Richard H Kallet1, Hanjing Zhuo2, Vivian Yip3, Antonio Gomez4, Michael S Lipnick5. 1. Respiratory Care Services in the Department of Anesthesia and Periopertive Care, University of California, San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center. rich.kallet@ucsf.edu. 2. Cardiovascular Research Institute, University of California, San Francisco. 3. Respiratory Care Services in the Department of Anesthesia and Periopertive Care, University of California, San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center. 4. Department of Pulmonary and Critical Care Medicine, University of California, San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center. 5. Department of Anesthesia and Periopertive Care, University of California, San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center.
Abstract
BACKGROUND: Spontaneous breathing trials (SBTs) and daily sedation interruptions (DSIs) reduce both the duration of mechanical ventilation and ICU length of stay (LOS). The impact of these practices in patients with ARDS has not previously been reported. We examined whether implementation of SBT/DSI protocols reduce duration of mechanical ventilation and ICU LOS in a retrospective group of subjects with ARDS at a large, urban, level-1 trauma center. METHODS: All ARDS survivors from 2002 to 2016 (N = 1,053) were partitioned into 2 groups: 397 in the pre-SBT/DSI group (June 2002-December 2007) and 656 in the post-SBT/DSI group (January 2009-April 2016). Patients from 2008, during the protocol implementation period, were excluded. An additional SBT protocol database (2008-2010) was used to assess the efficacy of SBT in transitioning subjects with ARDS to unassisted breathing. Comparisons were assessed by either unpaired t tests or Mann-Whitney tests. Multiple comparisons were made using either one-way analysis of variance or Kruskal-Wallis and Dunn's tests. Linear regression modeling was used to determine variables independently associated with mechanical ventilation duration and ICU LOS; differences were considered statistically significant when P < .05. RESULTS: Compared to the pre-protocol group, subjects with ARDS managed with SBT/DSI protocols experienced pronounced reductions both in median (IQR) mechanical ventilation duration (14 [6-29] vs 9 [4-17] d, respectively, P < .001) and median ICU LOS (18 [8-33] vs 13 [7-22] d, respectively P < .001). In the final model, only treatment in the SBT/DSI period and higher baseline respiratory system compliance were independently associated with reduced mechanical ventilation duration and ICU LOS. Among subjects with ARDS in the SBT performance database, most achieved unassisted breathing with a median of 2 SBTs. CONCLUSION: Evidenced-based protocols governing weaning and sedation practices were associated with both reduced mechanical ventilation duration and ICU LOS in subjects with ARDS. However, higher respiratory system compliance in the SBT/DSI cohort also contributed to these improved outcomes.
BACKGROUND: Spontaneous breathing trials (SBTs) and daily sedation interruptions (DSIs) reduce both the duration of mechanical ventilation and ICU length of stay (LOS). The impact of these practices in patients with ARDS has not previously been reported. We examined whether implementation of SBT/DSI protocols reduce duration of mechanical ventilation and ICU LOS in a retrospective group of subjects with ARDS at a large, urban, level-1 trauma center. METHODS: All ARDS survivors from 2002 to 2016 (N = 1,053) were partitioned into 2 groups: 397 in the pre-SBT/DSI group (June 2002-December 2007) and 656 in the post-SBT/DSI group (January 2009-April 2016). Patients from 2008, during the protocol implementation period, were excluded. An additional SBT protocol database (2008-2010) was used to assess the efficacy of SBT in transitioning subjects with ARDS to unassisted breathing. Comparisons were assessed by either unpaired t tests or Mann-Whitney tests. Multiple comparisons were made using either one-way analysis of variance or Kruskal-Wallis and Dunn's tests. Linear regression modeling was used to determine variables independently associated with mechanical ventilation duration and ICU LOS; differences were considered statistically significant when P < .05. RESULTS: Compared to the pre-protocol group, subjects with ARDS managed with SBT/DSI protocols experienced pronounced reductions both in median (IQR) mechanical ventilation duration (14 [6-29] vs 9 [4-17] d, respectively, P < .001) and median ICU LOS (18 [8-33] vs 13 [7-22] d, respectively P < .001). In the final model, only treatment in the SBT/DSI period and higher baseline respiratory system compliance were independently associated with reduced mechanical ventilation duration and ICU LOS. Among subjects with ARDS in the SBT performance database, most achieved unassisted breathing with a median of 2 SBTs. CONCLUSION: Evidenced-based protocols governing weaning and sedation practices were associated with both reduced mechanical ventilation duration and ICU LOS in subjects with ARDS. However, higher respiratory system compliance in the SBT/DSI cohort also contributed to these improved outcomes.
Authors: Friedrich Hohmann; Lisa Wedekind; Felicitas Grundeis; Steffen Dickel; Johannes Frank; Martin Golinski; Mirko Griesel; Clemens Grimm; Cindy Herchenhahn; Andre Kramer; Maria-Inti Metzendorf; Onnen Moerer; Nancy Olbrich; Volker Thieme; Astrid Vieler; Falk Fichtner; Jacob Burns; Sven Laudi Journal: Cochrane Database Syst Rev Date: 2022-06-29
Authors: Margarete Pierce; Steven W Gudowski; Karsten J Roberts; Anthony Jackominic; Karen K Zumstein; Amanda Shuttleworth; Joshua Ho; Phillip Susser; Alomi Parikh; John M Chandler; Ann Marie Huffenberger; Michael J Scott; C William Hanson; Krzysztof Laudanski Journal: J Clin Med Date: 2022-01-29 Impact factor: 4.241