1997 OPEN FORUM Abstracts
THE EFFECT OF A THERAPIST DRIVEN WEANING PROTOCOL ON THE DURATION OF MECHANICAL VENTILATION IN POST CARDIAC SURGICAL PATIENTS
Gregory Wehby, RRT; Morris Brown, MD; Linda K. Zimcosky, RRT; Detroit Medical Center-Sinai Hospital, Detroit, Michigan
INTRODUCTION: Traditionally, cardiac surgical patients remained intubated and mechanically ventilated for up to 24 hours postoperatively. However, there is increasing data to suggest that, with the use of a therapist driven weaning protocol, intubation and mechanical ventilation time can be significantly decreased. This study was undertaken as a quality improvement effort as part of a critical pathway to reduce the duration of intubation, mechanical ventilation, ICU length of stay (LOS) and cost, following cardiac surgery by using a therapist driven weaning protocol. METHODS AND MATERIALS: All patients who underwent coronary artery bypass grafting (CABG) between October, 1994 and September, 1996, were reviewed. This study was restricted to the uncomplicated post-cardiac surgical patient. This was defined as patients: 1) with no history of insulin dependent diabetes mellitus, 2) less than 70 years old, 3) undergoing initial CABG, 4) with no significant left ventricular failure, and 5) with no history of failed percutaneous transluminal coronary angioplasty. The evaluation included patient demographics, duration of intubation and mechanical ventilation, complication rate and overall LOS in the Surgical Intensive Care Unit (SICU). All patients had the medical staff approved therapist driven protocol utilized for weaning patients from mechanical ventilation. Results: A total of 119 patients met the inclusion criteria during the two year study period. There were 71 males and 48 females. Ages ranged from 35-69 years old (mean 58 years). Implementation of the therapist driven weaning protocol resulted in a median intubation time of eight hours (range 1.5-27 hours) post arrival into the SICU, or a 63% reduction in the duration of mechanical ventilation. During the study period, there was no increase in complication rate, as defined by either a readmission to the SICU, or reintubation. Patient LOS in the SICU fell an average of one day, facilitating an earlier transfer to the stepdown unit and progression to cardiac rehabilitation. In addition, ICU costs were reduced during the study period. Conclusions: The implementation of a therapist driven weaning protocol is an effective means to decrease intubation and mechanical ventilation time, LOS and cost in the SICU, without increasing complications. The weaning protocol is an integral part of a critical pathway for patients undergoing CABG surgery.