Multicenter implementation of a consensus-developed, evidence-based, spontaneous breathing trial protocol

Crit Care Med. 2008 Oct;36(10):2753-62. doi: 10.1097/ccm.0b013e3181872833.


Objective: Evidence-based practice recommendations abound, but implementation is often unstructured and poorly audited. We assessed the ability of a peer network to implement an evidence-based best practice protocol and to measure patient outcomes.

Design: Consensus definition of spontaneous breathing trial followed by implementation in eight academic medical centers.

Setting: Six medical, two surgical, and two combined medical/surgical adult intensive care units among eight academic medical centers.

Study population: Patients initiating mechanical ventilation through an endotracheal tube during a 12-wk interval formed the study population.

Interventions: Adoption and implementation of a common spontaneous breathing trial protocol across multiple intensive care units.

Measurements and main results: Seven hundred five patients had 3,486 safety screens for conducting a spontaneous breathing trial; 2072 (59%) patients failed the safety screen. Another 379 (11%) patients failed a 2-min tolerance screen and 1,122 (34%) patients had a full 30-120 min spontaneous breathing trial performed. Seventy percent of eligible patients were enrolled. Only 55% of passing spontaneous breathing trials resulted in liberation from mechanical ventilatory support before another spontaneous breathing trial was performed.

Conclusions: Peer networks can be effective in promoting and implementing evidence-based best practices. Implementation of a best practice (spontaneous breathing trial) may be necessary for, but by itself insufficient to achieve, consistent and timely liberation from ventilator support.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Critical Illness / therapy
  • Evidence-Based Medicine*
  • Guideline Adherence*
  • Health Plan Implementation
  • Humans
  • Intensive Care Units
  • Interdisciplinary Communication
  • Intubation, Intratracheal
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians'
  • Respiration, Artificial / standards*
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Sensitivity and Specificity
  • Total Quality Management
  • Ventilator Weaning / standards