The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

MULTIDISCIPLINARY APPROACH TO DECREASING EXTUBATION TIME FOR CARDIOVASCULAR SURGERY PATIENTS.

Victoria M. Roelker1, Lamar Thomas1, Tessa Korn2, Andrea Yates2, Michelle Sexton2, Connie Syme2, Amanda Sawyer2; 1Respiratory Care, The Christ Hospital, Cincinnati, OH; 2CVICU, The Christ Hospital, Cincinnati, OH

Background – Cardiovascular Surgery (CVS) Extubation Committee was formed in January 2010 to investigate prolonged intubation times for CVS patients. The multidisciplinary committee comprised of RCPs, RNs, CVS surgeons, pulmonologist and anesthesiologist. Method – The committee first reviewed the data collection process and identified areas in need of clarification. Times of intubation, extubation and reason for prolonged intubation were difficult to find in charting. Time of intubation was defined as time out of OR as charted on the Surgical Summary Report. Documentation of extubation time was standardized to one location. Respiratory therapist and CVICU nurses were educated on the new standards and were asked to document spontaneous breathing trials (SBT) attempts or reasons unable to perform SBT once every four hours. The goal was to extubate patients within six hours after surgery. As documentation improved, reasons for prolonged intubations were staff availability, level of sedation and hypoxia. An increase awareness of delays around shift change and improving collaboration between RNs and RCPs was encouraged. Review and re-evaluation of the reversal protocol showed opportunities for improvement. Staff were re-educated on the reversal process and were encouraged to look for alternative for pain management instead of sedation. Anesthesiologists began the reversal process in the OR if appropriate. A lung recruitment protocol was developed and added to the CVS order set. This enabled RCPs to perform a lung recruitment maneuver on hypoxic patients if their P/F ratio is less than 200, are hemodynamically stable and no pneumothorax documented on chest x-ray. Results – In the fourth quarter 2009 the median extubation time was 9.77 hours and had decreased to 6.17 hours by second quarter 2010. The lung recruitment protocol was implemented in June 2010 and additional improvements were seen. Results for third quarter 2010 had decreased to 4.36 hours. Conclusion – Standardization of documentation, improved collaboration and unified goals have improved extubation times of our CVS patients. Sponsored Research - None Extubation Times