Abstract 237: Protocol-guided Weaning From Mechanical Ventilation in The Cardiac Intensive Care Unit

Abstract

Background: Rates of prolonged mechanical ventilation (MV) in cardiac intensive care units (CICU) have significantly increased over the past few decades. MV is associated with numerous complications including prolonged ICU length of stay as well as increased mortality. The most effective method of liberation from MV includes a daily assessment of weaning readiness, interruption of sedation, and spontaneous breathing trials (SBTs). Effective weaning protocols require multidisciplinary collaboration between physicians, nurses, and respiratory therapists. Methods: We identified and implemented several quality improvement interventions to improve weaning from MV in the University of Michigan Health System (UMHS) CICU. We specifically changed the time of SBTs from 4-5 AM to 8-9 AM to promote physician involvement in weaning and improve physician-nursing-respiratory therapist communication. By performing SBTs during morning rounds, we intended to optimize physician communication with nursing and respiratory therapy regarding selection of patients for SBT, evaluation of SBT success, identification of barriers to weaning, and selection of patients for extubation. We hypothesized that these interventions would decrease MV time to initial SBT, duration of MV, and ICU length of stay. Results: We reviewed the clinical data and outcomes of 172 mechanically ventilated patients in the UMHS CICU (83 prior to and 89 following our intervention). Our intervention was associated with a trend toward decreased duration of MV (mean duration 4.95 vs. 3.66 days, p=0.13) and a trend toward a shorter ICU length of stay (mean duration 9.91 vs. 8.10 days, p=0.22) (Figure). Nonsignificant reductions in MV time to initial SBT (2.31 vs. 2.09 days, p not significant) and time from initial SBT to end of MV (2.40 vs. 1.82 days, p not significant) were also observed. Conclusions: These results suggest that a collaborative, multidisciplinary effort including physicians, nurses, and respiratory therapists may be effective in improving the care of mechanically ventilated patients in the CICU. Larger, multicenter studies further evaluating our protocol-guided weaning strategy are warranted to establish its efficacy in the management of these patients.