Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery

被引：57

作者：

Mahle, William T. ^{[1
]}

Nicolson, Susan C. ^{[2
]}

Hollenbeck-Pringle, Danielle ^{[3
]}

Gaies, Michael G. ^{[4
]}

Witte, Madolin K. ^{[5
]}

Lee, Eva K. ^{[6
]}

Goldsworthy, Michelle ^{[7
]}

Stark, Paul C. ^{[3
]}

Burns, Kristin M. ^{[8
]}

Scheurer, Mark A. ^{[9
]}

Cooper, David S. ^{[10
]}

Thiagarajan, Ravi ^{[11
]}

Ben Sivarajan, V. ^{[12
]}

Colan, Steven D. ^{[11
]}

Schamberger, Marcus S. ^{[13
]}

Shekerdemian, Lara S. ^{[7
]}

机构：

[1] Emory Univ, Dept Pediat, Atlanta, GA 30322 USA

[2] Childrens Hosp Philadelphia, Dept Anesthesia, Philadelphia, PA 19104 USA

[3] New England Res Inst, 9 Galen St, Watertown, MA 02172 USA

[4] Univ Michigan, Dept Pediat, Ann Arbor, MI 48109 USA

[5] Univ Utah, Dept Pediat, Salt Lake City, UT USA

[6] Georgia Inst Technol, Dept Ind Engn, Atlanta, GA 30332 USA

[7] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA

[8] NHLBI, Bldg 10, Bethesda, MD 20892 USA

[9] Med Univ South Carolina, Dept Pediat, Charleston, SC USA

[10] Cincinnati Childrens Hosp, Dept Pediat, Cincinnati, OH USA

[11] Boston Childrens Hosp, Dept Cardiol, Boston, MA USA

[12] Hosp Sick Children, Dept Crit Care Med, Toronto, ON, Canada

[13] Riley Childrens Hosp, Dept Pediat, Indianapolis, IN USA

来源：

PEDIATRIC CRITICAL CARE MEDICINE | 2016年 / 17卷 / 10期

基金：

美国国家科学基金会; 美国国家卫生研究院;

关键词：

mechanical ventilation; outcomes; tetralogy of Fallot; CARDIAC-SURGERY; OPERATING-ROOM; CHILDREN;

D O I：

10.1097/PCC.0000000000000918

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: To determine whether a collaborative learning strategy-derived clinical practice guideline can reduce the duration of endotracheal intubation following infant heart surgery. Design: Prospective and retrospective data collected from the Pediatric Heart Network in the 12 months pre- and post-clinical practice guideline implementation at the four sites participating in the collaborative (active sites) compared with data from five Pediatric Heart Network centers not participating in collaborative learning (control sites). Setting: Ten children's hospitals. Patients: Data were collected for infants following two-index operations: 1) repair of isolated coarctation of the aorta (birth to 365 d) and 2) repair of tetralogy of Fallot (29-365 d). There were 240 subjects eligible for the clinical practice guideline at active sites and 259 subjects at control sites. Interventions: Development and application of early extubation clinical practice guideline. Measurements and Main Results: After clinical practice guideline implementation, the rate of early extubation at active sites increased significantly from 11.7% to 66.9% (p < 0.001) with no increase in reintubation rate. The median duration of postoperative intubation among active sites decreased from 21.2 to 4.5 hours (p < 0.001). No statistically significant change in early extubation rates was found in the control sites 11.7% to 13.7% (p = 0.63). At active sites, clinical practice guideline implementation had no statistically significant impact on median ICU length of stay (71.9 hr pre- vs 69.2 hr post-implementation; p = 0.29) for the entire cohort. There was a trend toward shorter ICU length of stay in the tetralogy of Fallot subgroup (71.6 hr pre- vs 54.2 hr postimplementation, p = 0.068). Conclusions: A collaborative learning strategy designed clinical practice guideline significantly increased the rate of early extubation with no change in the rate of reintubation. The early extubation clinical practice guideline did not significantly change postoperative ICU length of stay.

引用

页码：939 / 947

页数：9

共 15 条

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