Cove Matthew E, Ying Chen, Taculod Juvel M, Oon Siow Eng, Oh Pauline, Kollengode Ramanathan, MacLaren Graeme, Tan Chuen Seng
Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore; Division of Respiratory Medicine and Critical Care, Department of Medicine, National University Hospital, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Ann Thorac Surg. 2016 Jul;102(1):28-34. doi: 10.1016/j.athoracsur.2016.02.071. Epub 2016 May 4.
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.
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.
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).
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.
标准化护理套餐可通过减少医疗差错、最小化实践差异及降低死亡率来改善患者护理。我们推测，引入多学科拔管方案将缩短三级心胸重症监护病房患者的机械通气时间和重症监护病房住院时长。
制定了一项多学科拔管方案。该方案应用于所有择期心脏手术后患者。在方案启动前3个月和启动后3个月收集数据。如果患者经历了禁忌应用该方案的事件，则将其排除。
纳入201例行择期心脏直视手术的患者：99例在方案实施前（方案前），102例在方案实施后（方案后）。中位拔管时间缩短了35%（620分钟对405分钟；p<0.001），而调整后的拔管时间仍显著缩短144分钟（p<0.001）。重症监护病房住院时长从方案前的2天降至方案后的1天（p<0.001）。两组的再次插管率相同（2.06%对1.96%；p = 1.0）。
一个简单的多学科拔管方案是安全的，且与择期心脏手术后机械通气时间和重症监护病房住院时长的显著缩短相关。
