To utilize the Rapid Shallow Breathing Index (RSBI) to lower extubation times in open heart surgery patients.
We studied 167 open heart surgery patients prospectively between April 1st 2004 and March 30th 2005.This included 33 valve surgery patients,122 coronary artery bypass graft (CABG),5 Stanford A Aneurysm patients,1 aortic dissection,1 combined valve/aneurysm patient,4 off pump CABG patients and 1 pericardial stripping. No patients were excluded.EXTUBATION CRITERIA: Rapid shallow breathing index≤105. EXTUBATION HALTING CRITERIA:(1)Medisatinal Hemorrhage≥ 200cc/hour(2)Ramsay Sedation scale≥4(3)Metabolic or respiratory acidosis on continuous positive airway ventilation.(4)Postoperative cardiogenic shock EXTUBATION TIME : defined as time from arrival in the intensive care unit to time extubated.REINTUBATION: was defined as any patient reintubated within 24 hours of extubation.Narcotic analgesia with morphine was used for postoperative pain.The patients cardiac anesthesiologists were informed of the weaning criteria with the RSBI that was going to be used.Drager ventilators; model EVITA XL; which calculate and display the RSBI continuously were used.All patients were placed in a semi recumbent position once the immediate postoperative blood samples had been taken.The head of the bed was raised to at least 45 degrees. Patients with intra-aortic balloon pumps were paced in a reversed trendelenburg position for weaning.Bedside physical therapy with incentive spirometers was commenced immediately post-extubation.
The overall mean extubation time was 2hours 40 minutes. The mean extubation time was unaffected by outliers who did not meet the weaning criteria for extubation. This included a total of 6 patients who remained intubated for≥ 18 hours. Zero reintubations. Overall mean extubation times were unaffected by the age,hemodynamic status,comorbidity, or ejection fraction.
The utilization of the rapid shallow breathing index as the sole criteria for weaning has lead to significantly low mean extubation times in cardiac surgery patients.No increased rates of reintubation were observed.Postoperative narcotic analgesia did not increase mean extubation times.
(1)Significant reductions in resource utilization of the respiratory department and ventilatory equipment.(2)Patient and family satisfaction at early extubation times. (3)Reduced length of stay in the intensive care unit.
Charles Oribabor, None.