title: Multidisciplinary Extubation Protocol in Cardiac Surgical Patients Reduces Ventilation Time and Length of Stay in the Intensive Care Unit.
abstract: BACKGROUND
  Protocolized care bundles may improve patient care by reducing medical errors, minimizing practice variability, and reducing mortality. We hypothesized that the introduction of a multidisciplinary extubation protocol would reduce duration of mechanical ventilation and intensive care unit length of stay in a tertiary cardiothoracic intensive care unit.
  
  
  METHODS
  A multidisciplinary extubation protocol was created. The protocol was applied to all elective postoperative cardiac surgery patients. Data were collected 3 months before and 3 months after protocol initiation. Patients were excluded if they experienced events that contraindicated application of the protocol.
  
  
  RESULTS
  Two hundred one patients undergoing elective open cardiac surgery were included: 99 patients before protocol implementation (preprotocol) and 102 patients after implementation (postprotocol). Median extubation time was reduced by 35% (620 minutes versus 405 minutes; p < 0.001), whereas adjusted extubation time remained significantly reduced by 144 minutes (p < 0.001). Intensive care unit length of stay was reduced from 2 days preprotocol to 1 day postprotocol (p < 0.001). Reintubation rate was the same in both groups (2.06% versus 1.96%; p = 1.0).
  
  
  CONCLUSIONS
  A simple multidisciplinary extubation protocol is safe and associated with a significant reduction in the duration of mechanical ventilation and intensive care unit length of stay after elective cardiac surgery.
authors.affiliation: Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore; Division of Respiratory Medicine and Critical Care, Department of Medicine, National University Hospital, Singapore. Electronic address: mdcmec@nus.edu.sg.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cove
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Chen
authors.initials: C
authors.lastname: Ying
authors.affiliation: Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore.
authors.forename: Juvel M
authors.initials: JM
authors.lastname: Taculod
authors.affiliation: Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore.
authors.forename: Siow Eng
authors.initials: SE
authors.lastname: Oon
authors.affiliation: Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore.
authors.forename: Pauline
authors.initials: P
authors.lastname: Oh
authors.affiliation: Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore.
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Kollengode
authors.affiliation: Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore.
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLaren
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Chuen Seng
authors.initials: CS
authors.lastname: Tan
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors