Impact of a Standardized Respiratory Therapist-Driven SBT Protocol on Length of Mechanical Ventilation in Critically Ill Pediatric Patients

Abstract

Background: Mechanical ventilation (MV), while life-saving, can lead to significant morbidity, hospital cost, psychosocial and physical risk to a child including death. It is critical to minimize length of mechanical ventilation while also preventing sequelae of failed extubation. Protocols aim to safely and efficiently liberate patients from MV, reducing harmful variations in approach. After implementing a RT-driven spontaneous breathing trial (SBT) protocol in a pediatric intensive care unit (PICU), we examined its effect on MV days pre/post SBT protocol initiation.

Methods: A protocolized, RT-driven SBT was implemented in March 2017. We completed an IRB approved retrospective data review for all MV patients in the PICU between January 2015 and October 2019. We eliminated patients with or who received tracheostomies during their PICU course, those who died, and patients intubated less than 24 hours from analysis. Variables for analysis included; SBT/intubation course, demographics, extubation failure status, MV hours, time of SBT, SBT results, and, time of extubation.

Results: 1107 intubations were included (507 pre-SBT, 600 post-SBT) with a median length of MV of approximately 93 hours. With implementation of the protocol, median (IQR) length of MV was reduced from 111 hours to 81 hours (P= 0.00069). No difference was seen in the rate of reintubation within 24 hours. Despite performing SBTs twice daily, the average time between passed SBT and extubation was nearly 13 hours. See Table 1 and Graph 1 for detailed results.

Conclusions: After implementation of a fully-integrated RT-driven SBT protocol, length of MV in the PICU was reduced with no increase in extubation failure. Significant length of time between passed SBT and extubation suggest that with more immediate extubation, length of MV could be reduced even further. Additional studies to evaluate this relationship and the possible decrease in MV hours must be done.

• Download figure
• Open in new tab
• Download powerpoint

Graph 1 displays the duration of intubation pre and post spontenour breathing trial implmentation.