Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jun 12, 2019; 8(3): 28-35
Published online Jun 12, 2019. doi: 10.5492/wjccm.v8.i3.28
Implementation of a nurse-led protocol for early extubation after cardiac surgery: A pilot study
Giovanni Serena, Carlos Corredor, Nick Fletcher, Filippo Sanfilippo
Giovanni Serena, Carlos Corredor, Nick Fletcher, Filippo Sanfilippo, Cardiothoracic Intensive Care Unit, Intensive Care Directorate – St Georges Healthcare NHS Foundation Trust, London SW170QT, United Kingdom
Author contributions: Sanfilippo F designed the research and proposed the clinical audit; Serena G, Sanfilippo F, Fletcher N designed the protocol; Sanfilippo F, Serena G, Corredor C and Fletcher N collected and analysed the data; Sanfilippo F, Corredor C wrote the paper; Fletcher N reviewed the paper.
Institutional review board statement: As part of a clinical audit, this study received a waiver from the institutional review board.
Clinical trial registration statement: This audit has not been registered as a clinical trial.
Informed consent statement: Informed consent was not required, as data were collected as part of a clinical audit.
Conflict-of-interest statement: Authors declared no conflict-of-interest.
Data sharing statement: Authors will provide full data declared in this manuscript on request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Filippo Sanfilippo, MD, PhD, EDIC, Consultant Anaesthetist, Cardiothoracic Intensive Care Unit, Intensive Care Directorate – St Georges Healthcare NHS Foundation Trust, Blackshaw Rd, London SW170QT, United Kingdom. filipposanfi@yahoo.it
Telephone: +44-20-87251504 Fax: +44-20-87252180
Received: February 14, 2019
Peer-review started: February 15, 2019
First decision: March 14, 2019
Revised: March 31, 2019
Accepted: May 21, 2019
Article in press: May 22, 2019
Published online: June 12, 2019
Processing time: 118 Days and 18 Hours
Abstract
BACKGROUND

Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit (ICU). Early extubation is a cornerstone of fast-track cardiac surgery, and it has been mainly implemented in post-anaesthesia care units. Introducing a nurse-led extubation protocol may lead to reduced extubation time.

AIM

To investigate results of the implementation of a nurse-led protocol for early extubation after elective cardiac surgery, aiming at higher extubation rates by the third postoperative hour.

METHODS

A single centre prospective study in an 18-bed, consultant-led Cardiothoracic ICU, with a 1:1 nurse-to-patient ratio. During a 3-wk period, the protocol was implemented with: (1) Structured teaching sessions at nurse handover and at bed-space (all staff received teaching, over 90% were exposed at least twice; (2) Email; and (3) Laminated sheets at bed-space. We compared “standard practice” and “intervention” periods before and after the protocol implementation, measuring extubation rates at several time-points from the third until the 24th postoperative hour.

RESULTS

Of 122 cardiac surgery patients admitted to ICU, 13 were excluded as early weaning was considered unsafe. Therefore, 109 patients were included, 54 in the standard and 55 in the intervention period. Types of surgical interventions and baseline left ventricular function were similar between groups. From the third to the 12th post-operative hour, the intervention group displayed a higher proportion of patients extubated compared to the standard group. However, results were significant only at the sixth hour (58% vs 37%, P = 0.04), and not different at the third hour (13% vs 6%, P = 0.33). From the 12th post-operative hour time-point onward, extubation rates became almost identical between groups (83% in standard vs 83% in intervention period).

CONCLUSION

The implementation of a nurse-led protocol for early extubation after cardiac surgery in ICU may gradually lead to higher rates of early extubation.

Keywords: Fast-track; Extubation protocol; Intensive care; Mechanical ventilation; Implementation strategies

Core tip: Fast-track is emerging in cardiac surgery, and early extubation is a cornerstone for fast-track. Nurse-led extubation protocols may be introduced in clinical practice with different teaching techniques, aiming for early extubation.