Assessing the Implementation of Intermittent Sedation to Reduce the Duration of Intubation

Abstract

Problem & Purpose: Adults admitted to a Cardiac Care Unit (CCU) at an urban teaching hospital are experiencing prolonged intubation times as evidenced by 5.0 ventilator days in 2021 and 4.8 ventilator days in 2022 as compared to 4.33 to 4.62 days nationally in similar settings. The purpose of this quality improvement (QI) initiative is to transition practice from utilizing high-dose continuous sedation for intubated patients to a nurse-driven intermittent sedation algorithm to reduce the duration of intubation for adults admitted to this unit. Evidence shows that utilizing intermittent sedation reduces the complications of intubation including delirium, immobility, and inappropriate sleep-wake cycle. Methods: This QI initiative was implemented over 15 weeks. A nurse-driven intermittent sedation algorithm was utilized for intubated patients who have a prescriber-ordered RASS goal of 0 or -1 with specific eligibility criteria. This QI initiative ensured daily spontaneous breathing trials (SBTs) were completed as a leading factor for extubation readiness. The primary outcome for this project was the duration of intubation in ventilator days. Secondary outcomes include CCU length of stay, use of nurse-driven intermittent sedation algorithm, average patient RASS for the previous 24 hours, and completion of daily SBT. Results & Conclusions: Total ventilator days during the implementation period was 6.46 days. Although most intubated patients were maintained on the nurse-managed intermittent sedation algorithm, ventilator days were still higher than historic data. This is likely because of the limited time that data was collected, higher rates of intubation during respiratory virus season, and the inability to extubate due to the patient’s clinical status. Keywords: adults, duration of intubation, intermittent sedation, nurse-driven, RASS, spontaneous breathing trial