Year of Publication

2021

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Luke Linz

Committee Member

Dr. Sheila Melander

Abstract

Background: Evidence correlates better patient outcomes with shorter ventilator days therefore, without contraindications, patients should be removed from continuous mechanical ventilation as soon as safely possible. Exactly how to assess readiness to extubate and when to extubate is still up in the air.

Purpose: Evaluation of a 30-minute spontaneous breathing trial extubation protocol on patient outcomes and to also evaluate staff education of the 30-minute spontaneous breathing trial extubation protocol on adherence and patient outcomes

Methods: This is a retrospective and prospective evidence-based quality improvement project comparing patient outcomes before and after staff education as well as patient outcomes between a 2-hour spontaneous breathing trial protocol and a 30-minute spontaneous breathing trial protocol. The project took place in a 10-bed surgical intensive care unit within St. Elizabeth Healthcare hospital in the Edgewood campus located in Northern Kentucky. 101 out of 4136 patients were included in the sample. 16 in the post education group, 40 in the 2-hour group, and 45 in the 30-minute group.

Results: Patient ventilator hours between the 30-minute SBT group and the post education group were 29 and 28 (p 0.91) respectively and SBT hours were 2.11 and 2.15 (p 0.89) respectively. Extubation failures between the 2-hour group and the 30-minute group were 2 out of 40 and 2 out of 45 (p 0.9) respectively and unplanned extubations 3 out of 40 and 1 out of 45 respectively. Within the 30-minute group ventilator hours resulted in a mean of 29 hours and 59.14 hours for the 2-hour group (p 0.001). SBT hours for the 30-minute group resulted in a 2.15 hour mean and 3.42 for the 2-hout group (p 0.022).

Conclusion: The statistically significant shorter ventilator and spontaneous breathing trial hours in the 30-minute group compared to the 2-hour group is an encouraging piece of evidence for the active spontaneous breathing trail protocol in the surgical intensive care unit. This, coupled with the lack of any statistically significant negative patient outcomes between the 30-minute and 2-hour groups, provides supporting evidence to continue the use of the 30-minute spontaneous breathing trial protocol over the 2-hour protocol in the surgical intensive care unit.

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