Paired Spontaneous Awakening Trial and Spontaneous Breathing Trial Protocol Implementation
Other Titles
Spontaneous Awakening and Breathing TrialAbstract
Problem & Purpose: Mechanical ventilation (MV) is a commonly used life-saving modality in the intensive care unit (ICU) patients. Sedation is widely used for improved patient MV tolerance. However, evidence shows a link between sedation use and increased MV duration and risk for MV-associated complications. This quality improvement (QI) project aimed to implement a paired Spontaneous Awakening Trial (SAT) and Spontaneous Breathing Trial (SBT) protocol in the ICU to promote early extubation and endorse a practice change that includes sedation guidelines and safety screening to identify appropriate candidates for extubation with a goal to reduce MV days. Methods: The QI project was implemented over a three months period on all intubated, MV adult ICU patients aged 18 years and older. Data was collected on monthly MV days, and Standardized Utilization Ratio (SUR) obtained from the infection prevention department as reported to the National Healthcare Safety Network (NHSN), and the percentage of mean staff compliance with the protocol implementation using a manual audit. Results: During the implementation period, the SUR decreased from 0.99 to 0.89, while the MV days increased from 154 to 162, and the percentage of mean staff compliance increased from 3% to 82%. Conclusion: The staff compliance goal was met, but the MV data is inconclusive. Data from the past 24 months have shown a seasonal variance pattern in the MV days and SUR, and there is insufficient data to analyze the impact of the protocol implementation on the clinical site. Barriers that affected the project implementation includes the synchronous merging of the Neuro and the Cardiothoracic ICUs with the hospital relocation during the implementation month.Identifier to cite or link to this item
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Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm deliveryFailure to predict and understand the causes of preterm birth, the leading cause of neonatal morbidity and mortality, have limited effective interventions and therapeutics. From a cohort of 2000 pregnant women, we performed a nested case control study on 107 well-phenotyped cases of spontaneous preterm birth (sPTB) and 432 women delivering at term. Using innovative Bayesian modeling of cervicovaginal microbiota, seven bacterial taxa were significantly associated with increased risk of sPTB, with a stronger effect in African American women. However, higher vaginal levels of β-defensin-2 lowered the risk of sPTB associated with cervicovaginal microbiota in an ethnicity-dependent manner. Surprisingly, even in Lactobacillus spp. dominated cervicovaginal microbiota, low β-defensin-2 was associated with increased risk of sPTB. These findings hold promise for diagnostics to accurately identify women at risk for sPTB early in pregnancy. Therapeutic strategies could include immune modulators and microbiome-based therapeutics to reduce this significant health burden. © 2019, The Author(s).
