Billie Lancaster is an adult-gerontology acute care nurse practitioner in the medical intensive care unit at Saint Thomas West Hospital, Nashville, Tennessee.
Megan M. Shifrin is an associate professor of nursing at Vanderbilt University School of Nursing, Nashville, Tennessee, and serves as the Intensivist AGACNP Focus Coordinator.
Crit Care Nurse. 2022 Apr 1;42(2):e1-e8. doi: 10.4037/ccn2022854.
Spontaneous awakening and breathing trials have been associated with shorter durations of mechanical ventilation and intensive care unit lengths of stay.
Inconsistent spontaneous awakening trials and spontaneous breathing trials, mechanical ventilation weaning strategies, and interdisciplinary rounding processes contributed to prolonged mechanical ventilation duration and length of stay in a 44-bed adult medical intensive care unit. Methods A standardized rounding tool that focused on coordinating spontaneous awakening and breathing trials, and on their outcomes, was integrated into daily multidisciplinary rounds in a medical intensive care unit. Aggregated patient data from the 4-month project implementation phase were compared with historical data collected for 2 months before project implementation.
During the 2-month preintervention phase, 613 adult patients were managed in the medical intensive care unit and 41 patients required mechanical ventilation, whereas during the 4-month intervention phase, 1271 patients were managed in the unit and 96 patients required mechanical ventilation. The project was associated with a 24% (0.89-day) reduction in the mean length of stay (3.72 vs 2.83 days) and a 46.3% (2.81 day) reduction in mechanical ventilation duration (6.06 vs 3.25 days) when comparing August 2019 to January 2020.
A standardized rounding tool emphasizing a coordinated process for spontaneous awakening and breathing trials was associated with a shorter length of stay and duration of mechanical ventilation among patients in the medical intensive care unit.
An evidence-based approach to weaning from mechanical ventilation and standardized rounding may be a cost-effective way to reduce mechanical ventilation duration and length of stay in a medical intensive care unit.
自主唤醒和呼吸试验与机械通气时间和重症监护病房住院时间的缩短有关。
不统一的自主唤醒试验和自主呼吸试验、机械通气撤机策略以及跨学科查房流程导致 44 张成人重症监护病房床位的机械通气时间和住院时间延长。方法：在一个成人重症监护病房，将重点关注协调自主唤醒和呼吸试验及其结果的标准化查房工具整合到日常多学科查房中。将项目实施阶段的 4 个月汇总患者数据与项目实施前 2 个月收集的历史数据进行比较。
在 2 个月的干预前阶段，有 613 名成年患者在重症监护病房接受治疗，其中有 41 名患者需要机械通气，而在 4 个月的干预阶段，有 1271 名患者在该病房接受治疗，其中有 96 名患者需要机械通气。与 2019 年 8 月相比，该项目与平均住院时间（3.72 天至 2.83 天）减少 24%（0.89 天）和机械通气时间（6.06 天至 3.25 天）减少 46.3%相关。
强调自主唤醒和呼吸试验协调过程的标准化查房工具与重症监护病房患者的住院时间和机械通气时间缩短有关。
基于证据的机械通气撤机方法和标准化查房可能是一种经济有效的方法，可缩短重症监护病房的机械通气时间和住院时间。
