Author Affiliations: Critical Care Clinical Nurse Specialist (Dr Seyller), UCHealth Memorial Hospital Central, UCHealth Memorial Hospital North, Colorado Springs, Colorado; and Professor (Dr Makic), College of Nursing, University of Colorado, Aurora.
Clin Nurse Spec. 2022;36(5):264-271. doi: 10.1097/NUR.0000000000000693.
PURPOSE/OBJECTIVES: Prolonged mechanical ventilation results from deeper levels of sedation. This may lead to impaired respiratory muscle functioning that develops into pneumonia, increases antibiotic use, increases delirium risk, and increases length of hospitalization. A trauma and surgical intensive care unit interdisciplinary team conducted a quality improvement project to lighten sedation levels and shorten mechanical ventilation time.
The project included multimodal elements to improve sedation practice. Standardizing the spontaneous awakening trial algorithm, creation of electronic health record tools, integration of sedation practices into daily rounds, and focused education for nursing were implemented in April 2021 through October 2021.
A reduction of median hours spent on mechanical ventilation was achieved. Mechanical ventilation hours decreased from 77 to 70. Richmond Agitation Sedation Scale levels improved from a median of -2 to -1, and daily spontaneous awakening trials increased from 10% to 27% completed.
The quality improvement project demonstrated that, with increased daily spontaneous awakening trials and lighter sedation levels, the time patients spent on mechanical ventilation was shortened. There was no increase to self-extubation with lighter sedations levels. Shorter time on mechanical ventilation can reduce patient harm risks.
目的/目标：深度镇静会导致机械通气时间延长。这可能导致呼吸肌功能受损，进而发展为肺炎，增加抗生素使用，增加谵妄风险，并延长住院时间。创伤和外科重症监护病房的跨学科团队开展了一项质量改进项目，以减轻镇静水平并缩短机械通气时间。
该项目包括多项措施来改善镇静实践。通过 2021 年 4 月至 2021 年 10 月，实施了标准化自主唤醒试验算法、创建电子病历工具、将镇静实践纳入日常查房以及对护理人员进行重点教育等多模式措施。
实现了机械通气时间中位数的减少。机械通气时间从 77 小时减少至 70 小时。Richmond 躁动镇静量表评分从中位数-2 改善至-1，每日自主唤醒试验完成率从 10%增加至 27%。
质量改进项目表明，随着每日自主唤醒试验增加和镇静水平降低，患者机械通气时间缩短。较轻的镇静水平并未增加自行拔管的风险。缩短机械通气时间可降低患者伤害风险。
