2010 OPEN FORUM Abstracts
RESPIRATORY THERAPY DRIVEN PROTOCOLS SIGNIFICANTLY DECREASED RE-INTUBATION RATES AND LOWERED EXTUBATION TIMES IN CARDIAC SURGERY PATIENTS.
Charles Oribabor1, Felix Khusid2, Naim Mansuroglu1, Emma Fisher2, Anthony Tortolani1; 1CARDIOTHORACIC SURGERY, NEW-YORK METHODIST HOSPITAL, Brooklyn, NY; 2RESPIRATORY THERAPY, NEW-YORK METHODIST HOSPITAL, Brooklyn, NY
The integration of a Respiratory Department Driven protocol utilizing Rapid Shallow Breathing Index (RSBI) resulted in low extubation times as well as low re-intubation rates in open heart surgery patients. The maximum allowed rapid shallow breathing index was 105. We studied 1000 open heart surgery patients prospectively between April 16th 2004 and June 16th 2010. This included 69 valve surgery patients,893 coronary artery bypass graft (CABG) patients, 16 Stanford A Aneurysm Patients, 6 aortic dissection patients and 16 off pump CABG patients. Out of the 1000 patients in CTICU that required post surgical ventilatory support, 773 patients were weaned and extubated within three hours. 215 patients were outliers and 12 patients were re-intubated within 24 hours. EXTUBATION HALTING CRITERIA/OUTLIERS: Mediastinal Hemorrhage 200cc/hour Ramsay Sedation scale 4 Metabolic or respiratory acidosis Postoperative cardiogenic shock Extubation time was defined as the time between the arrival of the patient in the intensive care unit to time that patient was extubated. The mean extubation time was 2 hours and 49 minutes. The mean extubation time was unaffected by outliers who did not meet the weaning criteria for extubation. We had total of 12 re-intubations in total over the study duration. Overall mean extubation times were unaffected by the age, hemodynamic status, comorbidity, or ejection fraction. We utilised non-invasive positive pressure ventilation (NIPPV), intrapulmonary percussive ventilation (IPV), super high flow therapy (SHFT) and Heliox modalities post extubation in patients with multiple co-morbidities. This significantly reduced our reintubation numbers. The overall re-intubation rate was 1.2% The utilization of the rapid shallow breathing index as the sole criteria for weaning has lead to significantly lower mean extubation times in cardiac surgery patients. No increased rates of re-intubation were observed. CLINICAL IMPLICATIONS: 1) Successful integration of respiratory therapy protocols into the cardiac surgery program. 2) Patient and family satisfaction with early extubation times. 3) Reduced length of stay in the cardiothoracic intensive care unit. 4) Integration of the respiratory therapy departments weaning expertise with cardiac surgery perioperative protocols. Sponsored Research - None