| Autor: |
Mukarram, Osama, Catalasan, Gerardo, Eddison, Kally, Awtery, Staton |
| Předmět: |
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| Zdroj: |
Respiratory Care; Oct2016, Vol. 61 Issue 10, pOF53-OF53, 1/4p |
| Abstrakt: |
Background: Between 5-10% patients undergoing cardiac surgery remain intubated for an extended period of time. Prolonged intubation is associated with longer hospital stays, higher health care cost and increased morbidity. Recently efforts have been directed to expedite mechanical ventilation discontinuation (fast track weaning) and even extubate patients in the operating room immediately after the surgery. Use of strict weaning protocols has shown to reduce the mean duration of ventilation, accelerate weaning process and decrease the total length of intensive care unit stay. Data on utilization of non-physician health care staff in such protocols is scarce. We report success of a Respiratory Therapist (RT) driven fast track ventilator weaning protocol in patients undergoing coronary artery bypass graft (CABG) surgery. Method: After getting the local IRB approval we conducted a retrospective study at Midland Memorial Hospital. Patients with only CABG surgery and who were more than 18 years of age were included. All patients undergoing CABG surgery between February 2015 and February 2016 were extubated using RT driven protocol. Those who had CABG surgery between January 2013 and January 2015 were extubated by physician driven conventional method and served as controls. Primary end point of this study was the mean extubation time between the two groups. For statistical comparison of the extubation times a t-test was used. Results: 47 patients were extubated using the RT driven protocol and 112 by conventional method. The mean difference in intubation time was 0.96 hours (8.12±4.46 vs. 7.16±3.96, p=0.206). The percentage of patients extubated in less than 6 hours (ultra-fast weaning) was comparable between the two groups (45.5% vs. 48.9%, p=0.695), with a corresponding odds ratio of 1.14 (95% CI: 0.60-2.27). Subsequent analysis of the Spearman rank correlation showed that female gender (r=0.348, p < .0001) and IABP use (r=0.216, p=0.006) were significantly correlated with prolonged intubation. 1 patient had to be re-intubated in the conventional weaning protocol and none in RT driven protocol. Conclusions: RT driven ventilator weaning protocols are equally as effective as conventional weaning protocols in modern day fast track ventilator weaning. Our study provides reassurance that RT driven initiatives like ours helps bridge the gap between the need and availability of critical care physicians around in community based hospitals. [ABSTRACT FROM AUTHOR] |
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