Introduction: The SCCM PADIS guidelines suggest sedative and analgesic strategies, including daily awakening and spontaneous breathing trials (DA-SBTs), light sedation, and minimizing exposure to benzodiazepines, to improve outcomes in mechanically ventilated (MV) patients. After revising our institution’s MV order set to better align with recommendations, we conducted a pre/post study to evaluate time at goal level of consciousness, hypothesizing it would increase. Methods: This IRB-approved, single-center, retrospective pre/post study evaluated adult MV patients with light sedation goals in medical and surgical ICUs at a community-based teaching hospital. Data from 1/21-6/21, when the previous order set was used, was compared to data from 10/24-12/24 after release of the revised order set. Key updates included: a shift from SAS to RASS level of consciousness assessment, recommendations to bolus opioid and benzodiazepines before increasing infusions, and a nurse-driven infusion weaning protocol. Demographics, medication dosing and administration data, and time at goal level of consciousness were collected. The primary endpoint was percent of time at light level of consciousness. Secondary endpoints were adherence to the DA-SBT protocol and sedative and opioid infusion rates. Descriptive statistics were used to compare endpoints. Results: 172 patients in the pre-group were compared to 40 patients in the post-group. Median age was 67 years in both groups and weight was 85 kg and 79 kg in the pre and post-groups, respectively. Median percent of time at light level of consciousness was higher in the pre-group overall (79% vs 63%) and in each ICU, driven by a lower percent of time below the goal level of consciousness (14% vs 30%). DA-SAT protocol adherence was higher before the update (73% vs 61%), but sedative infusion dose reduction after a failed DA-SBT improved (36% vs 74%). Median sedative and opioid rates were similar in both groups. Conclusions: Time at goal level of consciousness did not increase after updating our order set to align with guideline recommendations, illustrating a need to better communicate and educate to support optimal practices.
Grgurich et al. (Sun,) studied this question.