Implementation of a Nurse-Driven Spontaneous Awakening Trial Protocol in a Cardiac Intensive Care Unit

Author:

Ketcham Scott W.1,Adie Sarah K.2,Brummel Kent3,Walker Emily4,Prescott Hallie C.5,Thomas Michael P.6

Affiliation:

1. Scott W. Ketcham is a cardiology fellow in the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan.

2. Sarah K. Adie is a clinical specialist in cardiology in the Department of Clinical Pharmacy, University of Michigan.

3. Kent Brummel is a cardiology fellow in the Department of Internal Medicine, Division of Cardiology, University of Michigan.

4. Emily Walker is a nurse and clinical educator in the cardiac intensive care unit, Department of Nursing, University of Michigan.

5. Hallie C. Prescott is a physician in the Department of Internal Medicine, Institute for Healthcare Policy and Innovation, Division of Pulmonary and Critical Care Medicine, University of Michigan.

6. Michael P. Thomas is a physician in the Department of Internal Medicine, Division of Cardiology, University of Michigan.

Abstract

Background In patients receiving mechanical ventilation, spontaneous awakening trials reduce morbidity and mortality when paired with spontaneous breathing trials. However, spontaneous awakening trials are not performed every day they are indicated and little is known about spontaneous awakening trial protocol use in cardiac intensive care units. Local Problem Spontaneous awakening trial completion rate at the study institution was low and no trial protocol was regularly used. Methods A preintervention-postintervention retrospective cohort study was performed in adult patients with at least 24 hours of invasive mechanical ventilation in Michigan Medicine’s cardiac intensive care unit. Patients with SARS-CoV-2 infection were excluded. Data included demographics, sedation, mechanical ventilation duration, and in-hospital mortality. A nurse-driven spontaneous awakening trial protocol modified for the cardiac intensive care unit was implemented in October 2020. Results Compared with the preintervention cohort (n = 29, May through July 2020), the postintervention cohort (n = 27, October 2020 through February 2021) had a higher ratio of number of trials performed to number of days eligible for trial (0.91 vs 0.52; P < .01). Median continuous sedative infusion duration was shorter after intervention (2.3 vs 3.6 days; P = .02). Median mechanical ventilation duration (3.8 vs 4.7 days; P = .18) and mortality (41% vs 41%; P = .95) were similar between groups. Conclusions Spontaneous awakening trial protocol implementation led to a higher trial completion rate and a shorter duration of continuous sedative infusion. Larger studies are needed to assess the impact of protocolized spontaneous awakening trials on cardiac intensive care unit patient outcomes.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

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