The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

IMPACT OF USING AN EVIDENCE-BASED APPROACH IN DECREASING DURATION OF MECHANICAL VENTILATION

Ken Thigpen, BS, RRT, Blake Haynes, RRT, James S. Jones, MD, Carl Rost, RRT, John E. Studdard, MD St. Dominic Hospital, Jackson, Mississippi

Introduction: Improper choice of mode or approach may artificially prolong the duration of mechanical ventilation for patients. Evidence-based literature has been published over the past several years which has significantly impacted the approach toward weaning these patients we had traditionally taken. After an extensive review of this literature, we developed an approach which has had a significant and meaurable impact on how we care for our patients.

Method: We began actively tracking our ventilator length of stay in October, 2003. From October through December, 2003, our average ventilator length of stay for 80 patients was 7.89 days. During this time we began partnering with our pulmonologists in developing an evidence-based approach which supported utilizing spontaneous breathing trials rather than traditional weaning. Between October, 2003 and May, 2004, we formalized this new approach and implemented the use of a daily screen for weanability. If the screen was passed, a spontaneous breathing trial (SBT) was performed and patients were weaned as appropriate.

Results: Our ventilator lengths of stay are as follows:

October 1 - December 31, 2003 -        80   patients      7.89 days

January 1 - December 31, 2004 -         465 patients      5.20 days

January 1 - December 31, 2005 -         797 patients      2.80 days

The results indicate a reduction in ventilator length of stay from 7.89 days to 2.80 days since implementing the SBT approach. Conservative estimates place cost-savings to the institution at $22.3 million in 2005 alone based on a 5.09 day reduction in ventilator days for 797 patients.

Conclusion: Our evidence-based approach to weaning utilizing the SBT approach has proven to be a more efficient and cost-effective mechanism for ventilator discontinuance than our traditional approach.

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