Ventilator Associated Pneumonia Sedation Vacation and Weaning Protocol

1
Ventilator Associated Pneumonia- Sedation
Vacation and Weaning Protocol

• Lisa Hamel, Cardiopulmonary Services Director
• April 2005

2
Reliability/Redundancy for VAP

• Order set
• ICU Rounds daily- SUP/DVT
• ICU Nurses/Respiratory Therapist interactions
  HOB- Weaning- Sedation vacation
• Monitoring done by ICU manager/RT supervisor-
  Daily collection.

3
Ventilator Associated Pneumonia Rapid Action Team

• Team Champion- Sharon Schneller
• Team Leader- Lisa Hamel
• Members
• Judy Webber -IC RN Kathleen Frederick- ICRN
• Marie Griffin- ICU RN Carol Reichel-ICU RN
• Tom Pankonin- DPh Lance Lothert- CRTT
• George Elliot- RD Irene Pfeffer- SW
• Dr. Scott Sanders- Pulmonologist

4
Weaning Protocol

• Protocol based on best evidence.
• At least daily weaning attempt
• Piloted with pulmonologists- three phases

5
ISJ Weaning Protocol

• Phase I
• Patient met weaning criteria, only Pulmonologist
  directed patients included and he/she authorized
  weaning trial.
• Phase 2
• Patient met weaning criteria, RCP initiated
  weaning trial.
• Phase 3
• Spread to all patients.

6
Weaning Trial Criteria

• ISJ Respiratory Therapist-Driven Protocol for
  Weaning from Mechanical Ventilation
• DAILY SCREENING
• All patients deemed capable of spontaneous
  breathing will be screened each morning for the
  following
• PaO2 gt 60mmHg on FiO2 lt 40.
• PEEP lt 5cmH2O
• Adequate cough during suctioning
• f/Vt lt 105
• No vasopressors or sedatives (dopamine not gt
  5micrograms/Kg/min, intermittent sedation ok)
• lt moderate secretions.
• If patients pass the daily screening test, a
  spontaneous breathing trial will be initiated.

7
Weaning trial

• SPONTANEOUS BREATHING TRIAL
• TC mode on same FiO2 with 3cmH2O PEEP for 2 hrs
  and obtain an ABG(sometimes optional)
• Terminate trial if one of the following
  conditions occur
• f gt 35 for 5 minutes
• SpO2 lt 90
• HR gt 140
• Sustained change in HR of 20 in either
  direction.
• BPsys gt 180 or lt 90 mmHg
• Increased anxiety
• Diaphoresis

8
Sedation Vacation

• When patients are ventilated, a sedation vacation
  is attempted each day.
• Coordinated between the RN and RCP.
• At ISJ, we tend to keep patients light.

9
Sedation Vacation Procedure

• Attempt to lighten the patient to state of
  following commands.
• Assess for weaning
• If criteria is met, a trial is initiated.
• Coordination between the RN and RCP is key.

10
Building In Checks/Balances

• Monitoring if all bundle information is
  accomplished is through interdisciplinary rounds.
• Auditing through chart review and observation.