ATS 2007, SAN FRANCISCOA new study of intensive care unit patients who are breathing with the help of a mechanical ventilator has found that a two-step sedation and ventilator weaning protocolcalled a wake up and breathe strategyhelps patients come off the ventilator faster so that they can be discharged from the ICU and hospital more quickly. The study is being presented at the American Thoracic Society 2007 International Conference in San Francisco.
On average, patients managed with the intervention spent four more days alive and out of the ICU and out of the hospital than those managed in the control group, explained senior author Wes Ely, M.D., M.P.H., Professor of Medicine at Vanderbilt University and Associate Director of the Geriatric Research Education and Clinic Center.
In the first step of the protocol, the patients sedation is turned off, also known as a spontaneous awakening trial. Almost all patients on a ventilator in the ICU receive sedating medications that keep them comfortable or even comatose, says the studys first author, Timothy Girard, M.D., M.S.C.I., also of the Vanderbilt University School of Medicine in Nashville. The spontaneous awakening trial (SAT) allows them to wake up, so we can find out if they are ready to proceed without sedation. If the patient is uncomfortable, we restart sedation, but a lot of patients are comfortable enough to proceed with the next step in the protocol.
This second step involves allowing the patient to try breathing on their own without substantial help from the ventilator, called a spontaneous breathing trial. If the patient shows signs they are unable to breathe on their own, they are immediately placed back on full mechanical ventilation.
The multicenter study included 335 critically ill patients in four hospitals who were receiving mechanical ventilation. Patients managed with the combined wake up and breathe protocol (the SAT + SBT group) were compared with patients who were managed
Contact: Suzy Martin
American Thoracic Society