Optimizing daily spontaneous breathing trial timing to expedite extubation

Abstract

Background Spontaneous breathing trials (SBTs) are a crucial tool used to assess patients who are being mechanically ventilated for extubation readiness. Objectives As a quality improvement initiative, we have conducted a pre-post implementation study to evaluate whether changing the daytime scheduling of an SBT results in a reduction in SBT completion to extubation timing. Methods We conducted a retrospective chart review of randomly selected general medical intensive care unit patients before and after an SBT timing change from 0500–0600 to 0800–0900 over a 13-month period. We reviewed 220 subjects in the pre-intervention group and 226 in the post-intervention group, and data analysis was performed using scipy.stats in Python. Results There was a significant reduction in the time from SBT to extubation in the 0800–0900 group compared to the 0500–0600 group (1.13 [0.48, 2.67] vs 3.63 [1.32, 6.32] h, p = <0.001). Conclusion Therefore, we concluded that among this sample of intubated MICU subjects, changing SBT timing from 0500–0600 to 0800–0900 resulted in a significant decrease in SBT to extubation time. Reducing the SBT to extubation time minimizes the need to re-sedate a patient to promote continued ventilator tolerance. Thus, our results show that evaluating daily SBT timing can be a valuable quality improvement intervention that impacts patient centered outcomes.