(1232) Optimizing Timing of Daily Spontaneous Awakening and Breathing Trials to Improve Compliance

Introduction: Daily performance of a paired spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) involves pausing sedative medications and allowing the patient to breathe with minimal ventilator support, to assess readiness for extubation, as part of the ABCDEF Bundle. Completion of SAT/SBT synergistically has been shown to decrease the duration of mechanical ventilation, ICU, and hospital stay. While important, this can create logistic difficulty with competing interests at certain times of day. Given difficulty with consistent performance, the scheduled SAT/SBT time was moved from 0800 to 0530. The purpose of this study is to determine if the change in SAT/SBT schedule was associated with changes in compliance. We hypothes was that moving to an earlier time would be associated with improved compliance.

Methods: A retrospective chart review of randomly selected patients on mechanical ventilation in an academic, quaternary care ICU before and after an SAT/SBT process change was conducted. Demographic and acuity data were collected. The primary outcome was daily SAT/SBT compliance. Secondary outcomes included ventilator-free days, ICU-free days, time from starting SAT to extubation, and reintubation. Simple statistics were performed.

Results: We identified 90 patients; 30 pre-intervention and 60 post-intervention. The pre-intervention group consisted of 62.5% males with an average age of 62.19 years and mean Sequential Organ Failure Assessment (SOFA) score of 10.06, and the post-intervention group consisted of 51.7% males with an average age of 56.62 years and mean SOFA score of 12.05. Pre-intervention compliance was 37.5%, post-intervention was 86.7%. Pre-intervention median time from SAT initiation to extubation was 5.3 hours, post was 3.5 hours. Ventilator-free days increased from 28.1 days pre to 28.6 days post-intervention. ICU-free days increased from 24.9 days pre to 26.3 days post. Three patients required reintubation pre-intervention and zero post.

Conclusions: Paired SAT and SBT remain an important part of providing efficient and humanistic critical care. Barriers to completion may exist, and reconsidering the time of planned performance can be associated with improved compliance and subsequent increase in ventilator-free and ICU-free days without increasing adverse events.