The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

PATTERNS FOR LIBERATING MECHANICALLY VENTILATED PATIENTS BY DAY OF THE WEEK

John S. Emberger1, Francis Gott1, Joel M. Brown1, Gerard Fulda2, Marc T. Zubrow3



Background: A constant focus in ICU care is liberating patients from mechanical ventilation. Several studies have examined outcomes for patients admitted on weekdays versus weekends, with conflicting results. No data exists for differences in day of the week patterns of liberating patients from mechanical ventilation. We wanted to determine if such a pattern exists at our hospital for extubating mechanically ventilated patients.

Methods: We retrospectively reviewed two years of data for all mechanically ventilated adults at our hospital. We collected; number of ventilator patients, number of spontaneous breathing trials, number extubations, number of re-intubations and level of respiratory care workload for calendar years 2006 and 2007. We calculated the percent of each of those items by day of the week. An equal volume each day would equal 14.29% (100% � 7days = 14.29%).

Results: The figure displays extubations, spontaneous breathing trials, ventilator patients per day and respiratory care workload by % volume per day of the week. Re-intubation rate was between 4% and 9% without a significant difference between days. Volume of extubations Tuesday through Friday was significantly different then extubations Friday through Monday (p = 0.002). No other significant differences were noted.

Conclusion: The volume of respiratory care workload and ventilator patients per day remains fairly constant each day of the week. The number of spontaneous breathing trials is lower during the weekend. Extubation has a significant pattern variation; lowest on Saturday through Monday and highest on Tuesday through Friday. We speculate this variation occurs due to one or more of the following:

  1. limited resources on the weekend
  2. weekend staffing patterns
  3. attending physician coverage changes on the weekends and on Monday.
Further investigation is required to clarify the reason for this variable extubation pattern at our hospital. Other hospitals should investigate to see if similar patterns exist across facilities.