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Factors Associated with Spontaneous Awakening Trial and Spontaneous Breathing Trial Performance in Critically Ill Adults: Analysis of a Multicenter, Nationwide, Cohort Study.

Michele C Balas,Alai Tan,L. Mion,B. Pun,Jin Jun,Audrey Brockman,Jinjian Mu,E. W. Ely,E. Vasilevskis

Published 2022 in Chest

ABSTRACT

BACKGROUND Broad-scale adoption of spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) into everyday practice has been slow and uncertainty exists regarding what factors facilitate or impede their routine delivery. RESEARCH QUESTION What patient, practice, and pharmacologic factors are associated with SAT and SBT performance and to what extent do they predict overall SAT/SBT performance? STUDY DESIGN AND METHODS This secondary analysis used data collected from a national quality improvement collaborative comprised of 68 diverse intensive care units (ICUs). Critically ill adults who received mechanical ventilation and/or continuously infused sedative medications were included. We performed mixed-effects logistic regression modeling, created receiver operating characteristic curves, and calculated area under the curve (AUC). RESULTS Included in the SAT and SBT analysis were 4,847 and 4,938 patients respectively. In multivariable models controlling for admitting patient characteristics, factors independently associated with higher odds of a next-day SAT and SBT included physical restraint use (AOR, 1.63; 95% CI, 1.42-1.87; AOR, 1.83; 95% CI, 1.60-2.09), documented target sedation level (AOR, 1.68; 95% CI, 1.41-2.01; AOR, 1.46; 95% CI, 1.24-1.72), more frequent level of arousal assessments (AOR, 1.22; 95% CI, 1.03-1.43; AOR, 1.32; 95% CI, 1.13-1.54), and dexmedetomidine administration (AOR, 1.23; 95% CI, 1.05-1.45; AOR, 1.52; 95% CI, 1.27-1.80). Factors independently associated with lower odds of a next-day SAT and SBT included deep sedation/coma (AOR, 0.69; 95% CI, 0.60-0.80; AOR, 0.33; 95% CI, 0.28-0.37) and benzodiazepine (AOR, 0.83; 95% CI, 0.72-0.95; AOR, 0.67; 95% CI, 0.59-0.77) or ketamine (AOR, 0.34; 95% CI, 0.16-0.71, AOR 0.40; 95% CI, 0.18-0.88) administration. Models incorporating admitting, daily, and unit variations displayed moderate discriminant accuracy in predicting next-day SAT (AUC 0.73) and SBT (AUC 0.72) performance. INTERPRETATION There are a number of modifiable factors associated with SAT/SBT performance that are amenable to the development and testing of implementation interventions.

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