2001 OPEN FORUM Abstracts
Survey of PatientsRequiring Positive Pressure Ventilation A Descriptive Study
George W. Lantz, B.S.,R.R.T., C.P.F.T., R.C.P. and Bob Robinson, C.R.T., R.C.P. Shriners Hospitals for Children, Chicago
Introduction/Background: Pursuantto a significant increase of patients who required overnight post-operativemechanical ventilation a post-procedural analysis was developed to identifythe type patients who required ventilatory assistance. This was performed inan attempt to discover any precipitating factors leading to the steady increases,and determine the specific patient population and/or subgroup so these patientswho are at greater risk could be identified in advance. This would then assistin forecasting staffing acuity and improving patient care with proactive management.
Methods: A survey was developedto track issues thought to contribute to the need for mechanical ventilation.65 patients were analyzed this year. Patients age, primary diagnosis, secondarydiagnosis, surgical procedure, blood loss, fluid replacement, Surgeon, Anesthesiologist,date of intubation, day of week, time admitted to PICU, date extubated, timeof extubation, Physician who extubated, pulmonary history, post-operative complicationsand reason for ventilation were all recorded.
Results: It was discoveredthat the majority of patients were admitted into our PICU on Mondays. It wasapparent that there was no significance between Anesthesiologists. However,in some instances overnight ventilation was required due to laryngeal swellingsecondary to generous volume replacement perioperatively. Hemodynamics playedan important role in 50% of the cases. Furthermore, there was no correlationbetween age, gender, Surgeon or Attending Physician. The biggest contributingfactor was patients who had diagnoses relating to spinal deformities and henceforthreceived surgeries for correction. 47 of the patients had diagnosis relatingthe spinal deformities and 84% of the surgical procedures related to some typeof spinal intervention. There are several types of procedures, which includeanterior, posterior and combined spinal fusion. There was no major differencebetween these groups.
Conclusion: Analysis of thisprospective study reveals that the largest percentage of our patients studiedwho required overnight ventilation was pursuant to spinal surgery and that ?generous?fluid administration further precipitated this necessity in nearly half of thecases studied. Additionally, most of our ventilator patients were received earlyin the week (Mondays and Tuesdays) and from this discovery a system to provide?on-call? Respiratory Care was established to ?cover? the night shifts on theseparticular days and cases. This has resulted in a more cost-effective methodof providing Respiratory Care, as well as improving the quality, safety anddimension of care and customer satisfaction. Furthermore, closer attention isbeing placed on pre-operative pulmonary screening and patient education as wellas aggressive follow-up on these patients? pulmonary mechanics post-operatively.This has also improved patient outcomes and will hopefully shorten the length of stay.