Multidisciplinary Extubation Protocol in Cardiac Surgical Patients Reduces Ventilation Time and Length of Stay in the Intensive Care Unit

被引:43
作者
Cove, Matthew E. [1 ]
Ying, Chen
Taculod, Juvel M.
Oon, Siow Eng
Oh, Pauline
Kollengode, Ramanathan
MacLaren, Graeme
Tan, Chuen Seng
机构
[1] Natl Univ Singapore Hosp, Dept Med, Div Resp Med & Crit Care, NUHS Tower Block Level 10,1E Kent Ridge Rd, Singapore 119228, Singapore
基金
英国医学研究理事会;
关键词
EARLY TRACHEAL EXTUBATION; MECHANICAL VENTILATION; CONTROLLED-TRIAL; SURGERY; IMPLEMENTATION; PNEUMONIA; INTERVENTIONS; EPIDEMIOLOGY; INFECTIONS; OUTCOMES;
D O I
10.1016/j.athoracsur.2016.02.071
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Protocolized care bundles may improve patient care by reducing medical errors, minimizing practice variability, and reducing mortality. We hypothesized that the introduction of a multidisciplinary extubation protocol would reduce duration of mechanical ventilation and intensive care unit length of stay in a tertiary cardiothoracic intensive care unit. Methods. A multidisciplinary extubation protocol was created. The protocol was applied to all elective postoperative cardiac surgery patients. Data were collected 3 months before and 3 months after protocol initiation. Patients were excluded if they experienced events that contraindicated application of the protocol. Results. Two hundred one patients undergoing elective open cardiac surgery were included: 99 patients before protocol implementation (preprotocol) and 102 patients after implementation (postprotocol). Median extubation time was reduced by 35% (620 minutes versus 405 minutes; p < 0.001), whereas adjusted extubation time remained significantly reduced by 144 minutes (p < 0.001). Intensive care unit length of stay was reduced from 2 days preprotocol to 1 day postprotocol (p < 0.001). Reintubation rate was the same in both groups (2.06% versus 1.96%; p = 1.0). Conclusions. A simple multidisciplinary extubation protocol is safe and associated with a significant reduction in the duration of mechanical ventilation and intensive care unit length of stay after elective cardiac surgery. (C) 2016 by The Society of Thoracic Surgeons
引用
收藏
页码:28 / 34
页数:7
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