Spontaneous Breathing Trials versus Weaning Parameters for Extubation in the Post Operative Cardiac Surgery Patient

2.50
Hdl Handle:
http://hdl.handle.net/10755/156987
Category:
Abstract
Type:
Presentation
Title:
Spontaneous Breathing Trials versus Weaning Parameters for Extubation in the Post Operative Cardiac Surgery Patient
Author(s):
Gosnell, Dawn J.
Author Details:
Dawn J. Gosnell, CNS,APRN,MSN,CCRN, Via Christi Health, Wichita, Kansas, USA, email: dawn_gosnell@via-christi.org
Abstract:
POSTER PURPOSE: To improve clinical precision and decrease time to extubation in a nurse-led extubation protocol in postoperative cardiac surgery patients. Nurses in the cardiothoracic intensive care unit (CTICU) requested a change from the current weaning parameter (WP) method to a spontaneous breath trial (SBT) method. Presentation was made to the cardiothoracic surgeons and approved to begin in June 2008. BACKGROUND/SIGNIFICANCE:With the renovation and opening of the new CTICU, nurses educated and challenged the cardiothoracic surgeons to improve clinical precision in extubation time by using the SBT method. Weaning parameters require cooperation. Patients are often anxious and may not understand all instructions. The SBT method is not inhibited by cognitive ability or language barrier. Patients receiving mechanical ventilation rarely notice when the change is made and remain relaxed. METHOD: In a retrospective comparison study, data from 342 cardiac surgery cases in 2008 were collected. The SBT worksheet includes a clear, easy-flowing algorithm on one side and a recording sheet on the other side. The patient is continually observed during the 2-minute screen for signs of respiratory distress. If the patient is doing well, a 30-minute trial continues with the nurse observing for fatigue and monitoring the rapid shallow breathing index (RSBI). RSBI is respiratory rate/tidal volume in liters. If the RSBI is >105, the patient is returned to full support. If the RSBI is <105, the patient has had a successful SBT. RESULTS: Of the 342 patients, 190 were extubated by WP and 152 by SBT. The 2 populations were nearly identical in age, weight, height, ejection fraction, and EuroSCORE (risk of mortality score). Twice as many men (n = 238) as women (n = 104) participated. SBT patients were weaned 1.3 hours quicker than the WP group (SBT: 10.8 hours, WP: 12.1 hours). Only 2 patients were reintubated within 24 hours, one from each group. Results of the 2-tailed t test were not statistically significant (P = .13). Encouraged by this forward trend and acknowledging the learning curve by nursing and respiratory care, nursing staff continue to work diligently toward reducing hours to extubation. CONCLUSIONS: CTICU nurses have no intention of going back to the WP method. A Spontaneous Awake Trial (SAT) was added to the SBT in 2009 to aid nurses in first determining readiness and improving coordination with respiratory staff. Nurses describe the SBT process as a realistic picture, clear, not stressful, a better indicator, autonomous, and collegial in their impression of an improved clinical precision process. Was the change beneficial for our patients? Yes!
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleSpontaneous Breathing Trials versus Weaning Parameters for Extubation in the Post Operative Cardiac Surgery Patienten_GB
dc.contributor.authorGosnell, Dawn J.en_GB
dc.author.detailsDawn J. Gosnell, CNS,APRN,MSN,CCRN, Via Christi Health, Wichita, Kansas, USA, email: dawn_gosnell@via-christi.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156987-
dc.description.abstractPOSTER PURPOSE: To improve clinical precision and decrease time to extubation in a nurse-led extubation protocol in postoperative cardiac surgery patients. Nurses in the cardiothoracic intensive care unit (CTICU) requested a change from the current weaning parameter (WP) method to a spontaneous breath trial (SBT) method. Presentation was made to the cardiothoracic surgeons and approved to begin in June 2008. BACKGROUND/SIGNIFICANCE:With the renovation and opening of the new CTICU, nurses educated and challenged the cardiothoracic surgeons to improve clinical precision in extubation time by using the SBT method. Weaning parameters require cooperation. Patients are often anxious and may not understand all instructions. The SBT method is not inhibited by cognitive ability or language barrier. Patients receiving mechanical ventilation rarely notice when the change is made and remain relaxed. METHOD: In a retrospective comparison study, data from 342 cardiac surgery cases in 2008 were collected. The SBT worksheet includes a clear, easy-flowing algorithm on one side and a recording sheet on the other side. The patient is continually observed during the 2-minute screen for signs of respiratory distress. If the patient is doing well, a 30-minute trial continues with the nurse observing for fatigue and monitoring the rapid shallow breathing index (RSBI). RSBI is respiratory rate/tidal volume in liters. If the RSBI is >105, the patient is returned to full support. If the RSBI is <105, the patient has had a successful SBT. RESULTS: Of the 342 patients, 190 were extubated by WP and 152 by SBT. The 2 populations were nearly identical in age, weight, height, ejection fraction, and EuroSCORE (risk of mortality score). Twice as many men (n = 238) as women (n = 104) participated. SBT patients were weaned 1.3 hours quicker than the WP group (SBT: 10.8 hours, WP: 12.1 hours). Only 2 patients were reintubated within 24 hours, one from each group. Results of the 2-tailed t test were not statistically significant (P = .13). Encouraged by this forward trend and acknowledging the learning curve by nursing and respiratory care, nursing staff continue to work diligently toward reducing hours to extubation. CONCLUSIONS: CTICU nurses have no intention of going back to the WP method. A Spontaneous Awake Trial (SAT) was added to the SBT in 2009 to aid nurses in first determining readiness and improving coordination with respiratory staff. Nurses describe the SBT process as a realistic picture, clear, not stressful, a better indicator, autonomous, and collegial in their impression of an improved clinical precision process. Was the change beneficial for our patients? Yes!en_GB
dc.date.available2011-10-26T19:19:16Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:19:16Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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