2003 OPEN FORUM Abstracts
EVALUATION OF A TRIAL VENTILATOR WEANING AND EXTUBATION PROTOCOL: COST SAVINGS IDENTIFIED
April Farmer BS CRT, Justin Farris BS CRT, Deborah Cullen EdD, RRT, FAARC, Respiratory Therapy Program Director, Indiana University School of Allied Health; Charles Christoph, BS RRT, Clinical Education Coordinator, Indiana University Hospital, Indianapolis, IN; Wendy LaLone, BS RRT, Respiratory Care Department Manager, Indiana University Hospital, Indianapolis, IN
Background: Respiratory therapists are experiencing greater responsibility with evaluating appropriate care for their patients. This study evaluated a trial protocol for weaning then extubating surgical patients from ventilatory support. The significance of this study was to determine the efficacy of the protocol prior to formal implementation. The ability of respiratory therapists to conduct the protocol then extubate patients without a physician order was studied. Importantly, cost effectiveness may be improved by therapist intervention.
METHOD: The evaluation was limited to 55 surgical patients in the year 2002, who passed all protocol criteria, and with physician order were extubated. Protocol criteria were: Ve <20 L, FIO2 <.60, PEEP <10, cough/gag present, off sedatives/pressors, PaO2/FIO2 >200, f/Vt <105 and passing a spontaneous breathing trial. The data were then evaluated to project the number of days patients passed the protocol but were not extubated due to lack of physician order. Reintubations were calculated.
RESULTS: Of the 55 patients who were extubated per protocol only 3 required reintubation. There were a total of 71 passing days in which physicians chose not to extubate. When these patients were eventually extubated none required reintubation. There were 20 patients who did not meet all criteria and were extubated per physician order, none of which required reintubation. The common criterion that was excluded by physicians was the sedation scale. EXPERIENCE: The practical application for this evaluation was that extubating patients per protocol was more cost effective. The cost of a ventilator is $636/day with retaping of the endotracheal tube QD at a rate of $56. Ventilator circuit changes are required Q7 days at a rate of $110. The total cost of the 71 additional patient ventilator days was $50,236 for these three items related to patient care and treatment.
Conclusions: This study determined that the trial protocol is effective and would be an asset in surgical ICU. The ICU will have saved a considerable amount of money when the protocol is implemented. The respiratory therapist conducting the weaning protocol for each ventilator patient will provide efficacious, effective and cost saving care.