Patients at risk of experiencing respiratory failure can be identified through post-extubation surveillance. The purpose of this study was to compare the re-intubation rate before and after an automated continuous monitoring alert was used to commence postextubation RT-driven therapy versus our conventional respiratory therapist (RT) assessment tool. From March 2020 to September 2021, adults who had been on mechanical ventilation for more than 24 hours and were scheduled for extubation in the intensive care unit participated in a randomized clinical trial. A conventional RT evaluation instrument or an automatic monitoring alert was used to determine whether or not the participants required RT-driven treatment after extubation. The primary outcome was the time to re-intubation for respiratory failure (72 hours). Secondary outcomes included RT time related to patient assessment and therapy provision, ICU cost, ICU duration of stay, hospital mortality, and ICU length. For the primary analysis, 32 of the 234 randomized individuals were removed because of RT-driven care disruptions during the COVID-19 surge, and one subject was removed because of a delay in the commencement of automated monitoring. Researchers compared 85 patients in the standard RT evaluation group with 116 patients in the automated monitoring alert group to see whether the group was more effective at initiating RT-driven therapy. The study groups did not differ between re-intubation rates, median hospital stays, mortality rates, and intensive care unit costs. Treatment and evaluation times for automated systems were both significantly shorter (P<.001) and more efficient (P=.031). Comparing the normal RT evaluation tool to an automated monitoring alert to commence postextubation RT-driven treatment, they found no significant differences in outcome or cost in participants who received mechanical ventilation for more than 24 h. Reduced RT wait times were achieved using an automated continuous monitoring alert to initiate RT-driven care.
Source: rc.rcjournal.com/content/67/10/1282
