1995 OPEN FORUM Abstracts
OPTIMIZING VENTILATOR CARE USING A VENTILATOR MANAGEMENT TEAM IN A PEDIATRIC INTENSIVE CARE SETTING
Randy Scott BS RCP RRT, Ronald Perkin MD, Mark Rogers BS RCP RRT, Tom Malinowski BS RCP RRT, Leo Langga BS RCP RRT, Loma Linda University Children's Hospital, Loma Linda, California.
INTRODUCTION: Ventilator care constitutes a significant cost in intensive care management. We hypothesized that a ventilator management team (VMT) would optimize ventilator care, reduce ventilator hours, and increase the respiratory care practitioner's (RCP) involvement in patient management.
Methods: This was a retrospective study performed in a 25 bed, level 3 pediatric intensive care unit (PICU). The VMT consisted of: PICU intensivist, bedside RCP, RC supervisors, and RC director. The residents, fellows, and bedside nurses were invited to participate with the VMT. Rounds occurred once a week and consisted of the RCP presenting a brief history and physical, current medications, pertinent lab data, and respiratory care, After a discussion of the current regimen, a consensus was reached pertaining to the ventilator care plan supplied by the members of the VMT and recommendations for changes were made if indicated. Within 24 to 48 hours after rounds, recommendations made by the VMT were evaluated to determine patient benefits. Positive outcomes were defined by any of the following: documented reduction in measured/observed work of breathing, improved synchrony with the ventilator, blood gases improved to desired range, reduction in ventilator settings, or extubation. A negative outcome was evidenced by clinical deterioration (blood gases, hemodynamics) or reversal of implemented changes. The VMT visited every patient requiring CMV.
Group 1 (Pre VMT) Group 2 (Post VMT)
Study Period July 93-Dec. 93 July 94-Dec. 94
The two groups were compared for; duration of CMV, ICU stay, and hospital length of stay (LOS). Additional group 2 data included the number of recommendations made by the VMT, number of recommendations actually implemented, and patient tolerance to the changes.
Results: Of the 205 patients in group 2 admitted during the time period studied, the VMT rounded on 121 individual patients. Ventilator recommendations were made in 60 patients, with 55 being implemented. The five recommendations not implemented were due to attending physician disagreement. The VMT agreed with the management strategy of the remaining 61 patients. Of the 55 changes recommended by the team, 51 changes had a positive outcome, 3 had mixed results and 1 had a negative outcome. Between group analysis utilized ANOVA (p< 0.05).
Group 1 (Pre VMT) Group 2 (Post VMT) Significance
ICU LOS 12±3 10±2ns
Hosp. LOS/days22±4 17±3p< 0.05
Dur. of CMV/hr. 171±5895±22 p< 0.05
Of the two groups compared, group 2 showed a statistically significant decrease in ventilator hours and a decrease in overall LOS (p< 0.05).
Conclusions: VMTs can optimize respiratory and ventilator care modalities with positive results. Ventilator hours and LOS can be reduced with the use of VMTs.