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.