Effectiveness of implementing a wake up and breathe program on sedation and delirium in the ICU.
OBJECTIVE
Mechanically ventilated critically ill patients receive significant amounts of sedatives and analgesics that increase their risk of developing coma and delirium. We evaluated the impact of a "Wake-up and Breathe Protocol" at our local ICU on sedation and delirium.


METHODS
A pre/post implementation study design.


METHODS
A 22-bed mixed surgical and medical ICU.


METHODS
Seven hundred two consecutive mechanically ventilated ICU patients from June 2010 to January 2013.


METHODS
Implementation of daily paired spontaneous awakening trials (daily sedation vacation plus spontaneous breathing trials) as a quality improvement project.


RESULTS
After implementation of our program, there was an increase in the mean Richmond Agitation Sedation Scale scores on weekdays of 0.88 (p < 0.0001) and an increase in the mean Richmond Agitation Sedation Scale scores on weekends of 1.21 (p < 0.0001). After adjusting for age, race, gender, severity of illness, primary diagnosis, and ICU, the incidence and prevalence of delirium did not change post implementation of the protocol (incidence: 23% pre vs 19.6% post; p = 0.40; prevalence: 66.7% pre vs 55.3% post; p = 0.06). The combined prevalence of delirium/coma decreased from 90.8% pre protocol implementation to 85% postimplementation (odds ratio, 0.505; 95% CI, 0.299-0.853; p = 0.01).


CONCLUSIONS
Implementing a "Wake Up and Breathe Program" resulted in reduced sedation among critically ill mechanically ventilated patients but did not change the incidence or prevalence of delirium.
1Division of Pulmonary/Critical Care/Allergy and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN. 2Indiana University Center for Aging Research, Indianapolis, IN. 3Regenstrief Institute, Indianapolis, IN. 4Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN. 5Wishard Health Services, Indianapolis, IN. 6Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN. 7Division of Allergy/Pulmonary/Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 8VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN.
Babar A
BA
Khan
William F
WF
Fadel
Jason L
JL
Tricker
W Graham
WG
Carlos
Mark O
MO
Farber
Siu L
SL
Hui
Noll L
NL
Campbell
E Wesley
EW
Ely
Malaz A
MA
Boustani
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003128:Coma / Q000517:prevention & control; D016638:Critical Illness; D054810:Deep Sedation / Q000379:methods*; D003693:Delirium / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012119:Respiration; D012121:Respiration, Artificial / Q000379:methods*