The use of an interdisciplinary paired sedation and spontaneous breathing protocol to reduce duration of mechnical ventilation and reduce length of stay in a medical intensive care unit

Oversedation causes deleterious effects on patients that are mechanically ventilated in the intensive care unit and is linked to increased risk of hospital death and considerable economic burden to the patient and the hospital. The intention of this evidence-based project is to improve nurse's assessment and utilization of light sedation in the Medical Intensive Care Unit (MICU) which in turn would allow patients to proceed to a spontaneous breathing trial (SBT). Nurses and respiratory therapists (RT'S) in a MICU in a Medical Center were educated on a paired sedation and SBT protocol for mechanically ventilated patients. This protocol directed the nurses to use distinct sedation safety screening criteria to assess if their patients were a candidate for light sedation and follow the guidelines for sedation titration to achieve a Riker sedation agitation scale of 4. Subsequently, the RT's were trained to assess patients for SBT by using a specific SBT safety screen. Duration of mechanical ventilation and MICU length of stay was evaluated before and during the evidence based practice (EBP) project (sedation and SBT protocol). Statistical analysis revealed a decrease in duration of MV in the EBP group but the results were not statistically significant. MICU LOS was reduced in the EBP group which was statistically significant. Reeducating the staff with the use of the protocol during daily rounding at the bedside and providing quality tracking reports to the staff will improve adherence to the protocol and improve patient outcomes.;Keywords: sedation protocol, mechanical ventilation weaning protocol, sedation in critical care, prolonged MV, daily interruption of sedation, daily awakening, spontaneous breathing trial, and wake up and breath.