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

Abstract

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.