Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jun 12, 2019; 8(3): 28-35
Published online Jun 12, 2019. doi: 10.5492/wjccm.v8.i3.28
Implementation of a nurse-led protocol for early extubation after cardiac surgery: A pilot study
Giovanni Serena, Carlos Corredor, Nick Fletcher, Filippo Sanfilippo
Giovanni Serena, Carlos Corredor, Nick Fletcher, Filippo Sanfilippo, Cardiothoracic Intensive Care Unit, Intensive Care Directorate – St Georges Healthcare NHS Foundation Trust, London SW170QT, United Kingdom
Author contributions: Sanfilippo F designed the research and proposed the clinical audit; Serena G, Sanfilippo F, Fletcher N designed the protocol; Sanfilippo F, Serena G, Corredor C and Fletcher N collected and analysed the data; Sanfilippo F, Corredor C wrote the paper; Fletcher N reviewed the paper.
Institutional review board statement: As part of a clinical audit, this study received a waiver from the institutional review board.
Clinical trial registration statement: This audit has not been registered as a clinical trial.
Informed consent statement: Informed consent was not required, as data were collected as part of a clinical audit.
Conflict-of-interest statement: Authors declared no conflict-of-interest.
Data sharing statement: Authors will provide full data declared in this manuscript on request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Filippo Sanfilippo, MD, PhD, EDIC, Consultant Anaesthetist, Cardiothoracic Intensive Care Unit, Intensive Care Directorate – St Georges Healthcare NHS Foundation Trust, Blackshaw Rd, London SW170QT, United Kingdom. filipposanfi@yahoo.it
Telephone: +44-20-87251504 Fax: +44-20-87252180
Received: February 14, 2019
Peer-review started: February 15, 2019
First decision: March 14, 2019
Revised: March 31, 2019
Accepted: May 21, 2019
Article in press: May 22, 2019
Published online: June 12, 2019
Processing time: 118 Days and 18 Hours
ARTICLE HIGHLIGHTS
Research background

Nurse led-extubation is safe in the general intensive care unit (ICU) setting, but data in field of cardiac surgery are scarce and limited to post-anaesthesia care units.

Research motivation

Nurse-led extubation protocols may help in shortening postoperative mechanical ventilation, thus expediting patient recovery after cardiac surgery.

Research objectives

To evaluate the results of the implementation of a nurse-led extubation protocol.

Research methods

In a single centre prospective study during a 3-wk period, we implemented a nurse-led extubation protocol in patients admitted after cardiac surgery. The protocol was implemented with structured teaching sessions at nurse handover, teaching at bed-space, information provided via email and apposition of laminated sheets with the protocol at each bed-space. We performed a comparison of before and after protocol implementation (“standard practice” and “intervention” periods, respectively), measuring extubation rates at several time-points from the third until the 24th postoperative hour.

Research results

We included 109 patients, 54 in the standard and 55 in the intervention period. Although the intervention group displayed a higher proportion of patients extubated from the third to the 12th post-operative hour compared to the standard group, results were significant only at the sixth hour (58% vs 37%, P = 0.04) and not different at the third hour (13% vs 6%, P = 0.33). After the 12th post-operative hour time-point onward, extubation rates become almost identical between groups.

Research conclusions

The implementation of a nurse-led protocol for early extubation after cardiac surgery in the cardiac ICU may gradually lead to higher rates of early extubation.

Research perspectives

The present study adds information regarding a growing body of literature of fast-track extubation and identifies a nurse-led protocol as a possible intervention that shortens the length of mechanical ventilation in patients recovering after cardiac surgery. The study findings should be interpreted in the context of the level of training and the nurse-to-patient ratio.