Jeremy M Loberger1, Ryan M Jones2, Priya Prabhakaran1. 1. Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL. 2. Department of Respiratory Therapy, Children's Hospital of Alabama, Birmingham, AL.
Abstract
OBJECTIVES: Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a respiratory therapist-driven extubation readiness test pathway. DESIGN: Quality improvement project. SETTING: Single, tertiary care, 24-bed, academic PICU. PATIENTS: Pediatric patients admitted to the PICU and requiring mechanical ventilation for a primary pulmonary process. INTERVENTIONS: We developed an extubation readiness test pathway that consisted of an eligibility screen and a standard testing process. Patients were screened every 3 hours. Upon passing the screen and being cleared by a prescriber, a test was initiated. No clinical management was dictated to prescribers. MEASUREMENTS AND MAIN RESULTS: The preintervention and intervention cohorts included 109 and 43 mechanical ventilation courses, respectively. The mean delta time decreased from 33.77 hours to 2.92 hours after pathway implementation (p = 0.000). The medical length of stay decreased from 196.6 to 177.2 hours (p = 0.05). There were no statistically significant changes in duration of mechanical ventilation until first extubation (112.9 vs 122.3 hr; p = 0.651) and 48-hour extubation failure rate (16.5% vs 4.8%; p = 0.056). The sensitivity and positive predictive value for the extubation readiness test were 89.5% and 94.4%, respectively. The mean for all process compliance measures was 91.5%. CONCLUSIONS: A respiratory therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures-the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.
OBJECTIVES: Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a respiratory therapist-driven extubation readiness test pathway. DESIGN: Quality improvement project. SETTING: Single, tertiary care, 24-bed, academic PICU. PATIENTS: Pediatric patients admitted to the PICU and requiring mechanical ventilation for a primary pulmonary process. INTERVENTIONS: We developed an extubation readiness test pathway that consisted of an eligibility screen and a standard testing process. Patients were screened every 3 hours. Upon passing the screen and being cleared by a prescriber, a test was initiated. No clinical management was dictated to prescribers. MEASUREMENTS AND MAIN RESULTS: The preintervention and intervention cohorts included 109 and 43 mechanical ventilation courses, respectively. The mean delta time decreased from 33.77 hours to 2.92 hours after pathway implementation (p = 0.000). The medical length of stay decreased from 196.6 to 177.2 hours (p = 0.05). There were no statistically significant changes in duration of mechanical ventilation until first extubation (112.9 vs 122.3 hr; p = 0.651) and 48-hour extubation failure rate (16.5% vs 4.8%; p = 0.056). The sensitivity and positive predictive value for the extubation readiness test were 89.5% and 94.4%, respectively. The mean for all process compliance measures was 91.5%. CONCLUSIONS: A respiratory therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures-the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.
Authors: Jeremy M Loberger; Caitlin M Campbell; José Colleti; Santiago Borasino; Samer Abu-Sultaneh; Robinder G Khemani Journal: Crit Care Explor Date: 2022-05-27
Authors: Jeremy M Loberger; Caitlin M Campbell; José Colleti; Santiago Borasino; Samer Abu-Sultaneh; Robinder G Khemani Journal: Crit Care Explor Date: 2022-09-02
Authors: Sanjiv D Mehta; Kelly Martin; Nancy McGowan; Cheryl L Dominick; Chinonyerem Madu; Blair Kraus Denkin; Nadir Yehya Journal: Crit Care Med Date: 2021-02-01 Impact factor: 9.296