Multicenter implementation of a consensus-developed, evidence-based, spontaneous breathing trial protocol.

Abstract

Evidence-based practice recommendations abound, but implementation is often unstructured and poorly audited. We assessed the ability of a peer network to implement an evidence-based best practice protocol and to measure patient outcomes. Consensus definition of spontaneous breathing trial followed by implementation in eight academic medical centers. Six medical, two surgical, and two combined medical/surgical adult intensive care units among eight academic medical centers. Patients initiating mechanical ventilation through an endotracheal tube during a 12-wk interval formed the study population. Adoption and implementation of a common spontaneous breathing trial protocol across multiple intensive care units. Seven hundred five patients had 3,486 safety screens for conducting a spontaneous breathing trial; 2072 (59%) patients failed the safety screen. Another 379 (11%) patients failed a 2-min tolerance screen and 1,122 (34%) patients had a full 30-120 min spontaneous breathing trial performed. Seventy percent of eligible patients were enrolled. Only 55% of passing spontaneous breathing trials resulted in liberation from mechanical ventilatory support before another spontaneous breathing trial was performed. Peer networks can be effective in promoting and implementing evidence-based best practices. Implementation of a best practice (spontaneous breathing trial) may be necessary for, but by itself insufficient to achieve, consistent and timely liberation from ventilator support.