1096

Abstract

Introduction: Daily interruption of sedative medications hasbeen shown to improve outcomes in mechanically ventilated patients. Hypothesis: Introduction of a pragmatic clinical pathway for selection and dosing of sedation and analgesia during mechanical ventilation in a cardiac intensive care unit (CICU) will increase the frequency of daily interruption of sedation and reduce mechanical ventilation time. Methods: To assess the impact of a quality improvement initiative, we evaluated all mechanically ventilated patients admitted to the CICU during two phases, matched in timing: phase 1 (PRE) assessed prior to pathway implementation from February to September 2010 and phase 2 (POST) post-implementation from February to September 2011. Endpoints included duration of mechanical ventilation (primary endpoint), CICU length of stay (LOS), hospital LOS, number of sedation holidays completed, neuroimaging, and mortality. Results: A total of 198 patients (98 PRE and 100 POST) and 1,012 days of intubation (574 PRE and 434 POST) were included in this analysis. There was an increase in the frequency of daily interruptions in sedation completed post-implementation (49.3% PRE and 58.4% POST p=0.0041). There was a significant decrease in the mean duration of mechanical ventilation in the PRE vs. POST groups (6.1 ± 2.8 vs. 5.0 ± 2.3 days, p = 0.015). Mean CICU LOS and Hospital LOS respectively were 10.4 days and 16.8 days PRE and 10.4 days and 17.9 days POST (p = 1.0 and p = 0.55). Implementation was associated with a significant decrease in neuroimaging (50% vs 9%, p =0.0001), and a trend toward a decrease in tracheostomies (6.1% vs. 3.0% p=0.3286), and mortality (36.7% vs 32.0% p=0.55) Conclusions: Implementation of a pragmatic pathway for sedation and analgesia in a CICU was associated with an increase in the daily interruption of sedation and a corresponding decrease in mechanical ventilation days, and need for neuroimaging. The small impact on hospital length of stay highlights the need for continued investigation of changes in practice which can reduce CICU LOS.