title: The Combination of SAT and SBT Protocols May Help Reduce the Incidence of Ventilator-Associated Pneumonia in the Burn Intensive Care Unit.
abstract: There are few published reports on the unique nature of burn patients using a paired spontaneous awakening and spontaneous breathing protocol. A combined protocol was implemented in our burn intensive care unit (ICU) on January 1, 2012. This study evaluates the impact of this protocol on patient outcomes in a burn ICU. We performed a retrospective review of our burn registry over 4 years, including all patients placed on mechanical ventilation. In the latter 2 years, patients meeting criteria underwent daily spontaneous awakening trial; if successful, spontaneous breathing trial was performed. Patient data included age, burn size, percent full-thickness burn, tracheostomy, and inhalation injury. Outcome measures included ventilator days, ICU and hospital lengths of stay, pneumonia, and disposition. Data were analyzed using Graphpad Prism and IBM SPSS software, with statistical significance defined as P < .05. There were 171 admissions in the preprotocol period and 136 after protocol implementation. Protocol patients had greater percent full-thickness burns, but did not differ in other characteristics. The protocol group had significantly shorter ICU length of stay, fewer ventilator days, and lower pneumonia incidence. Hospital length of stay, disposition, and mortality were not significantly different. Among patients with inhalation injuries, the protocol group exhibited fewer ventilator and ICU days. Protocol implementation in a burn ICU was accompanied by decreased ventilator days and a reduced incidence of pneumonia. A combined spontaneous awakening and breathing protocol is safe and may improve clinical practice in the burn ICU.
authors.affiliation: From the *Department of Surgery, University of South Alabama School of Medicine, Mobile; and †Harris Methodist Hospital, Texas Health, Dallas.
authors.forename: Yann-Leei Larry
authors.initials: YL
authors.lastname: Lee
authors.forename: Kaci D
authors.initials: KD
authors.lastname: Sims
authors.forename: Charles C
authors.initials: CC
authors.lastname: Butts
authors.forename: M Amin
authors.initials: MA
authors.lastname: Frotan
authors.forename: Steven
authors.initials: S
authors.lastname: Kahn
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Brevard
authors.forename: Jon D
authors.initials: JD
authors.lastname: Simmons
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000379:methods; D002053:Burn Units; D002056:Burns / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control; D012042:Registries; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013781:Texas; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*