Mechanical ventilation can provide lifesaving respiratory support for critically ill patients; however, prolonged ventilation time is associated with numerous complications, even after the patient leaves the hospital.
Concerned about the potential negative outcomes, CHRISTUS Good Shepherd Medical Center in Longview, Texas, developed an integrated approach that reduced ventilation time for patients in its 34-bed intensive care unit.
"Implementing the ABCDE Bundle, Critical-Care Pain Observation Tool, and Richmond Agitation-Sedation Scale to Reduce Ventilation Time" is the first study to examine the effects of implementing protocol-directed sedation with the coordinated use of two evidence-based assessments across multiple disciplines.
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The awakening and breathing coordination, delirium monitoring/management and early mobility (ABCDE) bundle is a protocol used by respiratory therapists and nurses to assess patients receiving mechanical ventilation.
The bundle includes the Critical-Care Pain Observation Tool (CPOT) to assess a patient's pain levels and the Richmond Agitation-Sedation Scale (RASS), which measures the quality and depth of sedation.
The use of CPOT and RASS together gave critical care nurses a guideline to use when patients exhibited pain or agitation while receiving ventilation. Using both tools allowed the staff to either treat pain or adjust sedation as appropriate.
After ABCDE bundle implementation, mean ventilation time significantly decreased by nearly 50%, a decrease of nearly two days. The decrease in ventilation time was observed among all patients. Sedation time was also reduced, but this finding was not statistically significant.
Despite a nursing staff compliance rate of 76.5%, the data reveals that twice as many patients had a positive outcome after the protocol was implemented.
Co-author Jennifer Bardwell, DNP, FNP-C, AGACNP-BC, is a nurse practitioner at CHRISTUS Good Shepherd Medical Center and Taylor Medical Center Urgent Care in Longview, Texas.
Performing the CPOT assessment after finding high scores on the RASS assessment often helped nurses identify signs of pain rather than agitation, which would have required increasing the sedative dose. The components of the ABCDE bundle provided critical care providers with steps to discontinue sedation and mechanical ventilation for patients as early as possible."
Jennifer Bardwell, DNP, FNP-C, AGACNP-BC, Study Co-Author and Nurse Practitioner, CHRISTUS Good Shepherd Medical Center and Taylor Medical Center Urgent Care
Of the 34 patients included in the post-intervention phase of the study, one patient required reintubation within 24 hours. None of the remaining 33 patients was readmitted within 30 days of hospital discharge or reintubated within 30 days of extubation.
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