Introduction: Fast-track extubation following cardiothoracic surgery is essential in recovery with benefits including shorter ICU stays. Previously, patients were extubated with physician approval that often resulted in delays. However, evidence suggests that empowering critical care nurses through a nurse-driven extubation protocol may increase extubations. This allows trained nurses to extubate patients within predefined parameters. This study aims to evaluate the impact of implementing a nurse-driven extubation protocol in a CVICU setting by comparing rates of successful fast-track extubation and ICU length of stay before and after the nurse-driven protocol.
Methods: This is an implementation study that was conducted in a CVICU at a quaternary care facility in the Chicago suburbs. The objective was to evaluate the effectiveness of a nurse-driven extubation protocol by comparing outcomes before and after its implementation. The study was twelve months, divided into two consecutive six-month periods. During the first six months, patients underwent extubation according to a physician-driven protocol. During the second six months period, a nurse-driven extubation protocol was implemented. Under this new protocol, trained ICU nurses were authorized to assess extubation readiness and initiate extubation based on predetermined clinical criteria. The primary outcome measured was the rate of successful fast-track extubation within 6 hours. The secondary outcome was ICU length of stay (LOS), measured in hours.
Results: During the physician-driven protocol phase, the rate of successful fast-track extubation was 51.56%, with an average ICU length of stay (LOS) of 97.2 hours.Post implementation of the nurse-driven extubation protocol, the rate of successful fast-track extubation increased to 81.86%, while the average ICU LOS decreased to 67.08 hours. In comparison, there was a 30.3 percentage point increase in fast-track extubation success and a 30.12-hour reduction in ICU length of stay.
Conclusions: The implementation of a nurse-driven extubation protocol in the CVICU significantly improved the rate of successful fast-track extubation and reduced ICU length of stay. This suggests that incorporating nurse-led protocols is an effective strategy to improve postoperative care following cardiothoracic surgery.
