Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery

• Authors: William Mahle, Emory University; Susan C. Nicolson, Childrens Hospital of Philadelphia; Danielle Hollenbeck-Pringle, New England Research Institutes; Michael G. Gaies, University of Michigan; Madolin K. Witte, University of Utah; Eva K. Lee, Georgia Institute of Technology; Michelle Goldsworthy, Baylor College of Medicine; Paul C. Stark, New England Research Institutes; Kristin M. Burns, National Heart, Lung, and Blood Institute; Mark A. Scheurer, Medical University of South Carolina; David S. Cooper, Cincinnati Children’s Hospital; Ravi Thiagarajan, Boston Children’s Hospital; V. Ben Ben Sivarajan, Hospital for Sick Children; Steven D. Colan, Boston Children’s Hospital; Marcus S. Schamberger, Riley Children’s Hospital; Lara S. Shekerdemian, Baylor College of Medicine
• Journal Title: Pediatric Critical Care Medicine
• Volume: Volume 17, Number 10
• Publisher: Lippincott, Williams & Wilkins | 2016-10, Pages 939-947
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/PCC.0000000000000918
• Subjects: Health Sciences, Medicine and Surgery; Education, Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Critical Care Medicine; Pediatrics; General & Internal Medicine; mechanical ventilation; outcomes; tetralogy of Fallot; CARDIAC-SURGERY; OPERATING-ROOM; CHILDREN

Abstract

Objective: To determine whether a collaborative learning strategy-derived clinical practice guideline can reduce the duration of endotracheal intubation following infant heart surgery. Design: Prospective and retrospective data collected from the Pediatric Heart Network in the 12 months pre- and post-clinical practice guideline implementation at the four sites participating in the collaborative (active sites) compared with data from five Pediatric Heart Network centers not participating in collaborative learning (control sites). Setting: Ten children's hospitals. Patients: Data were collected for infants following two-index operations: 1) repair of isolated coarctation of the aorta (birth to 365 d) and 2) repair of tetralogy of Fallot (29-365 d). There were 240 subjects eligible for the clinical practice guideline at active sites and 259 subjects at control sites. Interventions: Development and application of early extubation clinical practice guideline. Measurements and Main Results: After clinical practice guideline implementation, the rate of early extubation at active sites increased significantly from 11.7% to 66.9% (p < 0.001) with no increase in reintubation rate. The median duration of postoperative intubation among active sites decreased from 21.2 to 4.5 hours (p < 0.001). No statistically significant change in early extubation rates was found in the control sites 11.7% to 13.7% (p = 0.63). At active sites, clinical practice guideline implementation had no statistically significant impact on median ICU length of stay (71.9 hr pre- vs 69.2 hr postimplementation; p = 0.29) for the entire cohort. There was a trend toward shorter ICU length of stay in the tetralogy of Fallot subgroup (71.6 hr pre- vs 54.2 hr postimplementation, p = 0.068). Conclusions: A collaborative learning strategy designed clinical practice guideline significantly increased the rate of early extubation with no change in the rate of reintubation. The early extubation clinical practice guideline did not significantly change postoperative ICU length of stay.