2011 OPEN FORUM Abstracts
TO PROTOCOLIZE OR NOT TO PROTOCOLIZE: THAT IS THE QUESTION!
Karen Shambaugh, Ronald Dechert; Respiratory Care, University of Michigan, Ann Arbor, MI
Background:Protocolized management of mechanical ventilation has received significant attention in mostly adult ICU populations. We have made multiple attempts to implement protocolized management in our pediatric population with limited success. The ability to facilitate adoption of similar protocols in pediatric ICUs may be related to extreme variability of duration of mechanical ventilation that is associated with patient demographics and severity. The purpose of this study was to evaluate the potential barriers to adopting protocolized management in a general med/surg pediatric ICU that may be attributable to patient characteristics or severity upon ICU admission. Method: Retrospective review of patient characteristics and duration of mechanical were extracted from our institutional ICU surveillance database for all mechanically ventilated pediatric patients over a 6 1/2 period (July 2004-Dec 2010). In addition, we extracted a metric of patient severity as assessed for the first 12 hours of ICU support. Results: A total of 7131 patients were admitted to our PICU during this review period, of which 2714 (38%)required mechanical ventilatory support. Duration of ventilation demonstrated significant variability (121 hours +/- 195 hours; mean +/- 1SD). This variability was present in most of the diagnostic categories we examined and was associated with patient characteristics and severity at time of admission. Conclusion: Substantial variability in duration of mechanical ventilation is present in our pediatric ICU population and appears to be associated with individual patient characteristics and severity. This variability makes adoption of standardized management protocols difficult and may limit success in various subsets of our general med/surg ICU patients. Further studies are warranted to identify subsets of patients whose variability is more homogenous to allow for standard ventilator management. Sponsored Research - None