2012 OPEN FORUM Abstracts
ESTABLISHING GOALS AND ROUTINE REPORTING FOR EXTUBATION FOLLOWING SUCCESSFUL SPONTANEOUS BREATHING TRIALS RESULTS IN INCREASED PHYSICIAN UTILIZATION OF SBT.
Michael Bocci1, Ken Hargett1, Faisal Masud2, Margaret Berger1, Jose Rodriguez1; 1Respiratory Care Services, The Methodist Hospital, Houston, TX; 2Critical Care, Methodist Debakey Heart and Vascular Center, Houston, TX
Background: Our institution has been utilizing Spontaneous Breathing Trials (SBT) since 2005 to assist physicians in liberation decisions. All eligible patients (Fio2< .6, PEEP < 8 and RR < 35) receive a SBT daily and for those patients that pass a recommendation for liberation is provided to the managing physician. The results for each of the 5 ICUs for utilization of the SBT to promote liberation has been tracked and reported to the Critical Care Quality Committee. While there is no National Benchmark, each of the 5 ICUs has been encouraged to increase utilization. In 2011 the Critical Care Quality Committee established a goal of 65% of those patients that passed SBT is liberated. This goal was increased to 75% in 2012. Methods: Every eligible patient receives a SBT daily. The SBT is performed with a PEEP of 0 and with tubing compensation active. SBT duration is 30-120 minutes. Failure criteria include RSBI > 105 for more than 5 minutes, Respiratory rate increase > 35, Heart rate increase more than 10%. In 2011 to increase utilization a program was put in place to verify data integrity, increase communication with managing physicians regarding the patients status and the program goals of the Quality Committee. SBT results were included in Progress Notes and discussed on rounds. Liberation within 4 hours of the SBT was considered a result of the SBT. The physicians decision to liberate or not was submitted to the Respiratory Information database and compliance data reported monthly by unit to the Critical Care Quality Committee. Results: Baseline results for the years 2005 to 2010 had a compliance rate of 48-55% of patients liberated following a successful SBT. The 2010 goal of 65% was exceeded at 68.6%. For the first quarter of 2012 the goal of 75% is exceeded at 78%. Re-intubation rates within 24 hours have been maintained at less than 5%. Conclusion: A standardized approach to implementing SBTs and monthly reporting with established goals has resulted in increased utilization of this technique to encourage physicians to consider liberation. Continued refinement of the process has resulted in increased physician confidence and an increased number of patients liberated while maintaining a low re-intubation rate. Sponsored Research - None