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Published on: January 17, 2011
An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment
Samer Abu-Sultaneh1, Acrista J Hole, Alvaro J Tori
11Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN. 2Department of Respiratory Care Services, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
Insights
A new respiratory therapist-led protocol for spontaneous breathing trials in pediatric intensive care units (PICUs) successfully reduced extubation failure rates. This quality improvement initiative standardized readiness assessments, improving patient outcomes and minimizing ventilation-related complications.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Quality improvement initiatives
Background:
- Minimizing morbidity from extubation failure and prolonged mechanical ventilation is crucial in pediatric intensive care units (PICUs).
- Standardized protocols for weaning mechanical ventilation and assessing extubation readiness are increasingly important.
Purpose of the Study:
- To establish a respiratory therapist-led daily spontaneous breathing trial (SBT) protocol.
- To standardize extubation readiness assessment and documentation within a PICU setting.
Main Methods:
- A quality improvement project was conducted at a single tertiary care children's hospital PICU.
- An interprofessional team developed and implemented a daily SBT protocol, including screening criteria and standardized documentation.
- Patients on mechanical ventilation were screened daily, and eligible patients underwent a 2-hour SBT.
Main Results:
- The study analyzed data from 398 patients during the SBT protocol period (February 2015-January 2016) and 833 patients prior.
- Daily SBT screening compliance was 92%.
- Extubation failure rates decreased from 7.8% to 4.5% after protocol implementation.
Conclusions:
- A respiratory therapist-led extubation readiness protocol, developed collaboratively, can be successfully implemented in a busy PICU.
- The protocol led to a significant reduction in extubation failure without adverse events.
Objectives:
Establishing protocols to wean mechanical ventilation and assess readiness for extubation, with the goal of minimizing morbidity associated with extubation failure and prolonged mechanical ventilation, have become increasingly important in contemporary PICUs. The aim of this quality improvement initiative is to establish a respiratory therapist-led daily spontaneous breathing trial protocol to standardize extubation readiness assessment and documentation in our PICU.
Design:
A quality improvement project.
Setting:
Single center, tertiary care Children's Hospital PICU.
Patients:
All intubated patients admitted to PICU requiring conventional mechanical ventilation between February 2013 and January 2016.
Interventions:
A working group of pediatric intensivists, respiratory therapists, nurses, and information technology specialists established the protocol, standardized documentation via the electronic medical record, and planned education. Daily spontaneous breathing trial protocol implementation began in February 2015. All patients on mechanical ventilation were screened daily at approximately 4 AM by a respiratory therapist to determine daily spontaneous breathing trial eligibility. If all screening criteria were met, patients were placed on continuous positive airway pressure of 5 cm H2O with pressure support of 8 cm H2O for up to 2 hours. If tolerated, patients would be extubated to supplemental oxygen delivered via nasal cannula in the morning, after intensivist approval. Daily audits were done to assess screening compliance and accuracy of documentation.
Measurements And Main Results:
We analyzed data from 398 mechanically ventilated patients during daily spontaneous breathing trial period (February 2015-January 2016), compared with 833 patients from the pre-daily spontaneous breathing trial period (February 2013-January 2015). During the daily spontaneous breathing trial period, daily screening occurred in 92% of patients. Extubation failure decreased from 7.8% in the pre-daily spontaneous breathing trial period to 4.5% in daily spontaneous breathing trial period. The use of high-flow nasal cannula slightly increased during the project, while there was no change in duration of mechanical ventilation or the use of noninvasive ventilation.
Conclusions:
An interprofessionally developed respiratory therapist-led extubation readiness protocol can be successfully implemented in a busy tertiary care PICU without adverse events.
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