Brittany Barber1, Jeffrey Harris1, Cameron Shillington2, Shannon Rychlik1, Joseph Dort3, Michael Meier4, Angela Estey5, Adam Elwi5, Patty Wickson6, Michael Buss7, David Zygun4, Kal Ansari1, Vincent Biron1, Daniel O'Connell1, Hadi Seikaly1. 1. Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada. 2. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 3. Division of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada. 4. Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada. 5. Alberta Provincial Cancer Strategic Clinical Network (SCN), Alberta Health Services, Edmonton, Alberta, Canada. 6. Alberta Provincial Critical Care Strategic Clinical Network (SCN), Alberta Health Services, Edmonton, Alberta, Canada. 7. Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Abstract
BACKGROUND: The purpose of this study was to optimize an existing clinical care pathway (CCP) for head and neck cancer with a high-observation protocol (HOP) and to determine the effect on length of intensive care unit (ICU) admission and length of stay in hospital (LOS). METHODS: The HOP mandated initiation of spontaneous breathing trials before the conclusion of the surgery, weaning of sedation, and limiting mechanical ventilation. All patients with head and neck cancer undergoing primary surgery on the HOP were compared to a historical cohort regarding length of ICU admission, ICU readmissions, and LOS. RESULTS: Ninety-six and 52 patients were observed in "historical" and "HOP" cohorts. The length of ICU admission (1.9 vs 1.2 days; p = .021), LOS (20.3 vs 14.1 days; p = .020), and ICU readmissions (10.4% vs 1.9%; p = .013) were significantly decreased in the "HOP" cohort. CONCLUSION: Rapid weaning of sedation and limiting mechanical ventilation may contribute to a shorter length of ICU admission and LOS, as well as decreased ICU readmissions.
BACKGROUND: The purpose of this study was to optimize an existing clinical care pathway (CCP) for head and neck cancer with a high-observation protocol (HOP) and to determine the effect on length of intensive care unit (ICU) admission and length of stay in hospital (LOS). METHODS: The HOP mandated initiation of spontaneous breathing trials before the conclusion of the surgery, weaning of sedation, and limiting mechanical ventilation. All patients with head and neck cancer undergoing primary surgery on the HOP were compared to a historical cohort regarding length of ICU admission, ICU readmissions, and LOS. RESULTS: Ninety-six and 52 patients were observed in "historical" and "HOP" cohorts. The length of ICU admission (1.9 vs 1.2 days; p = .021), LOS (20.3 vs 14.1 days; p = .020), and ICU readmissions (10.4% vs 1.9%; p = .013) were significantly decreased in the "HOP" cohort. CONCLUSION: Rapid weaning of sedation and limiting mechanical ventilation may contribute to a shorter length of ICU admission and LOS, as well as decreased ICU readmissions.