Dissertation
Daily Spontaneous Breathing Trials in a Medical Intensive Care Unit
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background: Patients in the intensive care unit (ICU) often require complex therapies, approximately 40% needing mechanical ventilation (MV). Daily spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT) provide opportunities for ventilation liberation, helping minimize complications like delirium. Most ICUs lack consistent SAT/SBT identification and implementation, which results in suboptimal outcomes. Consistent implementation of the SAT/SBT screening is crucial for timely extubation.Purpose: Many institutions are adopting nurse-driven protocols to enhance cost-effectiveness and safety. This project aimed to ensure the consistent application of nurse-driven protocols and effective communication to reduce the MV hours and the risk of delirium.Methods: The quality improvement project in a Midwest hospital ICU utilized a SAT/SBT protocol in the ICU. The Six Sigma framework was implemented using a previously accepted modified SAT protocol. The SBT protocol was developed based on a literature search in the PubMed and CINAHL databases. Integrating the protocol into the staff s daily workflow began with education during pre-shift huddles.Findings: The findings indicate that the nurse-driven SAT/SBT protocol significantly reduced MV hours by 81.41. No reintubations within 24 hours. Although four of the 18 patients required BiPAP post-extubation. The average ICU Delirium Screening Checklist (ICDSC) score reduced by 0.55 points. A significant improvement in documentation in the electronic health record via bedside staff was noted after the protocol implementation. The intervention group had 11 of 66 patients needing a higher level of care before protocol implementation, while only one in 60 in the pre-intervention group.Discussion: Encouraging interdisciplinary communication and leveraging the full capabilities of staff allowed quicker extubation. An unexpected outcome was increased staff documentation of the electronic healthcare record. Although SAT/SBT protocols have yet to be the nationwide standard, the growing body of literature, including this project, urges healthcare to adopt them as a best practice.
Details
- Title: Subtitle
- Daily Spontaneous Breathing Trials in a Medical Intensive Care Unit
- Creators
- Jillian Willhoite - University of Iowa
- Contributors
- Julie Stanik-Hutt (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Adult/Gerontology Nurse Practitioner (Acute Care)
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Jillian Willhoite
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841528902771
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