The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

EXTUBATION TIMES AFTER OPEN HEART SURGERY: COMPARISON OF VENTILATOR MODES

Phillip Thaut2, Jim Hamilton2, Amelia Fitzpatrick1, Vrena Flint1, Kristin Mote1, Emily Allison1



Background: The length of time a patient requires mechanical ventilation is associated with an increased incidence of VAP, hospital LOS, cost and patient discomfort. Several years ago, LDSH/IMC initiated a "Rapid Wean" ventilator protocol for our stable post-op thoracic surgery patients using SIMV as the ventilator mode. At that time, we decreased our average extubation times from 20 hours to 10 hours. We established a new goal extubation time of less than 7.5 hours in February 2008; to reach that goal we adopted the weaning protocol used since September 2006 by our sister hospital, UVRMC. This protocol utilizes Mandatory Minute Ventilation (MMV) as the ventilator mode. In this mode, if the patient breathes spontaneously and meets the minute ventilation set criteria, breaths will be delivered by Pressure Support or CPAP mode. Presented below are data from both institutions showing a statistically significant decrease in ventilator time with the use of MMV.

Method 1:

SIMV weaning
Monitoring of Ve, CO2
Temp>36
Fio2 <.6
SpO2 >93%
Bleeding < 100cc/hr x 2hr
Hemodynamic stability

Methods 2:

MMV weaning
Monitor EtCo2, Ve, RR
Temp>35.5 <39
Fio2<.5 and Peep <5
SpO2 > 90%
Chest tube output <100cc/hr x 2hr
Hemodynamic stability

All patients were confirmed eligible for Rapid Weaning by their anesthesiologist and surgeon when they returned from the O.R. All healthcare team members participated in the early extubation process, using pain control protocols, active voice management, and emotional support for patients as they awakened.

Results: Patients meeting criteria for Rapid Wean were placed on MMV mode. The MMV mode displays when patients resume spontaneous breathing. Our previous support processes were continued by the Respiratory Therapists and RNs. The average time to extubation decreased significantly at both institutions, by 27% at LDSH/IMC (from 9.4 to 6.8 hours) and 28% at UVRMC (5.3 to 3.8 hours) with the use of the MMV weaning protocol.

Conclusion: The utilization of the MMV mode on the Drager ventilator helped us meet our goal of extubation times less than 7.5 hours in our team approach to the rapid weaning process for the stable post-op thoracic patient population.