​A standardized practice model reduced intensive care unit (ICU) length of stay and time spent on ventilators among cardiac surgery patients in a large hospital-based practice, according to a study in the December 2014 Annals of Surgery. The study compared the care of 769 patients undergoing a variety of cardiac surgeries (coronary artery bypass grafting, valve surgery, and combined procedures) using a standardized ventilation protocol in 2012 to patients undergoing identical procedures in 2008 without the protocol. When patients arrived in the ICU after one of the selected surgeries, providers were prompted by the electronic health information system to regularly assess a number of signs to determine if patients were ready to wean from mechanical ventilation. Those indicators were physiologic (e.g., cardiac index, blood pressure, heart rate/rhythm, temperature, urine output), neurologic (e.g., anesthetic recovery, residual neuromuscular blockade, comfort), and hemostatic (e.g., hemoglobin, coagulation status, chest tube drainage). When these criteria were met, providers began weaning patients from ventilators, again using a standardized protocol for assessing readiness to extubate and initiating postextubation care. The practice used the protocol on more than 50% of all cardiac surgery patients in 2012, of whom the study group was a subset. Compared with the 2008 patients, the 2012 patients spent less time in the ICU (22.5 versus 26.3 hours) and received less mechanical ventilation (6.3 versus 9.3 hours). Other quality measures, such as the need for reintubation and readmission to the ICU, did not change between the two groups.

HRC Recommends: Mechanical ventilation of patients can be associated with a host of issues, including ventilator disconnections, physical injuries from the tubes themselves, and ventilator-associated pneumonia and other healthcare-associated infections. Standardized protocols, such as the one described here, and "bundles" of care interventions have been shown to reduce ventilation time and associated adverse outcomes. Critical care staff should be familiar with processes and protocols in place at their organizations, and the effects of these protocols should be tracked over time to determine their effectiveness.