The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

IMPLEMENTATION OF A POST-OPERATIVE VENTILATOR WEANING PROTOCOL IN A PEDIATRIC CARDIOVASCULAR INTENSIVE CARE UNIT REDUCES VENTILATOR LENGTH OF STAY.

Jill Gouvion, RRT-NPS, Suzanne Iniguez, RRT-NPS, Antonio Mott, MD, Charles Fraser, MD, Lee Evey, BS, RRT Texas Children’s Hospital, Houston, Texas

BACKGROUND:
The Respiratory Care Department and Congenital Heart Surgery Services at Texas Children’s Hospital in Houston, Texas created a ventilator weaning protocol for the approximately 800 pediatric patients who undergo cardiac surgery each year. The purpose of this protocol was to decrease ventilator length of stay (VLOS) and reintubation rates of hemodynamically stable post-surgical patients.

METHODS: All intubated post-operative patients transferred to the Cardiovascular Intensive Care Unit were placed on one of two arms of the weaning protocol; Physician directed weaning or Therapist directed weaning. Once the patient was placed on the Therapist directed weaning arm, The Respiratory Care Practitioner was able to wean the patient from ventilatory support to extubation. Data was collected and analyzed from twenty-eight patients prior to the implementation of the protocol and from thirty-four patients after implementation.

RESULTS:
The median ventilator length of stay for the patients in the pre protocol group was 33.0 hours. After the protocol was implemented, the median length of stay decreased to 15.8 hours. There was one reintubation in the pre protocol group and zero after the protocol was implemented.

CONCLUSION: The use of a Therapist directed ventilator weaning protocol in the Cardiovascular Intensive Unit decreases VLOS. This method of liberation from mechanical ventilation is safe, efficacious, and decreases VLOS. Staff and Physician education and periodic up-dates has led to acceptance of the protocol.

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