(240) Early Ventilator Liberation Assessment in Patients With Low-Dose Vasopressors (VAPORS)

Introduction: A common criteria for the daily safety screening for patients receiving mechanical ventilator support is hemodynamic stability, often clinically defined as no vasopressor support. Consequently, patients on low-dose vasopressors fail the screening despite current literature indicating safety, and do not proceed to a spontaneous breathing trial (SBT). An updated screening protocol was implemented to assess its impact on ventilator liberation outcomes at our institution.

Methods: This single-center study included patients 18 years or older, admitted to the intensive care unit (ICU), on mechanical ventilation for at least 24 hours with at least one documented SBT attempt. Exclusion criteria included patients with a tracheostomy, death prior to or within 24 hours of extubation, terminal and incidental extubations. An updated protocol was implemented, which defined hemodynamic stability to include a single low-dose vasopressor use with pre-specified dose cutoffs. The primary outcome was the time on mechanical ventilation. Secondary outcomes included: causes of SBT screening failure, time to initial successful SBT screening, reintubation within 48 hours, and ICU length of stay. Cohort 1 represents patients receiving a single vasopressor at extubation. Cohort 2 represents patients who were extubated with no vasopressors. Data was analyzed using inferential statistics.

Results: Twenty-three patients were included in the prospective study, with 4 patients in Cohort 1 and 19 patients in Cohort 2. Median ventilator days was 3.7 days in Cohort 1 and 4.5 days in Cohort 2 (p=0.82). Time to initial successful SBT screening was 5 days in Cohort 1 and 3 days in Cohort 2 (p=0.33). No patients in either Cohort were reintubated within 48 hours. 3 patients from Cohort 2 were reintubated at some point during their hospital stay. Of note, no patient failed SBT screening strictly due to vasopressor use.

Conclusions: Implementation of a protocol defining hemodynamic stability in combination with pharmacist interventions resulted in improved outcomes for patients on mechanical ventilation. A systematic process implementation and multi-disciplinary education may assist in earlier identification of patients for earlier ventilator liberation.