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Wake Up and Extubate: A Case Control Study Investigating the Association Between the Daily Spontaneous Awakening Trial and Unplanned Extubations
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A6824 - Wake Up and Extubate: A Case Control Study Investigating the Association Between the Daily Spontaneous Awakening Trial and Unplanned Extubations
Author Block: M. Ferrera1, R. Hyzy2, J. Du2; 1Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States, 2University of Michigan, Ann Arbor, MI, United States.
In 2000, Kress et al demonstrated that scheduled daily interruptions of sedative infusions led to a shorter duration of mechanical ventilation and shorter length of stay in the intensive care unit. Building on this research, Girard et al combined sedation holidays and spontaneous breathing trials which led to fewer days of mechanical ventilation, fewer days in the intensive care unit, and shorter overall hospital stays. Both of these trials showed an increase in the rate of unplanned extubation (UE) in the experimental arm compared to the control but the rates of re-intubation and long-term mortality were about equal. The work in these trials contributed to the creation of the ABCDEF bundle.A 2013 study of 1384 ICU physicians, nurses, respiratory therapist and pharmacists analyzing adherence to the ABCDEF bundle showed that one-third did not use a sedation protocol. Similar studies have shown inconsistent implementation of the protocol as a whole. At least one study explored provider attitudes relating to implementation of the ABCDEF bundle and noted that fear of adverse events (e.g. removal of endotracheal tube/central line) was a barrier to implementation despite the evidence from the original trials. To our knowledge, no study has investigated the association between the daily SAT and UEs outside of the original investigations.This study was designed as a case control study looking at all of the unplanned extubations in the University of Michigan Medical Intensive Care Unit over a 22 month period in order to see if the findings of the original trials bear outside of a clinical trial and over a longer time period or if the concerns regarding perceived increased rates of adverse events have merit. This study included 65 unplanned extubations obtained from the Office of Clinical Safety from October 2014 to August 2016 which were matched 4:1 with control subjects who were in the ICU at the same time but did not have an unplanned extubation. Based on our multivariate statistical analysis, being on an SAT (defined as morning holiday of 4 hours off sedation) was associated with an increased rate of UE. Male gender and high RASS score were also risk factors associated with unplanned extubation. Being on an SAT without a concomitant SBT was also a risk factor for unplanned extubation.We believe that this data could be a first step for helping to predict those patients that will have a UE during a SAT.
Author Block: M. Ferrera1, R. Hyzy2, J. Du2; 1Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States, 2University of Michigan, Ann Arbor, MI, United States.
In 2000, Kress et al demonstrated that scheduled daily interruptions of sedative infusions led to a shorter duration of mechanical ventilation and shorter length of stay in the intensive care unit. Building on this research, Girard et al combined sedation holidays and spontaneous breathing trials which led to fewer days of mechanical ventilation, fewer days in the intensive care unit, and shorter overall hospital stays. Both of these trials showed an increase in the rate of unplanned extubation (UE) in the experimental arm compared to the control but the rates of re-intubation and long-term mortality were about equal. The work in these trials contributed to the creation of the ABCDEF bundle.A 2013 study of 1384 ICU physicians, nurses, respiratory therapist and pharmacists analyzing adherence to the ABCDEF bundle showed that one-third did not use a sedation protocol. Similar studies have shown inconsistent implementation of the protocol as a whole. At least one study explored provider attitudes relating to implementation of the ABCDEF bundle and noted that fear of adverse events (e.g. removal of endotracheal tube/central line) was a barrier to implementation despite the evidence from the original trials. To our knowledge, no study has investigated the association between the daily SAT and UEs outside of the original investigations.This study was designed as a case control study looking at all of the unplanned extubations in the University of Michigan Medical Intensive Care Unit over a 22 month period in order to see if the findings of the original trials bear outside of a clinical trial and over a longer time period or if the concerns regarding perceived increased rates of adverse events have merit. This study included 65 unplanned extubations obtained from the Office of Clinical Safety from October 2014 to August 2016 which were matched 4:1 with control subjects who were in the ICU at the same time but did not have an unplanned extubation. Based on our multivariate statistical analysis, being on an SAT (defined as morning holiday of 4 hours off sedation) was associated with an increased rate of UE. Male gender and high RASS score were also risk factors associated with unplanned extubation. Being on an SAT without a concomitant SBT was also a risk factor for unplanned extubation.We believe that this data could be a first step for helping to predict those patients that will have a UE during a SAT.
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