Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-12-2023

Graduate Advisor

Vanessa Loyd- College of Nursing

Committee

Dr. Vanessa Loyd, PhD, DNP, RN

Dr. Elise Schaller DNP, MHA, APRN, CPNP-AC

Dr. Jessica Mann. DNP, CPNP-AC

Abstract

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample to include children aged neonate to 18 years of age admitted to the pediatric cardiac ICU who were mechanically ventilated with non-cyanotic single ventricle heart defects. Data collected from Oct 2022-May 2023 and included cardiac defect/admission diagnosis, ERTs used, number of extubation failures, and length of intubation.

Results: A (N=77) patients met criteria for an ERT to be administered during the data collection period. Pre implementation (Oct 22-Dec 22) of ERT a (n=40) and post implementation (Feb 23-May 23) (n=37) met criteria for an ERT to be administered. In the post implementation (n=37; 100%) had an ERT performed. There was a (n=2; 5%) extubation failure rate pre-implementation and (n=0; 0%) extubation failures in the post implementation group.

Implications for Practice: ERTs should be used in the cardiac ICU to prevent extubation failure, potentially decrease length of mechanical ventilation, and aide clinicians in identifying patients ready for liberation from mechanical ventilation earlier.

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