2007 OPEN FORUM Abstracts
THE CORRELATION OF SPONTANEOUS BREATHING TRIALS AND REDUCTION IN VENTILATOR LENGTH OF STAY IN A MEDICAL ICU
K. D. Hargett1, R. Wolff1, B. Green1, S. Akin1, D. Joseph1
Background: Current literature on weaning a patient from mechanical ventilation indicates that no measurement other than a daily Spontaneous Breathing Trial(SBT)has a high predictive value of success. Many physicians continue to manage patients conservatively which results in longer ICU and ventilator length of stay(LOS). A process to perform SBTs on all eligible patients was introduced into a Medical ICU. The physician utilization of liberation after successful SBT was tracked on a monthly basis and compared with ventilator LOS to determine if there was a correlation.
Methods: A process to perform SBTs was implemented in late 2005. The process included a daily SBT on all ventilated patients that met criteria. Exclusion criteria included hemodynamic instability, arrhythmias, FiO2>.6 or PEEP>8cmH20. A short trial period to determine patient response was conducted by reducing the PEEP to 0 and placing the patient in spontaneous ventilation. If the patient tolerated the short trial,it was extended to a SBT lasting 90-120 minutes. Successful completion of the SBT resulted if the patient had no periods greater than 5 minutes when the Rapid Shallow Breathing Index (RSBI) exceeded 105.
Results: A total of 1932 SBTs have been safely performed on 715 patients in 2006-2007. Patients passed 46% of the SBTs (888/1932). Of the patients that passed, 434(48.87%) were liberated from the ventilator based on the SBT. The initial months after initiation of the SBT process showed low utilization by physicians of the SBT (12-15%)to liberate. Monthly reports were generated which resulted in increased physician comfort with the process and reaching a high of 63% liberation based on successful SBTs. Ventilator LOS decreased from an average of 145 hours per patient in 2005 to 118 hours in 2006 and down to 99 hours in 2007. This represents a 19% reduction in ventilator LOS in 2005 and 32% reduction from baseline for 2007. An analysis utilizing the Pearson Product Moment results in a negative 0.729 correlation coefficient between use of SBT and ventilator LOS indicating there is a strong inverse relationship.
Conclusions: SBTs are a safe and effective way to determine the readiness for a patient to be liberated from mechanical ventilation. A standardized approach to implementing SBTs and monthly reporting has resulted in increased utilization of this technique to encourage physicians to consider liberation. Ventilator LOS is reduced when using SBTs to facilitate liberation.