Helgeson, S A

Abstract Background Ventilated patients in the intensive care unit are often complex and require multiple care team members including bedside nurses, respiratory therapists, advanced practice providers, and physicians. A Quality Improvement initiative was created to address any barriers in communication. Spontaneous breathing trials (SBT) are often used as a surrogate for multidisciplinary communication. Both Respiratory therapist (RT) and provider led spontaneous breathing trial protocols are often performed but not necessarily documented or communicated appropriately. Our primary aim was to increase spontaneous breathing trial documentation from a baseline of 12% to 80% with a counterbalance of not increasing the 24-hour reintubation rate. Methods Using the DMAIC framework, we defined the gap in quality by getting baseline patient data for 3 months including SBT completion rate, SBT documentation rate, time to first SBT, total time on ventilator, 24-hour reintubation rate, and total ICU days. All care team members including providers, RTs, and nurses completed a 10-questions Likert 5-scale survey regarding their views of multidisciplinary communication and SBT completion. We identified the lack of documentation of SBTs and implemented a standardized respiratory therapy shift summary note which included SBT details and major ventilator changes. We then collected the same data over 3 months after implementation. Results Post intervention analysis revealed documentation of daily spontaneous breathing trials improved from 12% to 79%. Pre and post intervention means for patient focused outcomes were statistically unchanged for time to first SBT 26 hours vs 32 hours (p = 0.16), Total ventilator time 5.6 vs 5.4 (p = 0.83), total ICU days 1.9 days vs 2.7 days (p = 0.11), and reintubation rate 14% vs 15%.Survey results showed that there was a statistically significant improvement in overall satisfaction regarding multidisciplinary communication, satisfaction regarding ventilator management discussion on rounds, and if documentation amount was appropriate. Also, there was a significant improvement in the percentage of care team members that were aware of daily SBTs occurring. Conclusion The implementation of RT shift summary greatly improved staff member satisfaction, multidisciplinary discussion during rounds, and awareness of SBT occurrence among providers, RTs, and nurses. While patient centered outcomes were statistically unchanged over this very brief period of observation, having better staff satisfaction and communication may eventually lead to improved outcomes over time and can lead to further analysis to avoid mishaps that can arise from miscommunication. This abstract is funded by: None

Abstract Purpose Diagnostic bronchoscopy plays a critical role in management for immunocompromised patients hospitalized with new pulmonary infiltrations. Most existing data on bronchoscopy in immunocompromised patients are derived from ICU cohorts or mixed inpatient/outpatient populations. This study aimed to assess the relationship between specific immunosuppression types-classified per the 2025 IDSA guidelines-and bronchoscopy yield and its impact on hospital management among non-ICU patients with new pulmonary infiltrates compared to non-immunocompromised. Methods A retrospective review of 447 hospitalized (immunocompromised and non-immunocompromised) patients who underwent bronchoscopy for new pulmonary infiltrates was completed between January 2022 and December 2024 in a single center tertiary care center. Data collected included demographics, immunosuppression type, and bronchoscopy results (cell count, differential, cultures, biopsies). Post-bronchoscopy management changes were also recorded. Multivariate logistic regression was used to correlate immunosuppression subtypes to diagnostic yield and management impact. Results The overall positivity rate for significant findings was 46% (n = 205). 367 of 447 (82%) met criteria for immunosuppressed. The immunosuppressed positivity rate was 46% vs 45% for non-immunosuppressed (P=.43). Broken down by subtype, positivity rates were: Active immunotherapy 33%, active chemotherapy 45%, hematologic malignancy 45%, hematopoietic stem cell transplant 44%, solid organ transplant 43%, active HIV 66%, primary immunodeficiency 78%, autoimmune modulator therapy 45%, daily prednisone use >20 mg 45%. Only primary immunodeficiency was associated with a statistical higher likelihood of a positive bronchoscopy (Odds ratio 4.69; P = 0.025).The overall rate of a significant change in management as a direct result of the bronchoscopy was 26%. Immunosuppressed was 26% compared to 22% for non-immunosuppressed (p = 0.5). Broken down by subtype management change rates were: Active immunotherapy 66%, active chemotherapy 18%, hematologic malignancy 19%, hematopoietic stem cell transplant 26%, solid organ transplant 32%, active HIV 100%, primary immunodeficiency 78%, autoimmune modulator therapy 70%, and daily prednisone use >20 mg 23%. Active immunotherapy and active immunomodulator therapy were correlated with a significant change in management (OR 8.9; P = 0.02, OR 3.6; P = 0.02, respectively). Conclusions Bronchoscopy yield and management impact were similar between immunosuppressed and non-immunosuppressed hospitalized patients. However, bronchoscopy more frequently influenced management in patients receiving active immunotherapy or immunomodulators, supporting earlier diagnostic use in these populations. This abstract is funded by: None

Abstract Rationale Glucagon-like peptide 1 (GLP-1) receptor agonists are novel antihyperglycemic drugs that have shown benefit in various disease states, namely in cardiovascular and renal disease. GLP-1 agonists in murine models of obstructive lung diseases have been shown to decrease airway inflammation and hyperresponsiveness. In humans, some observational studies show an association between GLP-1 agonist use and reduced exacerbations of chronic obstructive pulmonary disease (COPD). In a meta-analysis, GLP-1 agonist use decreased the risk of several respiratory disorders including bronchitis (3). Bronchiectasis is another chronic airway disease, characterized by abnormal airway dilation leading to impaired mucous clearance and increased risk of infection (4). Data on the association between GLP-1 agonist use and bronchiectasis is sparce. We, therefore, examined the effects of GLP-1 agonists on the mortality of patients with bronchiectasis in a large sample size. Methods In this retrospective case control study, we identified patients with bronchiectasis from a single-center database of patients at our institution. We identified patients with bronchiectasis who received a GLP-1 agonist and compared them to patients who never received a GLP-1 agonist. Data was displayed as median with interquartile range and a Kaplan-Meier curve was used for mortality analysis. Results We identified a total of 256,777 patients with bronchiectasis. Of these, 249911 patients with bronchiectasis had not received a GLP-1 agonist and 6866 patients had received a GLP-1 agonist. The median age for patients in the GLP-1 group was 63 vs. 64 for the control group. 54.5 % of patients in the GLP-1 group were female compared to 52.9% in the control. Patients who received a GLP-1 agonist had improved survival at 1 month (99.9% for the GLP-1 group vs. 98.7% for the control group), 5 months (98.9% for the GLP-1 group vs. 95.9% for the control group), 10 months (97.9% for the GLP-1 group vs. 93.5% for the control group), 30 months (91.9% for the GLP-1 group vs. 86.8% for the control group) and 60 months (81.8% for the GLP-1 group vs. 79.3% for the control group), p < 0.001, Hazard ratio 0.56 (95% CI 0.50 - 0.62). Conclusion Our study showed that GLP-1 agonists are associated with improved survival in patients with bronchiectasis. Several mechanisms may contribute to this effect, including weight loss and reduction of cardiovascular mortality. Further studies are needed to investigate GLP-1 agonists as a potential therapeutic option for bronchiectasis, and to elucidate the mechanisms behind this association. This abstract is funded by: none