Abstract:
Aim The aim of this research study was to evaluate the impact of an enhanced recovery pathway, utilizing Warm, Wake and Wean (WWW) protocol in eligible post surgical cardiac patients. Background The cardiothoracic and vascular intensive care unit (CVICU) at Auckland City Hospital began initiatives to increase our elective cardiac surgery cases, streamline patients’ journey and improve cardiac service delivery. This initiative led to the development and use of an enhanced recovery pathway for elective cardiac surgical patients. Design An observational study was conducted using quantitative methods. A sample of 83 postsurgical cardiac patients was recruited into the study. They were enrolled if they met the inclusion criteria for the warm wake and wean protocol. Patients were excluded if they returned to theatre, had cardiac tamponade or heat failure. The WWW protocol was applied to all patients recruited into the study. Demographic and postoperative data from the patients clinical bypass charts including sedation, extubation times were measured in hours. Postoperative complications following extubation were analysed in percentages and number of hours in ICU were also measured. Results The overall finding of this study showed that length of sedation time was strongly associated with length of intubation time and was a significant predictor of prolonged intubation time in this small size, single-centre observational study. When sedation time was reduced in CVICU, the study group showed an increased number of extubations within less than six hours. There were also minimal postoperative complications seen post cardiac surgery, but more significantly no complications seen in early extubated patients in this study group. Conclusion This research study concluded that WWW has suggested a promising approach to fast tracking this population group. Multi-centre research is needed to determine whether reducing sedation time in the intensive care unit can promote early extubation safely in a larger sample of patients following cardiac surgery.
