The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

OPTIMIZATION OF EXTUBATION WITHIN THE BPD POPULATION UTILIZING A PARAEXTUBATION PROCESS.

Erin Wishloff1, Brandon Kuehne1, Sandra Keeling1, Edward Shepherd2; 1Neonatal Respiratory Services, Nationwide ChildrenÂ’s Hospital, Columbus, OH; 2Department of Neonatology, Nationwide ChildrenÂ’s Hopsital, Columbus, OH

Background: Extubating patients with bronchopulmonary dysplasia (BPD) from mechanical ventilation is often difficult. There is little data in the literature to predict successful extubation in this group. The Comprehensive Center for Bronchopulmonary Dysplasia (CCBPD) is a chronic care facility focused on infants with BPD and has significant experience extubating such patients. While the majority of outcomes are positive, the CCBPD felt that improvement could be made if a standard approach to the extubation process were to be created. Objective: Our objective is to improve the overall success rate of extubations in the CCBPD through the initiation of a Paraextubation Process. We defined successful extubation attempts as avoiding the need to intubate for at least 72 hours. Methods: A multidisciplinary work group consisting of neonatologists, neonatal nurse practitioners, registered nurses and respiratory therapists was created. This group developed a set of tools to guide the care team in the determination of readiness to extubate (Extubation Checklist Tool), the process of the extubation procedure (Extubation Timeline Tool), and the care of the patient in the 48 hours following the extubation (Post Extubation Score Card and Interventions Tool). The team then provided education to the staff of the Paraextubation Process and utilization of the corresponding tools. Results: Prior to the initiation of the Paraextubation Process the CCBPD had a success rate of 65%. Following staff education and initiation of the Paraextubation process we found an increase in success of 12% to a total 77%. Conclusions: This study suggests that by creating a standardized approach to the extubation of the BPD infant through utilization of the Paraextubation Process we can potentially improve outcomes. It is our hopes that through continued use of this process we will note a more measureable improvement in our outcomes. Sponsored Research - None