1. MCSQI Reasons for Prolonged Ventilation: N = 239
STS Data Managers & Surgeons Enhancing Quality Measurement:
Statewide Review of Reasons for Prolonged Ventilation
Diane Alejo, Jennifer Bobbitt, Filiz Costantini, Diane Sender, Mary Brogan, Karen Getson, Angela Toro, Heather Romine,
Gail Hanna, Martha Kakellos, Dawn Roach, Kim Behrens, Clifford Fonner, and the MCSQI Collaborative
Background
The Maryland Cardiac Surgery Quality Initiative (MCSQI) is a statewide consortium of all 10 cardiac programs in Maryland. The Quality Committee reviewed the state’s Society of Thoracic Surgeons (STS) prolonged ventilation rates, as the duration of postoperative ventilation is associated with a greater risk of pneumonia, increased ICU/hospital stay, and increased hospital costs. The committee reviewed statewide extubation protocols, and sites reported reasons why patients were on the ventilator longer than 24 hours.
Results
Reasons for prolonged ventilation were recorded in a subset of 239 patients. Early results indicate that the “Hemodynamic Instability (2+ Drips) and/or Cardiac Arrest” category was the underlying reason for prolonged ventilation in 43% of cases.
MCSQI Reasons for Prolonged Ventilation: N = 239
Hemodynamics Unstable (2+ Drips) / Cardiac Arrest
43.1%
Re-Operation / Bleeding
13.2%
Hypoxia / Hypercarbia / Mechanics
12.8%
Re-Intubation
9.8%
Delirium; Mental Status / Neurological Reasons
7.5%
Open Chest
5.4%
Other
8.2%
Methods
MCSQI reviewed STS outcome measures in patients with prolonged ventilation. Member sites recorded prolonged ventilation reasons for Isolated Coronary Artery Bypass Grafting (CABG) and Isolated Aortic Valve Replacement (AVR) procedures and submitted these to the MCSQI Quality Committee. Upon review of the ten potential reasons for prolonged ventilation, a statewide consensus of seven classifications was defined and adopted. With the support of the surgeon community and engaging the Cardiovascular Intensive Care Unit (CVICU) staff to educate and implement the classification system, data managers prospectively collected reasons for prolonged ventilation and reported these to MCSQI.
Conclusion
Identifying reasons for prolonged ventilation may provide insight into goal-directed ICU management strategies. Sharing data with surgeons, intensivists, anesthesiologists, nurse practitioners, physician assistants, respiratory therapists and the nursing team in the CVICU has enhanced coordination of post-operative extubation management. Quality improvement is moving forward through the collaborative efforts of the cardiovascular team. MCSQI has successfully provided a foundation for hospitals in Maryland to share protocols and ICU care among its members.
“Working together to improve the quality of cardiac surgery in the state of Maryland”