hallett, D., Bowman, D.… Cook, DJ. (2006). Canadian survey of the use of sedatives, ananlgesica, and neuromuscular blocking agents in critically ill patients. Critical Care Medicine. 34: 374-380. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectProtocolsen_GB
dc.subjectVentilatoren_GB
dc.date.available2012-01-16T11:06:28Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:06:28Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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