Study procedures — usual care
Agitation, Delirium, Pain
In preparation for the randomized clinical trial, we will measure baseline implementation and effectiveness primary outcomes for 6 months. Results will be used as the baseline performance on the primary outcomes prior to randomization in order to perform a final power analysis and refine the final statistical analysis plan.We developed a standardized C-SAT/SBT screening and performance protocol algorithm (Fig. Algorithm for coordination of spontaneous awakening trials and spontaneous breathing trials color coded for nurse (light blue, RN), respiratory therapist (green, RT), and joint tasks (dark blue) including safety screens and failure criteria. MD is physician and APP is advanced practice providerAll patients will have analgesia and sedation managed according to the Intermountain “Pain, Agitation, and Delirium Guideline for Mechanically Ventilated Patients” (Additional File All patients on mechanical ventilation will be managed using clinical decision support with computerized open-loop protocols within our Cerner electronic medical record that provide instructions for ventilation, oxygenation, weaning assessment, and continuous positive airway pressure (CPAP) or pressure support (PS) weaning [