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

Abstract

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.