Education, Teaching, and Quality Improvement |

Extubation Readiness in the Pediatric Population FREE TO VIEW

Kimberly White, RCP
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Levine Children's Hospital, Charlotte, NC

Chest. 2014;146(4_MeetingAbstracts):539A. doi:10.1378/chest.1995072
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Published online


SESSION TITLE: Quality & Clinical Improvement Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Intubation and mechanical ventilation is often lifesaving, but can be associated with several complications. Prolonged use of an artificial airway can increase these complications; therefore, early extubation is an essential step in a patient's successful recovery. Having a reliable method of determining extubation readiness in the pediatric population is crucial to ensuring faster recovery times, improved patient outcomes, and decreased length of stay.

METHODS: A process improvement (PI) committee was formed by a panel of nurse practitioners, doctors, and respiratory therapists. The goal of this multidisciplinary team was to create an extubation readiness protocol that would clarify the indications for extubation. The team utilized randomized controlled study group literature that showed the importance of protocol driven weaning versus physician driven weaning methods. The PI committee wanted to build upon the unit's current ventilator weaning protocols and encompass all aspects of patient care when determining appropriate extubation readiness guildelines.

RESULTS: Extubation criteria was based on a number of factors that play an important role in the patient's success or failure; PIP ≤ 25cm; PEEP ≤ 6cm; Set RR ≤ 10bpm or PS mode; age appropriate RR; blood gas analysis results at clinical goals; sedation discontinued at discretion of MD/NP at least 4 hours prior to extubation; gastric feeds held for at least 4 hours prior to extubation; cough or gag present; no clinical need for increased ventilator support in the last 24 hours; no planned operative procedures requiring heavy sedation in the next 12 hours; PS trial of 30 minutes to 1 hour on recommended PS settings per tube size table. These specific criteria have become the standard across the unit and have led to an increase in successful extubations.

CONCLUSIONS: The use of mechanical ventilation is an option for critically ill patients that require the need for ventilator support. Mechanical ventilation can cause physiologic complications, prolong the duration of hospitalization, and increase patient mortality. Through the efforts of a collaborative team of professionals, the Ricky Hendricks Intensive Care Unit has a standardized tool to aide in indentifying measures for early extubation.

CLINICAL IMPLICATIONS: Emplying early extubation techniques and extubation readiness strategies has led to a successful standard of practice encompassing a vast array of diagnoses in the critically ill pediatric population.

DISCLOSURE: The following authors have nothing to disclose: Kimberly White

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