Abstract
Background:
Weaning by a spontaneous breathing trial (SBT) is superior to previous weaning methods. In 2007, SBT protocol-based was established at our institution; the most salient outcome of which was a 1.5-day reduction in average mechanical ventilation duration. Since last analyzed in 2017 there has been a large turnover in staff. The aim of this QI project was to assess SBT adherence and its current impact on duration of ventilation using data from the last year of our historical quality assurance monitoring as a control.
Methods:
This QI project screened 60 randomly-selected subjects taken from Medical, Surgical, and Neuro ICUs and equally divided them into 2 cohorts (8/2019 to 3/2020; 2/2021 to 2/2023 respectively). We excluded the first year of COVID-19 as a potential confounder. Inclusion criteria was management by SBT protocol. Exclusion criteria were: 1) death before extubation, 2) self-extubation, 3) tracheostomy, and 4) patients not weaned. Assessment criteria were defined as: 1) meeting weaning readiness criteria (WRC: PEEP ≤ 8 cm H2O, FIO2 < 0.50), Positive SBT (ie, unassisted breathing (UAB) tolerated ≥ 2 h), 3) Successful extubation (ie, UAB ≥ 48 h). Data were captured from our electronic medical record (EPIC) and entered into REDCap. The primary outcome was duration of mechanical ventilation. Secondary outcomes were variables related to SBT adherence.
Results:
Of the 60 subjects screened, 15 were excluded and the remaining 45 average ventilator days were substantially below historical controls (Table): Subjects who met WRC promptly underwent SBT and expeditiously extubated. The 48-hour extubation failure rate was 2%. None of the secondary variables differed between cohorts.
Conclusions:
Compared to our historical data, despite large staff turnover, SBT protocol adherence was consistent. Although overall mechanical ventilation duration was reduced, this likely reflected the small sample size.
Key: *Data expressed as median [IQR], comparisons by Wilcoxon rank-sum test. Categorical variables by Chi-squared test. ETI = endotracheal intubation. +SBT = Passing SBT View all access options for this article.Table 1.
Variable
All Subjects
Pre-COVID
Post-COVID
P
N
45
23
22
MV days
1.52 [0.5-3.6]
1.06 [0.5-3.3]
2.41 [0.5-3.6]
0.76
ETI to WRC (h)
0.92 [0-2.5]
1.15 [0-4.5]
0.79 [0.3-1.5]
0.58
WRC to 1st +SBT (h)
12.9 [6.7-36]
11.4 [6.0-30.7]
20.23 [9.7-35.5]
0.28
+SBT to Extubation (h)
5.42 [2.3-29]
6.00 [2.3-28]
5.35 [2.7-30.4]
0.96
48h Reintubation
1 (2%)
0 (0%)
1 (2%)
0.98
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