1996 OPEN FORUM Abstracts
RAPID EXTUBATION PROTOCOL FOR OPEN HEART SURGERY PATIENTS.
Keith A. Lakes, A.A.S., R.R.T., George Brown, M.D., F.A.C.S., F.A.C.C., Laura Middleton, R.N., C.C.R.N., Miami Valley Hospital, Dayton, OH.
Introduction: Our open heart program performs about 400 coronary bypass graft surgeries per year. Through a benchmarking process, we identified three areas with opportunity for improvement. First, less than 5% of the patients were extubated the day of surgery with an average ventilator length of stay of 15.6 hours. Second, bronchodilator utilization postoper atively was 100%. Third, an average of 6.4 arterial blood gases were performed. Methods: A multi-disciplinary group began meeting to address these issues. The group included representatives of respiratory care, nursing, anesthesia and a cardiothoracic surgeon. We developed a rapid extubation protocol, utilizing end tidal CO2 monitoring and pulse oximetry to drive an aggressive weaning schedule. This protocol included a decreased need for blood gases and specific indications for bronchodilator therapy. Results: After three months of this protocol 106 patients were included in the study. 59% of the patients were extubated the day of surgery with an average ventilator length of stay of 7 1/2 hours. 50% of the patients received bronchodilator therapy and 4.4 blood gases were performed. No patients required reintubation and no negative patient outcomes were identified. Conclusion: We concluded that a patient driven protocol using end tidal CO2 and oximetry monitoring combined with an aggressive weaning approach by the respiratory therapist and nurse would result in shorter ventilator times and more effective utilization of respiratory care.