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- Title
OPEN HEART WEANING PROTOCOL - A PERFORMANCE IMPROVEMENT PROJECT.
- Authors
Lamb, Keith; Oetting, Trevor W.; Kingery, Lisa; Wasko, Jennifer; Schleef, David
- Abstract
Background: Protocols and guidelines are used in many aspects of clinical care and have been proven to improve outcomes. However, they are not often updated as the literature evolves. We wanted to implement a new open heart weaning protocol that would give bedside practitioners the autonomy to make adjustments to patient care in a timely manner based on the current literature surrounding ventilator and sedation management. Methods: We developed a new protocol that incorporates the latest literature supporting the use of protective ventilator strategies and minimal sedation. Once the protocol was developed and approved by all the interested parties, education was provided to all respiratory care and nursing staff that provide clinical care to open heart patients. After local IRB approval, we collected data retrospectively for 3 months prior to protocol implementation and then for 3 months prospectively as patients were being taken care of following the new protocol. Median hours intubated, days in the ICU, and days in the hospital were noted and compared. Other demographics were also compared. Results: A total of 114 patients were evaluated. 61 patients were in the before protocol group and 53 patients were managed using the new protocol. Median hours on the ventilator before the new guideline was 5.08, and after was 3.83 for a difference of 1.25 hours (p=<0.0001). Median days in the ICU were 1.90 days (45.6 hours) and 1.81 (43.44 hours) for a difference of 0.09 (2.16 hours) (p=0.34) and Median days in the hospital were 7.77 (186.5 hours) before the protocol and 7.22 (173.28 hours) after for a difference of 0.55 (13.22 hours) (p=0.01). Conclusions: This study demonstrated that a new protocol focusing on protective ventilation strategies, conservative sedation practices, and more autonomy over ventilator management resulted in fewer hours on the ventilator, in the ICU and in the hospital. There were no significant differences in survival or complications as only one patient returned to the operating room and only one patient did not survive till discharge. Disclosures: Keith Lamb has consulted for Bayer Pharmaceuticals and Medtronic.
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF8
- ISSN
0020-1324
- Publication type
Academic Journal