Survey of Patients Requiring Positive Pressure Ventilation – A Descriptive Study

Introduction/Background: Pursuant to a significant increase of patients who required overnight post-operative mechanical ventilation a post-procedural analysis was developed to identify the type patients who required ventilatory assistance. This was performed in an attempt to discover any precipitating factors leading to the steady increases, and determine the specific patient population and/or subgroup so these patients who are at greater risk could be identified in advance. This would then assist in forecasting staffing acuity and improving patient care with proactive management.

Methods: A survey was developed to track issues thought to contribute to the need for mechanical ventilation. 65 patients were analyzed this year. Patients age, primary diagnosis, secondary diagnosis, surgical procedure, blood loss, fluid replacement, Surgeon, Anesthesiologist, date of intubation, day of week, time admitted to PICU, date extubated, time of extubation, Physician who extubated, pulmonary history, post-operative complications and reason for ventilation were all recorded.

Results: It was discovered that the majority of patients were admitted into our PICU on Mondays. It was apparent that there was no significance between Anesthesiologists. However, in some instances overnight ventilation was required due to laryngeal swelling secondary to generous volume replacement perioperatively. Hemodynamics played an important role in 50% of the cases. Furthermore, there was no correlation between age, gender, Surgeon or Attending Physician. The biggest contributing factor was patients who had diagnoses relating to spinal deformities and henceforth received surgeries for correction. 47 of the patients had diagnosis relating the spinal deformities and 84% of the surgical procedures related to some type of spinal intervention. There are several types of procedures, which include anterior, posterior and combined spinal fusion. There was no major difference between these groups.

Conclusion: Analysis of this prospective study reveals that the largest percentage of our patients studied who required overnight ventilation was pursuant to spinal surgery and that ?generous? fluid administration further precipitated this necessity in nearly half of the cases studied. Additionally, most of our ventilator patients were received early in the week (Mondays and Tuesdays) and from this discovery a system to provide ?on-call? Respiratory Care was established to ?cover? the night shifts on these particular days and cases. This has resulted in a more cost-effective method of providing Respiratory Care, as well as improving the quality, safety and dimension of care and customer satisfaction. Furthermore, closer attention is being placed on pre-operative pulmonary screening and patient education as well as aggressive follow-up on these patients? pulmonary mechanics post-operatively. This has also improved patient
outcomes and will hopefully shorten the length of stay.