1995 OPEN FORUM Abstracts
COMPARING THE LENGTH OF VENTILATION ON CABG PATIENTS PRE/POST WEANING PATHWAY.
Daniel J. Reily BS. RRT, Michael Santoro BS. RRT. John Sestito BA. RRT, David Shulkin MD. University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA. 19104-4283.
Introduction: This study was undertaken to compare the length of ventilation (LOV) on patients after undergoing a coronary artery bypass graft (CABG) with and without a weaning pathway. Background: Previous to this study post CABG patients were weaned by a task-oriented method. The physician writes an order and respiratory care practitioners (RCP) carries it out. The pathway was designed to have the RCP more actively involved in the weaning process (RT-driven weaning). The pathway called for the patients to be weaned from the ventilator by RCP without a physician order. RCP followed specific guidlines to insure efficiency and patient safety. Criteria: Patients enrolled in the pathway received a non complicated CABG without any other surgical procedure. Exclusion criteria included excessive bleeding, blood pressure complications, complex acid-base disturbances, acute neurological event, packed open chest, intraortic balloon pump, excessive narcotics and a history of lung disease. Method: Data were collected on all CABG patients for a two month period as a control group. The data were analyzed and it was found that 41 patients met the criteria to be placed in the pathway had the pathway been in effect at this time. Then the pathway was initiated with the same exclusion criteria. Data were collected on all CABG patients until 41 patients were enrolled in the pathway. The data collected on the 41 patients who met the criteria pre pathway (control group) was compared to the 41 patients who participated in the pathway.
Results: The mean LOV pre pathway was 11.2 ± 4.2 hours on the control group. Using RT-driven weaning the mean LOV decreased to 6.4 ± 1.4 hours. This was a significant difference [p < 0.001]. CONCLUSION: We determined this pathway to be a success by the statistically significant reduction in LOV and the opportunity for the RCP to be more actively involved in patient outcome instead of performing a task.