Implementation of an Early Extubation Protocol in Cardiac Surgical Patients Decreased Ventilator Time But Not Intensive Care Unit or Hospital Length of Stay

Abstract

Objective: The optimal timing of extubation following cardiac surgery is currently unknown. Protocols implemented in order to achieve a rapid extubation may achieve this goal, but not prove beneficial in terms of outcomes.

Design: A prospective clinical trial.

Setting: Tertiary care cardiac surgical intensive care unit.

Participants: Adult cardiac surgical patients.

Interventions: Implementation of an 8-tier multidisciplinary rapid weaning protocol.

Measurements and main results: Ventilator times 6 months prior to and 6 months after implementation of the protocol were measured. Outcomes associated with ventilator times were measured by dividing the patients into tertiles (<6 hours, 6-12 hours, >12 hours). Primary outcomes were intensive care unit (ICU) and hospital length of stay. Secondary outcomes included mortality at 30 days and other major morbidities. In all, 459 patients were included in the study. With implementation of the protocol, median ventilation times decreased from 7.4 hours (interquartile range, IQR = 3rd quartile - 1st quartil e= 6.72 hours) to 5.73 hours (IQR = 5.51 hours) (p < 0.0001). However, median ICU length of stay in patients who achieved extubation within 6 hours increased to 49.45 hours (IQR = 44.4) from 40.3 (IQR = 25.6) (p = 0.0017). Median hospital length of stay was not significantly changed due to the protocol in any ventilation tertile (p = 0.650).

Conclusions: Decreasing intubation times to <6 hours in postsurgical cardiac patients is obtainable with implementation of a multidisciplinary rapid weaning protocol. However, patients extubated within 6 hours had increased ICU length of stay and no difference in hospital length of stay with this intervention.

Keywords: cardiac intensive care unit; cardiac surgery; extubation; fast-track cardiac surgery; length of stay; rapid weaning protocol.