PATRONuS: Predicting eArly exTubation after ROutiNe cardiac Surgery

Abstract

Aim The aim of this study was to discover the number of children who were meeting the target time for extubation on a nurse led early extubation pathway, and to identify variables of influence in the early extubation process that may predict success or failure to meet this target. Background Early extubation rationalises economic and human resources by facilitating early discharge from PICU and potentially hospital. As a result of short ventilation times there is a reduction in clinical risk for children, by use of less sedative and as a result less inotrope. A nurse led early extubation pathway has been in place at Starship Children’s Hospital for 2 years. It is a multidisciplinary approach that places the child at the centre of the process to enhance the patient journey. Study Design The study was a quantitative, descriptive, observational study in a single centre. Sixty-­‐ nine children allocated to the nurse led early extubation pathway were recruited using convenience sampling. Demographic data was collected and nurse participants completed a self-­‐report form about the process. Results Fifty-­‐five per cent of the sample met the allocated target time and 80% of children were extubated by six hours following return from theatre. Children under one year of age consistently didn’t meet the target time and Pacific Island children showed disproportionate representation in the sample. The Pacific Island children met the target time (p = 0.03) and were older (mean 51 months) which proved a significant factor (p = 0.001). The primary reason that extubation was delayed was ‘too sleepy’ but this did not prolong ventilation time for more than 2 hours. Ventilation was prolonged due to pulmonary hypertension and non-­‐specific clinical concern. Conclusion The study concluded that meeting the target time for early extubation is not paramount but achieving short ventilation times and reducing the clinical risk to children is possible using a nurse-­‐led pathway. Theatre scheduling should target longer complex cases in the morning and shorter more simple cases in the afternoon to maximise the potential benefit. Further study may identify that reducing ventilation time leads to early discharge from PICU and even hospital.