2012 OPEN FORUM Abstracts
PREDICTING EXTUBATION SUCCESS AFTER TOTAL ARTIFICIAL HEART PLACEMENT: A COMPARISON OF TWO WEANING ASSESSMENT TOOLS.
Amelia A. Lowell, Jillian Maloney, Linda Staley, Francisco Arabia, Bhavesh Patel; Mayo Clinic Hospital, Phoenix, AZ
Background: Very little is known about the pulmonary-ventilator interactions and possible weaning complications with patients who have undergone total artificial heart (TAH) placement with delayed sternal wound closure. Weaning assessments are one size fits all tools that try to predict extubation success in various patient populations. With so little known about this unique population, our aim was to analyze whether our six item standard weaning assessment (SWA) could accurately predict extubation failure when compared to a comprehensive assessment. We chose the Burns Weaning Assessment Protocol (BWAP) which incorporates 26 clinical assessment criteria. In a fast paced ICU, it is essential that we use the simplest and most effective method of assessment while providing safe patient care. Method: Retrospectively, 12 TAH patients were categorized as no extubation failure < 72 hr and extubation failure < 72 hr. A modified BWAP score was assessed for each group. The modification to the BWAP included the removal of 2 items: physical activity and positive expiratory pressure. The score was calculated by taking the number of yess and dividing by 24, with a score of >65% predicting success. Utilizing the SWA, the groups were scored by the same method on 6 items including blood gas analysis, NIF, vital capacity and tidal volume. The modified BWAP scores were compared to the SWA scores. Results: Comparing the two groups, extubation success to extubation failure using the modified BWAP, the mean score was 69.3% and 50% respectively (p=0.03). Comparing the same groups using the SWA, the mean score was 68.8% and 37.5% respectively (p= 0.09). This suggests that both methods of scoring may accurately be able to identify patients who would fail extubation. Conclusion: The BWAP is a predictive tool, but requires extensive assessment that may not be feasible in a busy critical care setting. The data demonstrates that utilizing a 6 item SWA may be as effective as using the comprehensive BWAP at predicting extubation success in post operative TAH patients. The p value of the SWA trended to significance and may reflect the small sample size. More research with a larger sample size will need to be done to verify these results. Sponsored Research - None