Spontaneous Breathing Trials and Conservative Sedation Practices Reduce Mechanical Ventilation Duration in Subjects With ARDS.
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...
| Publicado en: | Respiratory Care Vol. 63; no. 1; pp. 1 - 11 |
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| Autores principales: | , , , , |
| Formato: | CEU research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Jan2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126845365&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 126845365 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Jan2018 vid: 63 iid: 1 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 126845365 126845365 126845365 10.4187/respcare.05270 126845365 ppf: 1 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Spontaneous Breathing Trials and Conservative Sedation Practices Reduce Mechanical Ventilation Duration in Subjects With ARDS. aug: au: Kallet, Richard H. Hanjing Zhuo Yip, Vivian Gomez, Antonio Lipnick, Michael S. affil: 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 sug: subj: Respiratory Distress Syndrome, Acute Therapy Respiration, Artificial Respiration Evaluation Ventilator Weaning Sedation Treatment Duration Education, Continuing (Credit) Human Protocols Program Implementation Length of Stay Intensive Care Units Retrospective Design Urban Areas Descriptive Statistics Paired T-Tests Mann-Whitney U Test Kruskal-Wallis Test Post Hoc Analysis One-Way Analysis of Variance Linear Regression P-Value Treatment Outcomes Data Analysis Software Chi Square Test APACHE (Acute Physiology and Chronic Health Evaluation) Clinical Assessment Tools Positive End-Expiratory Pressure Odds Ratio Aged Middle Age Adult Male Female Confidence Intervals Aged: 65+ years Middle Aged: 45-64 years Adult: 19-44 years Male Female ab: 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. pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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