The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

LOW EXTUBATION TIMES IN CARDIAC SURGERY PATIENTS:INTEGRATION OF RESPIRATORY THERAPY DRIVEN PROTOCOLS

Charles Oribabor1, Felix Khusid2, Emma Fisher2, Naim Mansuroglu1, Leonard Lee1, Anthony Tortolani1



Purpose: To integrate a Respiratory Department Driven protocol utilizing Rapid Shallow Breathing Index (RSBI) to lower extubation times in open heart surgery patients

Methods: We studied 689 open heart surgery patients prospectively between April 1st 2004 and June 2008.This included 45 valve surgery patients,619 coronary artery bypass graft (CABG),12 Stanford A Aneurysms,4 aortic dissections,9 off pump CABG patients.EXTUBATION CRITERIA: Rapid shallow breathing index less than 105. EXTUBATION HALTING CRITERIA/OUTLIERS:(1)Medisatinal Hemorrhage 200cc/hour(2)Ramsay Sedation scale 4(3)Metabolic or respiratory acidosis (4)Postoperative cardiogenic shock EXTUBATION TIME:Time from arrival in the intensive care unit to time extubated.REINTUBATION:Patients reintubated within 24 hours of extubation. Cardiac anesthesiologists were informed of the weaning criteria with the RSBI that was going to be used.Drager Evita XL and Servo-I ventilators which calculate and display the RSBI continuously were used.Patients were placed in a semi recumbent position. Reversed trendelenburg position for patients with intra-aortic balloon pumps

Results: Mean extubation time was 2hours 45 minutes. The mean extubation time was unaffected by outliers who did not meet the weaning criteria for extubation. 8 reintubations in total over the study duration. Overall mean extubation times were unaffected by the age,hemodynamic status,comorbidity, or ejection fraction. We utilized non-invasive positive pressure ventilation (NIPPV),intra-pulmonary percussive ventilation(IPV),super high flow therapy and Heliox modalities post extubation in patients with multiple co-morbidities. This significantly reduced our reintubation numbers. 21%(147) of the patients total did not meet weaning criteria. Overall reintubation rate is 1.1 %

Conclusion: The utilization of the rapid shallow breathing index as the sole criteria for weaning has lead to significantly low mean extubation times in cardiac surgery patients.No increased rates of reintubation were observed.Postoperative narcotic analgesia did not increase mean extubation times. CLINICAL IMPLICATIONS:

  1. Successful Integration of Respiratory Therapy in Cardiac surgery program
  2. Patient and family satisfaction at early extubation times.
  3. Reduced length of stay in the intensive care unit.
  4. Integration of the respiratory departments weaning expertise with Cardiac surgery perioperative protocols