Implementation of an sbt protocol to reduce unplanned extubations and mechanical ventilation days

Introduction: Prolonged mechanical ventilation (MV) is associated with increased patient morbidity and mortality. Medical University of South Carolina (MUSC) PICU is above Solutions for Patient Safety (SPS) national average for unplanned extubations (UE) (In 2020, 0.870 vs 0.5, respectively). Upon review, the majority of UEs in our PICU (67%) do not require reintubation, suggesting an opportunity for earlier extubation attempts. To address this concern, a protocol to increase SBT with the goal to shorten length of MV was implemented. Methods: MUSC PICU SBT protocol was implemented in January 2021. Using QI methodologies, we compared pre and post SBT protocol data. Our SBT process includes daily screening of all intubated patients. Patients who meet criteria complete an SBT the next day. If passed, patient is prepared for extubation. If not successful, areas for optimizing chance of successful SBT are reviewed. Metrics assessed include percentage who qualified for SBT, percentage who completed an SBT, and percentage who were extubated following successful SBT. Secondary measures include rate of UE and rate of reintubation after SBT guided extubation. Data analysis for UE rate includes comparison of pre-protocol data (4/2020 - 12/2020) to post SBT protocol data (cycle 1 1/21 - 9/21 and cycle 2 10/21 - 6/22). Results: A total of 1193 screenings were performed (Cycle A: 612, Cycle B: 581). Cycle A data includes 220 (36%) SBTs, and 85 (39%) had successful SBT. Of the patients who had successful SBT 47 (55%) were extubated and 2 (4%) required reintubation within 24 hours. Cycle B data includes 176 (30%) SBTs, and 156 (89%) had successful SBT. Of the patients who had successful SBT 101 (65%) were extubated and 5 (11%) required reintubation within 24 hours. After implementation of SBT protocol UE rates were reduced by 31% (0.91 to 0.75). Conclusions: MUSC PICU SBT program was feasible and achieved reduction in UE rates. There are opportunities to improve the rate of SBT trial completion and extubation attempts after a successful SBT. Continuing to monitor data for longer period as interventions become more standard practice will determine true outcome.