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Document Type

Poster

Department

Nursing

Abstract

Background: Prolonged intubation after cardiac surgery increases the risk of morbidity and mortality and lengthens hospital stays. Factors that influence the ability to extubate patients with speed and efficiency include the type of operation, the patient’s baseline physiological condition, and provider practice patterns. The purpose of this research was to prove that the change of practice patterns that followed the addition of an intensivist lessened extubation times in cardiac surgery patients. It was hypothesized that the interventions brought on by the introduction of an intensivist would greatly reduce the amount of time a patient is intubated while in the intensive care unit.

Problem: Prolonged intubation times contributed to increased length of stay in the intensive care unit, increased morbidity and mortality rates.

Method: Barriers of extubation were identified and a protocol was agreed upon by advanced practice providers along with RN’s. A comprehensive unit based safety initiative was designed and put into practice. From April 2020 to April 2021 data was collected where the cardiac intensive care unit was without an intensivist. Data was then collected from April 2021 to April 2022 when there was an intensivist on site. The data analyzed included the number of patient’s extubated under six hours out of the total number of cases. Cases included in the study consisted of CABG’s and Valves. Cases excluded from the study were aneurysm repairs and minimally assisted CABG’s where the patients came out of the OR extubated. Considerations included the elimination of Morphine/Versed, the introduction of Precedex and Propofol and more attention to the last paralytic/reversal agent out of the operating room.

Results: Extubation in under six hours on the unit without an intensivist occurred in 116/571 patients (20.3%). With the introduction of an intensivist on the unit there was a total of 181/531 patients extubated in under six hours (34%).

Conclusion: The number of early extubations increased with an intensivist in the intensive care unit.

Publication Date

9-30-2022

Comments

Rebecca Gooch, MD, MPH, Chance Nadritch, BSN, CCRN-CSC-CMC, Kimberly Vent, BSN, CCRN, Lauren Grip, BSN, CCRN

Rochester General Hospital, Cardiothoracic ICU

Reducing Intubation Time in Adult Cardiothoracic Surgery Patients: A Review of Data under the Direction of a Board Certified Critical Care Intensivist

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