(1215) Decreasing Time to Extubation With a Collaborative Spontaneous Breathing Trial Algorithm

Introduction: Spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT) are key components of the Society of Critical Care Medicine’s ICU Liberation Bundle. They have been shown to decrease ventilator days, need for tracheostomy, and delirium. Prolonged ventilator days can lead to both increased ICU and hospital length of stay. Without a multiprofessional approach to SAT and SBTs, delays in extubation were identified in our Surgical Trauma Intensive Care Unit (STICU). We aimed to develop a SAT and SBT protocol in the STICU to reduce time to extubation after SBT.

Methods: This is a retrospective study of intubated STICU patients conducted in 2022. This protocol was developed in a multiprofessional work group. Touchpoints were protocolized on day and night shift. Patients who met criteria were placed on a SAT at set time points. Patients who passed the SAT were then placed on a SBT and results were reported at multiprofessional rounds. Decision for extubation would be made immediately after passing SBT. SBT times, duration from completion of SBT to extubation, reintubation, and unplanned extubation rates were collected.

Results: A total of 385 patients were evaluated, 193 in the PRE-implementation and 192 in the POST-implementation group. SBT duration was not significantly different among groups (43.2 minutes versus 39.6 minutes; p = 0.332). Duration to extubation following successful SBT was significantly shorter in the POST-implementation group (130.9 minutes (± 164.1) versus 71.1 minutes (± 107.9); p = 0.0002). Duration to extubation following SBT strategy was most significantly impacted at night (179.0 minutes versus 39.6 minutes). Unplanned extubations and reintubation rates were reduced, but not significantly (4 versus 2; p = 0.4466; and 13 versus 6; p = 0.2331).

Conclusions: Implementing a structured SAT and SBT protocol that enhanced coordination of the multiprofessional team reduced time to extubation after successful SBT. This was shown to be most effective at night when staffing is limited. There were trends toward reduction in unplanned extubations and reintubation, however the values did not reach significance. In the future, we hope to show that improved coordination of care will have a positive impact on outcomes such as ventilator duration and ICU length of stay.