Feasibility of a sedation wake-up trial and spontaneous breathing trial in critically ill trauma patients: A secondary analysis

Milagros I. Figueroa-Ramos,  Carmen Mabel Arroyo-Novoa, Geraldine Padilla, Pablo Rodríguez-Ortiz,  Bruce A. Cooper, Kathleen A. Puntillo

Intensive and Critical Care Nursing

February 2013 (Vol. 29 | No. 1 | Pages 20-27)

Summary

Objectives: To determine the feasibility of conducting a sedation wake-up trial (SWT) plus a spontaneous breathing trial (SBT) in critically ill trauma patients based on the ability to implement the combined intervention; to measure and describe patients’ physiological responses; and to maintain patient safety.

Methods: A secondary analysis of the intervention group from a trial of 20 mechanically ventilated patients receiving SWT plus SBT in a trauma-intensive care unit.

Results: Patients passed 67% of the 39 SWTs performed; those who failed presented RASS scores of +1 and +2 (70%), tachycardia (15%) or ventilator asynchrony (15%). Eighteen patients tolerated their first SBT, and after the second SBT, more than half of the patients were discontinued from the mechanical ventilator. A significant increase from the beginning to the end of the SWT was found in heart rate (p=.021), respiratory rate (p=.043) and systolic blood pressure (p=.04). Although these measures increased significantly, their overall mean did not increase by 20%.

Conclusion: SWT plus SBT was well tolerated and successfully implemented. Our data showed that it is not necessary to withhold continuous-infusion analgesia during the SWT.