2005 OPEN FORUM Abstracts
REDUCING MECHANICAL VENTILATION TIME OF OPEN HEART SURGERY PATIENTS THROUGH CHANGES IN PRACTICE
Jeffrey K. Child, R.R.T., Amy C. Hupp, R.R.T. McKay-Dee Hospital, Ogden, Utah
Introduction: The multitude of impending complications that evolve from positive pressure ventilation was the driving force to develop and implement our early extubation protocol. Missing the window of opportunity for extubation leads to increased cost and decreased patient satisfaction. The patient's limitations and discomfort for the duration of endotracheal intubation is one of the major dissatisfiers of all post-operative patients.
Methods: This is a prospective study that began in 1994 and will continue indefinitely. We collect data that includes mechanical ventilation time on all open-heart patients (CABG & Valves), the number of patients requiring reintubation, patients excluded from the study (ventilation time > 72 hrs.), as well as the therapists responsible for the extubation. Mean extubation times are reported to the team on a quarterly basis, and special attention is given to individuals who may be considered out of standard. We document all changes in practice to measure the impact on extubation time.
Results: We found that through the use of a ventilator weaning protocol, extubation time decreased by 20.8%. By deploying a select group of therapists for continuity and expertise, extubation time decreased another 21.6%. When we monitored protocol compliance and reported the results to each therapist, extubation time decreased by another 30%. When the deployed group of therapists was recentralized with the main respiratory department, our extubation times increased by 8%. Over this 10-year period, our extubation time has decreased by 62% (8.3 hours). Since the study's inception, only 75 patients (2.49%) have been excluded from the study. These patients required mechanical ventilation for > 72 hours which we categorize as ventilator dependent. These patients fall into another group that is also under study. There have been 45 patients (1.49%) who required reintubation within 24 hours of extubation.
Conclusion: Protocol utilization coupled with compliance tracking, along with the use of a designated core group of therapists to wean and extubate patients in this subset, will notably decrease mechanical ventilation time, decrease cost and improve patient satisfaction.
CHANGES IN PRACTICE:
1994 Early extubation protocol introduced
1995 Select respiratory therapists deployed to ICU Care Team
1996 Protocol compliance tracking
2000 Recentralization of the Respiratory Department