The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

INCREASED VENTILATOR LENGTH OF STAY (LOSv) DUE TO OBSTRUCTIVE AIRWAYS IN ELECTIVE CORONARY ARTERY BYPASS SURGERY (CABG)

John Emberger BS RRT, Herbert Patrick MD, Dept. of Respiratory Care, Thomas Jefferson University Hospital Inc, Philadelphia PA

Background: We have observed that post-op patients with obstructive airways tend to remain intubated longer than patients without underlying airway problems. Specialized ventilator management and extubation practice for patients with obstructive airways may need to be part of our educational programs for these patients. Hypothesis: We wanted to determine if obstructive airways increased LOSv in patients undergoing elective CABG. Methods: Data was collected prospectively from Jan 96 - Mar 96 on CABG patients in our Surgical Cardiac Care Unit (SCCU). Data included: LOSv, Ventilator Settings, presence/absence of AutoPEEP (PEEPi), presence of pulmonary consult, and patient outcome. PEEPi was defined as >= 5 cmH_{2}O of intrinsic PEEP with a ventilator respiratory rate < =15 BPM, and adequate exhalation time. To prevent skewing of statistics, patients with LOSv < 14 days were separated from patients with LOSv >= 14 days. Results: 173 CABG patients were examined and separated into LOSv < 14 days or LOSv >= 14 days.

Data for CABG patients: Without With

LOSv < 14 days. PEEPi PEEPi

Patients 159** 10

LOSv*, Avg ± SD 2.4 ± 1.1 4.1 ± 2.5

LOSv Range, days 1 to 13 2 to 9

Had Pulmonary Consultation,% 3% 0%

Wean Trials Failed, % 8% 53%

LOSv O 14 days.

Patients 0 4

LOSv in SCCU, Avg ± SD 0 21.8 ± 7.4

Transferred to Medical

ICU for Weaning 0 4

*Anova variance between groups, p < 0.001 ** Two patients expired

Of the patients with LOSv < 14 days, patients with PEEPi had a significantly higher average LOSv (4.1 versus 2.4) and failed the majority of weaning trials (53%). All patients with LOSv >= 14 days and all of the patients transferred out of the unit to wean were patients with PEEPi. Conclusion: Obstructive airways appear to increase LOSv in patients undergoing elective CABG. We now plan to increase our education on management of patients with PEEPi detected immediately post-op. Future studies should expand on other factors such as age and co-morbidities.

Reference: OF-96-149

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