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Reducing failed extubations in the intensive care unit.

Peter J Pronovost1, Mollie Jenckes, May To

  • 1Departments of Anesthesiology/Critical Care Medicine and Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 295, Baltimore, MD 21287-7294, USA. ppronovo@jhmi.edu

The Joint Commission Journal on Quality Improvement
|November 12, 2002
PubMed
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Implementing a quality improvement model significantly reduced failed extubation rates in surgical intensive care units (SICUs). Identifying risk factors like frequent suctioning and agitation helps decrease extubation failure in ventilated patients.

Area of Science:

  • Critical Care Medicine
  • Quality Improvement Science
  • Respiratory Therapy

Background:

  • Failed extubation in mechanically ventilated patients increases morbidity, mortality, and costs.
  • A study was conducted to identify risk factors for failed extubation and implement a quality improvement model.
  • The study focused on a surgical intensive care unit (SICU) in an academic hospital.

Purpose of the Study:

  • To identify risk factors associated with failed extubation in SICU patients.
  • To implement a quality improvement model to reduce the rate of failed extubations.
  • To evaluate the effectiveness of the quality improvement intervention.

Main Methods:

  • Prospective cohort study design comparing an intervention SICU with a concurrent control SICU.

Related Experiment Videos

  • Data collection on risk factors for failed extubation and ventilator days.
  • A three-phase quality improvement model: factor identification, guideline development, and guideline implementation (October 1998 - June 2000).

    • Main Results:

    • Significant risk factors for failed extubation included frequent suctioning, patient agitation/sedation, and oxygen saturation < 95%.
    • The intervention SICU experienced a decrease in failed extubation rate from 8/1,000 to 1.5/1,000 ventilator days.
    • Control SICU rates remained unchanged at 8/1,000 ventilator days.

    Conclusions:

    • The implemented quality improvement model significantly reduced failed extubation rates in the SICU.
    • Identifying and addressing specific risk factors can decrease extubation failure.
    • This approach offers a strategy for improving outcomes in SICU patients requiring mechanical ventilation.