The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Brandon Daigle, Andre Finley, Brian K. Walsh, Kristen Hood, Joshua Wolovits; Respiratory Care Services, ChildrenÂ’s Medical Center Dallas, Dallas, TX

Background: Prospective, randomized, controlled studies suggest that the use of ventilator weaning protocols, particularly extubation readiness testing by respiratory therapists, can decrease the duration of mechanical ventilation, the length of ICU stay, and significantly reduce cost, when compared to traditional methods. The concept of early liberation from mechanical ventilation following cardiac surgery with the help of protocols is not new and is standard of care in adult facilities. The use of protocols has not gained the same traction in pediatric care. We sought to change this practice. Methods: In October of 2010 we developed a respiratory therapist-driven mechanical ventilation support and weaning protocol that provides consistent clinical practice and timely interventions. Following staff training we implemented the protocol in January of 2011 as an option for physicians to order. Six months following the implementation we modified the protocol to offer adjustable goal parameters such as pH, pCO2, pO2 and SPO2; as well as a fast track option for patients whose anticipated ventilator course was < 24 hours. Patients were stratified using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) scoring system. Protocol patients were matched to control patients by RACHS-1 score and month of admission. All non RACHS-1 scored patients (non-surgical) were excluded from analysis. Data was collected retrospectively from the electronic health record and randomly audited for accuracy. Results: We reviewed data for all patients placed on the protocol during 2011. There were 121 protocol patients and 120 matched controls. Statistical analysis was performed using a paired t-test. The combined outcome measures for all 6 risk categories showed a trend toward improvement in the protocol group but did not reach statistical significance: average intubation time (0.9 vs 1.6 days, p=0.06), ICU stay (5.5 vs 8.7days, p=0.16), and average hospital stay (12.4 vs 18.9, p=0.14) (Figure 1). There was no difference in adverse events between the protocol and control groups (7 vs 9, p=0.49). Conclusions: Respiratory therapist-driven ventilator support and weaning is a safe and effective method of ventilator management in patients following surgery for congenital heart disease. The use of respiratory therapist-driven ventilator management protocols in this group of patients may improve medical provider efficiency and resource utilization in a complex ICU environment. Sponsored Research - None