Wake Up and Breathe
In the Awakening and Breathing Controlled (ABC) Trial (Lancet 2008), we examined the efficacy and safety of a “wake up and breathe” protocol that paired management of sedation with ventilator weaning. Specifically, our protocol of paired daily spontaneous awakening trials (i.e., daily interruption of sedatives) with daily spontaneous breathing trials improved the number of days that patients spent breathing without assistance by 3 days, reduced time spent in the ICU and hospital by 4 days each, and improved overall one-year survival (risk of death was 32% lower). Additionally, the protocol was safe and well-tolerated; only 5% of patients developed signs of anxiety, agitation, or pain during a spontaneous awakening trial and the percentage of “self-extubation requiring reintubation” was similar in both groups. For a more detailed description of the results of the ABC Trial, please see (click on the link below):
Girard TD, Kress JP, Fuchs BD, Thomason JWW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126-134, 2008.
Vanderbilt University Medical Center
Veterans Affairs TN Valley Geriatric Research Education and Clinical Center (GRECC)