2006 OPEN FORUM Abstracts
SAW II (Short-Term Accelerated Weaning): A Combined Ventilator Liberation & Sedation Evidence Based Project
Wayne Wallace RRT, Jacqueline Redeemer CNS, Todd
Weiss RRT, Christina Judan RN, Juan Lombard, RN
Kaiser Permanente West Los Angeles Medical
Center, Los Angeles CA
Background: Kaiser
Permanente West Los Angeles Medical Center is a mid sized community hospital
which provides critical care services in an urban setting. Prior to the advent
of continuous sedation, the medical center enjoyed an excellent average
ventilator LOS of slightly under 3.0 days per ventilator patient. After FY 2000, ventilator LOS steadily
climbed and reached its zenith in the 4th quarter of 2002 of 6.2
ventilator ALOS. Moreover, there were an
increased number of patients requiring ventilator care being admitted to the
hospital (293 ventilator patients in FY 2000 vs. 420 ventilator patients in FY
2003). This created a bottleneck in the critical care unit and overwhelmed the
staff. A literature review demonstrated that sedation and ventilator protocols
were able independently to reduce ventilator ALOS. However, it was unclear if a
combined protocol would show a further synergistic effect.
Method: Utilizing the IOWA EBP Model, a combined nursing-driven
sedation protocol and a respiratory care-driven ventilator protocol called SAW
II was implemented in phases which would allow observation of each protocol's
relative contribution to the reduction of ventilator ALOS over the traditional
physician-driven ventilator liberation attempts. Key patient safety, severity
of illness, and other key indices were monitored to ensure that SAW II was at
least as safe as the traditional physician driven weaning.
Results: Physicians were able through their own efforts to reduce
the ventilator ALOS from 6.2 days to a range between 5.5 to5.0 days. The Respiratory Care driven protocol was able
to drive ventilator ALOS from 5.0 to 4.2 days.
The Nursing driven sedation protocol thus far appears to drive
ventilator LOS from 4.2 to 3.7 days. 55
SAW II ventilator patients totaling 216 ventilator patient days were reviewed
from August 6-October 12, 2005. The
outcomes were 72% liberated, 22% Died, and 6% ventilator dependent at
discharge. There has been no change in severity of illness as measure by APACHE
II scores, increases in untoward events, or increases in VAP during the entire
time period. EXPERIENCE: SAW II
appears to be a safe and effective strategy to reduce ventilator ALOS and
achieve roughly the same patient outcomes. There appears to be a sustained downward
trend in ventilator ALOS back to the previous acceptable levels. A more
systematic approach to ventilator liberation was evidently needed to handle the
increased number of ventilator patients efficiently.
Conclusion: Thus far, SAW II appears to have a synergistic positive
effect on ventilator liberation while promoting interdisciplinary cooperation
and collaboration over traditional physician-driven ventilator liberation
attempts. However, more study is required
to confirm this provisional conclusion.