Scott W. Ketcham is a cardiology fellow in the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
Sarah K. Adie is a clinical specialist in cardiology in the Department of Clinical Pharmacy, University of Michigan.
Crit Care Nurse. 2022 Apr 1;42(2):56-61. doi: 10.4037/ccn2022114.
In patients receiving mechanical ventilation, spontaneous awakening trials reduce morbidity and mortality when paired with spontaneous breathing trials. However, spontaneous awakening trials are not performed every day they are indicated and little is known about spontaneous awakening trial protocol use in cardiac intensive care units.
Spontaneous awakening trial completion rate at the study institution was low and no trial protocol was regularly used.
A preintervention-postintervention retrospective cohort study was performed in adult patients with at least 24 hours of invasive mechanical ventilation in Michigan Medicine's cardiac intensive care unit. Patients with SARS-CoV-2 infection were excluded. Data included demographics, sedation, mechanical ventilation duration, and in-hospital mortality. A nurse-driven spontaneous awakening trial protocol modified for the cardiac intensive care unit was implemented in October 2020.
Compared with the preintervention cohort (n = 29, May through July 2020), the postintervention cohort (n = 27, October 2020 through February 2021) had a higher ratio of number of trials performed to number of days eligible for trial (0.91 vs 0.52; P < .01). Median continuous sedative infusion duration was shorter after intervention (2.3 vs 3.6 days; P = .02). Median mechanical ventilation duration (3.8 vs 4.7 days; P = .18) and mortality (41% vs 41%; P = .95) were similar between groups.
Spontaneous awakening trial protocol implementation led to a higher trial completion rate and a shorter duration of continuous sedative infusion. Larger studies are needed to assess the impact of protocolized spontaneous awakening trials on cardiac intensive care unit patient outcomes.
在接受机械通气的患者中，与自主呼吸试验联合进行自主唤醒试验可降低发病率和死亡率。然而，并非在所有需要进行自主唤醒试验的情况下都进行该试验，并且对于心脏重症监护病房中自主唤醒试验方案的使用情况知之甚少。
研究机构中的自主唤醒试验完成率较低，且没有定期使用试验方案。
在密歇根大学医学中心心脏重症监护病房中，对至少接受了 24 小时有创机械通气的成年患者进行了一项前瞻性队列研究。排除 SARS-CoV-2 感染患者。数据包括人口统计学、镇静、机械通气时间和院内死亡率。2020 年 10 月实施了一项经过修改的护士主导的心脏重症监护病房自主唤醒试验方案。
与干预前队列（n=29，2020 年 5 月至 7 月）相比，干预后队列（n=27，2020 年 10 月至 2021 年 2 月）进行的试验次数与有资格进行试验的天数之比更高（0.91 比 0.52；P<0.01）。干预后连续镇静输注时间中位数更短（2.3 天比 3.6 天；P=0.02）。机械通气时间中位数（3.8 天比 4.7 天；P=0.18）和死亡率（41%比 41%；P=0.95）在两组之间相似。
自主唤醒试验方案的实施提高了试验完成率，并缩短了连续镇静输注的时间。需要更大规模的研究来评估方案化自主唤醒试验对心脏重症监护病房患者结局的影响。
