Margaret Harvey, PhD, APRN, ACNP-BC, CHFN
Subject Matter Expert
Donna Lynch-Smith DNP, ACNP-BC, APRN, NE-BC, CNL
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Critical Care Nursing | Diagnosis | Diseases | Investigative Techniques | Medicine and Health Sciences | Nursing | Other Nursing | Respiratory Tract Diseases | Therapeutics
Purpose/Background For ventilated patients in the intensive care unit, ventilator-associated pneumonia (VAP) is a major source of morbidity. It is difficult to diagnose due to many of the diagnostic criteria being subjective, its clinical signs that are broad, and its association with various respiratory disorders. Hospitals have developed varying ventilator bundles in expectation to prevent the incidence of Ventilator-associate pneumonia. We performed scoping review to determine the impact of spontaneous breathing trials (SBT) on reducing VAP.
Methods From August to November of 2021, using the MEDLINE, ScienceDirect, and Scopus databases and MeSH search terms, we identified over 20,000 articles containing our keywords. Of those, thirty met our inclusion criteria, and ten were most relevant. The publication dates of the articles reviewed ranged from 2017-to 2021, were full-text, and were from peer-reviewed sources.
Results The publications reviewed utilized retrospective data analysis, a survey approach, or a randomized study design. Due to variations in terminology (i.e.: ventilator-associated pneumonia, ventilator-associated events) and clinical criteria, we cannot say spontaneous breathing trials alone reduce the patient's diagnosis of VAP by a statistically significant amount.
Implications for Nursing Practice More research is needed to investigate the effects of spontaneous breathing trials alone on ventilator-associated pneumonia. So, providers should focus attention on addressing potential risk factors. The articles reviewed suggest ventilator bundles including SBT helped reduce days mechanically ventilated, therefore reducing risk. Subsequent plans are required, as spontaneous breathing trials are not appropriate for all patient populations. One article suggests subglottic secretion drainage systems and ETT cuff pressure control devices as devices to diminish risk.
Johnson, Jireh R. BSN, RN; Aysheh, Hamzha BSN, RN; Luckett, Keianna BSN, RN; and Harvey, Margaret PhD, APRN, ACNP-BC, CHFN , "Impact of Spontaneous Breathing Trials on Reducing Ventilator-Associated Pneumonia in Adult Intubated Patients: A Scoping Review" (2022). Doctor of Nursing Practice Projects. Paper 17. http://dx.doi.org/10.21007/con.dnp.2022.0017.
Impact of Spontaneous Breathing Trials on Reducing Ventilator-Associated Pneumonia in the Adult intubated Patient: A Scoping Review