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Summary:
This article was found in the Respiratory Care journal that was published in January of 2018. The main topic being spontaneous breathing trials (SBIs) and daily sedation interruptions (DSIs). These two items have been thought to help decreases the amount of mechanical ventilator days and intensive care unit days that a patient may be on. This study specifically looked at these two items for patients who are suffering from acute respiratory distress syndrome (ARDS). The Respiratory Care field has used these two techniques for a while to help wean patients off of ventilators, but as far as the authors of this study know they “are the first to have examined specifically the impact of adopting SBT/DSI and targeted light sedation practices on the duration of mechanical ventilation and ICU LOS intensive care unit length of stays in subjects with ARDS” (Kallet, Hanjing, Yip, Gomez, and Lipnick, 2018, p. 6-7). These authors decided to do a retrograde study to either confirm or deny if SBTs and DSIs shortened duration of mechanical ventilation and ICU days. The authors stated that they studied “a retrospective group of subjects with ARDS at a large, urban, level- 1 trauma center” (Kallet et al., 2018, p. 1) with the time frame “from 2002 to 2016” (Kallet et al., 2018, p. 1) with all surviving ARDS patients during that time frame. They then split all of these surviving members up into two groups one that was made up of “397 pre-SBT/DSI group and 656 in the post-SBT/DSI group” (Kallet et al., 2018, p. 3). By them splitting it into two groups it helped determine what patient with ARDS were getting the supposedly beneficial SBT/DSI and which ones were not. They then used a database with Mann- Whitney, Kruskal- Wallis, and Dunn’s testing, along with linear regressions for the intensive care unit length of stay in days. These different tests were meant to assess outliers of the data, normality of data, and comparisons between different patients or data. The linear regression helped show that the patients that were in the pre-group had significantly more days in the ICU than those who were in the post-group by putting the data into a graph form. The authors concluded that “subjects with ARDS managed with current, evidenced-based practices for weaning by SBT and sedation managed by DSI and/or targeted light sedation required substantially less time receiving mechanical ventilation and fewer days of care in the ICU compared to physician-directed, usual-care practices in place…” (Kallet et al., 2018, pg. 6). Their conclusion confirms that the SBTs and the DSIs are helping improve our patients on mechanical ventilators with ARDS faster.
Application:
When it comes to medical practices new improvements in how practices are done are not always known if they are going to improve the patients in the long run or not. That is why the FDA and many governing bodies in some other countries have made it so clinical trials and or studies are done. SBTs and DSIs are something that has been done for a little while, and studied minutely because they are trials/interruptions that don’t 100% put the patient in harm’s way. This group helped show that with all the data they collected in this retrospective study that the work with SBTs and DSIs is helping patients. This information will be helpful in the field to ensure that what we are proving out patients is actually helping them improve and go home sooner than without either the SBT or the DSI.
Reaction:
I was not aware on how much SBIs and DSIs could affect the length of stays for patients. Any days in the hospital, a patient is at a higher risk for nosocomial infections. If these two items work to get the patients stable sooner and on their own out of the hospital setting, the better off they will be in the long run. I think that with them choosing to do a study with close to 1000 members involved and at a level 1 trauma center it shows that their study was inclusive of critical care patients, while making sure that they focused on just one specific illness that is almost always put on a mechanical ventilator to try and save their lives.

References
Kallet, R. H., Hanjing, Z., Yip, V., Gomez, A., ; Lipnick, M. S. (2018). Spontaneous Breathing Trials and Conservative Sedation Practices Reduce Mechanical Ventilation Duration in Subjects With ARDS. Respiratory Care, 63(1), 1-10. doi:10.4187/respcare.05270

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