The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

REDUCED VENTILATOR LENGTH OF STAY (VLOS) THROUGH IMPLEMENTATION OF A SPONTANEOUS AWAKENING AND BREATHING TRIAL (SAT & SBT) WITH A MULTIDISCIPLINARY APPROACH

Shane Blake1, James Lamberti1, Parul Shah1, Monica Raich1, Gail Bush1, Jean Crow1, Tom Arrowsmith1, Dorothy Belkoski2, Sonia Astle2, Linda Schakenbach2, Lavonia Thomas2, Heather Russell2, Jason Vourlekis4, Christopher Michetti3; 1Department of Respiratory Care Services, Inova Fairfax Hosptial, Falls Church, VA; 2Critical Care and Neurosciences, Inova Fairfax Hospital, Falls Church, VA; 3Trauma Services, Inova Fairfax Hospital, Falls Church, VA; 4Critical Care, Inova Fairfax Hospital, Falls Church, VA

Background: Since 1997, our institution has implemented therapist-driven protocol for weaning from mechanical ventilation based on Ely et al (New Engl J of Med 1996; 335:1864-9). Results were initially favorable and were sustained. Refinements to this protocol have been implemented based on clinical evidence. For example, criteria for readiness to move to Spontaneous Breathing Trials (SBT) were modified based on the ACCP/AARC Guidelines (2001). In 2007, our institution noticed an increased time on ventilation (VLOS). Based on continuous monitoring of the weaning protocol, these aberrations were identified to be in relation to sedation use. This resulted in the inability to move individuals to SBT. Method: To address this disconnect between sedation and SBT, a multi-disciplinary team (Respiratory Therapist, Physician and Nurse) collaborated together to address the increased VLOS in relation to sedation. Based on the recent clinical trial of Girard et al (Lancet 2008; 371:126-134) a sedation protocol was established to include spontaneous awakening trials (SAT) and new criteria for SBT initiation. The team piloted this new protocol in a medical surgical ICU for up to 5 months before implementing house-wide (6 ICUs) to 122 adult critical care beds. Results: After implementing this protocol, the first quarter of 2009 showed a decrease in VLOS to 5.8 days. From 2007 through 2008 (2 years), the average VLOS was 6.9 days. We noticed similar results when comparing overall length of stay (LOS) of 15.4 days for 2008 (1 year) to that of the first quarter of 2009. The overall LOS decreased to 14.3 days. Conclusions: These results are preliminary but show a favorable trend in lowering VLOS and overall LOS. These results also show that there is an ability to duplicate the lowering of VLOS based on the methodology established by Girard et al (Lancet 2008). Our institution also was able to duplicate the multidisciplinary team approach to successful liberation from mechanical ventilation. There are also favorable financial outcomes with a linked protocol of sedation evaluation and SBT. Based on Dasta et al (Critical Care Med 2005), it has been projected that the incremental cost of mechanical ventilation in the ICU is $1,522/day. Based on our analysis, we projected a potential cost savings with the implementation of this new protocol. Sponsored Research - None

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