185 Early extubation following cardiac surgery: Pre-operative scorecard using the Manitoba model

2011 ◽  
Vol 27 (5) ◽  
pp. S126-S127
Author(s):  
K. Kumar ◽  
B. Hiebert ◽  
H. Grocott ◽  
E. Jacobsohn ◽  
A.H. Menkis ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Early Extubation

scholarly journals Enhanced recovery and early extubation after pediatric cardiac surgery using single-dose intravenous methadone

2020 ◽  
Vol 23 (1) ◽  
pp. 70 ◽  
Author(s):  
BryanG Maxwell ◽  
JohnP Iguidbashian ◽  
PeterH Chang ◽  
John Iguidbashian ◽  
Jason Lines
Keyword(s):  
Cardiac Surgery ◽  
Single Dose ◽  
Enhanced Recovery ◽  
Pediatric Cardiac Surgery ◽  
Early Extubation

Role of the Clinical Nurse Specialist in Improving Patient Outcomes After Cardiac Surgery

2015 ◽  
Vol 26 (1) ◽  
pp. 35-42
Author(s):  
Lisa M. Soltis
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Postoperative Period ◽  
Open Heart Surgery ◽  
Pulmonary Complications ◽  
Nurse Specialist ◽  
Early Extubation ◽  
Clinical Nurse

Health care reform continues to focus on improving patient outcomes while reducing costs. Clinical nurse specialists (CNSs) should facilitate this process to ensure that best practice standards are used and patient safety is enhanced. One example of ensuring best practices and patient safety is early extubation after open heart surgery, which is a critical component of fast track protocols that reduces may reduce the development of pulmonary complications in the postoperative period while decreasing overall length of stay in the hospital. This project was an interdisciplinary endeavor, led by the CNS and nurse manager, which combined early extubation protocols with enhanced rounding initiatives to help decrease overall length of ventilation time as well as reduce pulmonary complications in patients in the cardiac surgery intensive care unit. The project resulted in a significant decrease in length of stay and a decrease in pulmonary complications in the postoperative period.

FACTORS ASSOCIATED WITH EARLY EXTUBATION AFTER CARDIAC SURGERY: A RETROSPECTIVE STUDY

2020 ◽  
Vol 36 (10) ◽  
pp. S97
Author(s):  
Q. Nguyen ◽  
K. Coghlan ◽  
J. Nagendran ◽  
R. MacArthur ◽  
W. Lam
Keyword(s):  
Cardiac Surgery ◽  
Retrospective Study ◽  
Early Extubation ◽  
Factors Associated

scholarly journals Variation in Implementation and Outcomes of Early Extubation Practices After Infant Cardiac Surgery

2019 ◽  
Vol 107 (5) ◽  
pp. 1434-1440 ◽  
Author(s):  
Katherine E. Bates ◽  
William T. Mahle ◽  
Lauren Bush ◽  
Janet Donohue ◽  
Michael G. Gaies ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Early Extubation

Early Tracheal Extubation after Coronary Artery Bypass Graft Surgery Reduces Costs and Improves Resource Use

1996 ◽  
Vol 85 (6) ◽  
pp. 1300-1310. ◽  
Author(s):  
Davy C. H. Cheng ◽  
Jacek Karski ◽  
Charles Peniston ◽  
Ganesh Raveendran ◽  
Buvanendran Asokumar ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Resource Use ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cost Savings ◽  
Tracheal Extubation ◽  
Early Extubation ◽  
Total Cost ◽  
Cabg Surgery

Background Economics has caused the trend of early tracheal extubation after cardiac surgery, yet no prospective randomized study has directly validated that early tracheal extubation anesthetic management decreases costs when compared with late extubation after cardiac surgery. Methods This prospective, randomized, controlled clinical trial was designed to evaluate the cost savings of early (1-6 h) versus late tracheal extubation (12-22 h) in patients after coronary artery bypass graft (CABG) surgery. The total cost for the services provided for each patient was determined for both the early and late groups from hospital admission to discharge home. All costs applicable to each of the services were classified into direct variables, direct fixed costs, and overhead (an indirect cost). Physician fees and heart catheterization costs were included. The total service cost was the sum of unit workload and overhead costs. Results One hundred patients having elective CABG who were younger than 75 yr were studied. Including all complications, early extubation (n = 50) significantly reduced cardiovascular intensive care unit (CVICU) costs by 53% (P < 0.026) and the total CABG surgery cost by 25% (P < 0.019) when compared with late extubation (n = 50). Forty-one patients (82%) in each group were tracheally extubated within the defined period. In the early extubation group, the actual departmental cost savings in CVICU nursing and supplies was 23% (P < 0.005), in ward nursing and supplies was 11% (P < 0.05), and in respiratory therapy was 12% (P < 0.05). The total cost savings per patient having CABG was 9% (P < 0.001). Further cost savings using discharge criteria were 51% for CVICU nursing and supplies (P < 0.001), 9% for ward nursing and supplies (P < 0.05), and 29% for respiratory therapy (P < 0.001), for a total cost savings per patient of 13% (P < 0.001). Early extubation also reduced elective case cancellations (P < 0.002) without any increase in the number of postoperative complications and readmissions. Conclusions Early tracheal extubation anesthetic management reduces total costs per CABG surgery by 25%, predominantly in nursing and in CVICU costs. Early extubation reduces CVICU and hospital length of stay but does not increase the rate or costs of complications when compared with patients in the late extubation group. It shifts the high CVICU costs to the lower ward costs. Early extubation also improves resource use after cardiac surgery when compared with late extubation.

Establishing the Content Validity of an Early Extubation Protocol: A Quality Improvement Project for Improving Early Extubation of Coronary Artery Bypass Graft Patients

2016 ◽  
Vol 9 (2) ◽  
pp. 236-248
Author(s):  
Alicia Williams ◽  
Lyn Stankiewicz Murphy
Keyword(s):  
Cardiac Surgery ◽  
Content Validity ◽  
Patient Population ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Interrater Agreement ◽  
Early Extubation ◽  
Artery Bypass Graft ◽  
Validity Index ◽  
Item Content

Introduction:Patients undergoing coronary artery bypass graft surgery will require intubation and the use of mechanical ventilation during and after surgery. It is well accepted that early extubation is associated with not only positive patient outcomes but also organizational outcomes as well. Patients who are not extubated early are at risk for complications associated with prolonged intubation. The literature supports the use of protocol aid with early extubation. The goal and expected outcome of this project is to establish the usability of an early extubation protocol by assessing its appropriateness for use in the postoperative cardiac surgical adult patient.Methods:For the purpose of establishing content validity of an early extubation protocol, 2 protocols were chosen from the literature. Fifteen cardiac surgery experts were invited to select the protocol they felt was most appropriate for use in this patient population. These reviewers were then asked to further analyze the protocol based on a 5-question survey. Their response was used to calculate a scale-content validity index (S-CVI) and an item-content validity index (I-CVI).Results:Twelve of 15 experts participated in the project. The content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI) and (b) S-CVI. The means were established for each item. Content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI: 0.75–1.00); and the S-CVI/average = 0.92. Cronbach’s alpha was estimated to establish reliability (0.972).Conclusion:Selecting an appropriate protocol to be used in this patient population is the first step in implementing an effective early extubation process. The results highly suggest that the content of this protocol is quite relevant in this patient population. It is hoped that this will set the stage for early extubation in postoperative cardiac surgery patients.

Early extubation following pediatric cardiac surgery. An analysis of 198 consecutive admissions

1976 ◽  
Vol 4 (2) ◽  
pp. 109
Author(s):  
P. G. Barash ◽  
F. Lescovich ◽  
N. S. Talner ◽  
Berman ◽  
Katz ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pediatric Cardiac Surgery ◽  
Early Extubation
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