2006 OPEN FORUM Abstracts
Daily Spontaneous Breathing Trials: Opportunities Created-and Missed
Lisa Cracchiolo, RRT,
Marcy Buckles RRT, Schallom, Lynn, RN, CCNS, Sona, Carrie, RN, APRN,
BC,; Barnes_Jewish Hospital, St. Louis, MO, Schuerer, Douglas, MD, Buchman,
Timothy, PhD, MD, Robertson, T. Elizabeth, MD; Washington University, St.
Background: A multiprofessional protocol for daily spontaneous breathing trials (SBT) was developed in response to inconsistent adherence (20%) with this evidence based recommended practice.
Methods: A protocol for daily SBTs was developed by our SICU QI committee. The protocol assigns shared RN and RT responsibility for accomplishing the protocol, as well as physician responsibility for acting on the data. Briefly, RNs perform a safety screen, and then RT/RN pairs initiate the trial with patient evaluations at 1 min, 2 min and 30 min. Only those patients who were evaluated as safe at 1 and 2 min by both RT and RN continued to a thirty minute SBT on protocol minimal ventilator settings. Performance is reported to physician staff.
Results: 503 opportunities for daily breathing trials were assessed and 472 (94%) of these were completed. Opportunities are defined as one trial for each ventilated patient each day. Some patients had more than one trial a day, yielding 540 trials. Of these evaluations, 343 trials (64%) completed the 30 minute portion of the SBT. In 242 trials, patients passed the SBT, but after 93 (38%) of these, patients were nevertheless placed back on full support. 39 (16%) patients were immediately extubated.
Conclusions: RNs and RTs successfully implemented daily spontaneous breathing trials 94% of the time. There was a gap between this high trial implementation rate (94%) compared to anticipated physician action (62%) after passing the spontaneous breathing trial. Investigation of the reasons why physicians did not liberate those "passing" patients from mechanical support will provide a basis for future behavioral interventions.