Clinical Outcomes and Cost of Ventilator Weaning and Endotracheal Extubation Guided by An Established Ventilator Weaning Protocol in Patients Undergoing Elective Cardiac Surgery

Supanan  Innok; Witchuda  Dokphueng; Kamol  Udol; Worawong  Slisatkorn; Prasert Sawasdiwipachai

doi:10.33192/Smj.2021.106

Authors

Supanan Innok Department of Nursing, Siriraj Hospital, Bangkok
Witchuda Dokphueng Department of Nursing, Siriraj Hospital, Bangkok
Kamol Udol Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Worawong Slisatkorn Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Prasert Sawasdiwipachai Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University

DOI:

https://doi.org/10.33192/Smj.2021.106

Keywords:

Early extubation, cardiac surgery, ventilator weaning protocol, complication, cost

Abstract

Objective: To compare successful early extubation rates, complications, and cost before and after the use of an
established ventilator weaning protocol in patients undergoing elective cardiac surgery.
Materials and Methods: Subjects were adult patients undergoing elective cardiac surgery who were clinically stable
within 2 hours after surgery. The control group underwent conventional ventilator weaning at the discretion of their
attending staff. The intervention group underwent protocol-guided ventilator weaning. The primary outcome was
a successful early extubation (within 6 hours after surgery). Secondary outcomes were complications from weaning
to 24 hours after surgery, and the relevant cost related to respiratory and cardiovascular care within 24 hours after
admission to the postoperative intensive care unit.
Results: The primary outcome occurred in 37 out of 65 patients (56.9%) in the intervention group and in 5 out of
65 patients (7.7%) in the control group (adjusted odds ratio 20.6; 95% confidence interval 6.7–62.9, p<0.001). The
complication rates were not statistically different between the intervention and control groups (26.2% vs. 20.0%,
p=0.41). The relevant cost, approximated by the service charges, related to respiratory and cardiovascular care was
significantly less in the intervention group than in the control group (median 2,491 vs. 2,711 Thai baht, p<0.001).
Conclusion: The use of the established ventilator weaning protocol after elective cardiac surgery was associated with
a higher rate of successful early extubation and lower cost related to respiratory and cardiovascular care compared
to the conventional practices of ventilator weaning and extubation. The rates of overall complications were not
significantly different.

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