Barriers to the Paired Use of Standard Spontaneous Awakening Trials and Spontaneous Breathing Trials To Improve Outcomes in a Community Hospital

Development, Implementation, and Evaluation of an Institutional Daily Awakening and Spontaneous Breathing Trial Protocol

“…27 While the potential for protocols incorporating DA to improve patient outcome is great, many institutions have yet to implement such protocols into practice and even when implemented, survey data suggest that the adherence remains low. [22][23][24][25][26] The current gap between published evidence and bedside practices in this area can be best closed by carefully adapting a DA-SBT protocol to local institutional practices, augmenting protocol implementation with extensive education led by protocol ''champions,'' incorporating triggers at point of use including electronic reminders and daily rounding checklists, and encouraging feedback from ICU users that may result in modifications of DA-SBT protocol when necessary. 4,9,14,[31][32][33][34][35] The 3 most common reported barriers to the use of DA by ICU physicians are fear of respiratory compromise (26%), unwillingness of nurses to conduct it (22%), and an increased incidence of patient-initiated device removal (20%).…”

“…1,20,21 Although DA efforts have been protocolized at many institutions, survey and observational data suggest that DA use is low. [22][23][24][25][26] This may be a result of existing ICU clinician perception surrounding DA use (ie, it compromises patient comfort, increases the incidence of patient-initiated device removal, leads to respiratory compromise, and/or is difficult to coordinate among clinicians) and the challenges of replicating an intervention that has been evaluated in a tightly controlled clinical trial in routine ICU clinical practice. [25][26][27]28 While rigorous, controlled studies demonstrate a DA-SBT strategy is both safe and effective when DA-SBT compliance is very high, the impact of a DA-SBT protocol on patient outcomes in the uncontrolled clinical setting, where compliance may be low, remains unclear.…”