Reducing intensive care unit costs by re-engineering respiratory support for the extubated trauma patient

Introduction: To implement a cost effective practice strategy for intensive care unit trauma patients by Himinaring the routine use of post-cxtubation supplemental oxygen, and by utilizing noninvasive ventilatory support to manage postextubation hypoxemia. Methods: 536 trauma patients were prospectively evaluated over a period of 11 months. All patients were ventilated using pressure support ventilation as the primary ventilatory support combined with positive end expiratory pressure. Patients were extubated to room air after meeting a 20 minute room air continuous positive airway pressure (CPAP) pre-extubation criteria. Patients who were reintubated all ailed within the first 72 hours. The sub-group of patients who became hypoxic on room air, within 24 hours post-extubation, were "Vidged" using CPAP or bi-level positive airway pressure (BiPAP) mask therapy for up to 48 hours. Patients who failed therapy were intubated. RenJts: 451 of 536 patients were successfully extubated to room air. 72 patients became hypoxic within 24 hours post-extubation requiring CPAP/BiPAP therapy, 52 were successfully treated, with treatment lasting an average of 2 days. 20 patients failed therapy and were reintubated for an average of 4 days. Another 13 patients were reintubated for other reasons. The overall reintubatioo rate was 6.2%; that for hypoxemia is 3.7%. Eliminating the use of supplemental oxygen via nasal cannula resulted in a direct cost savings of S50.006.88 for 4SI patients per day. Moreover, the 52 patients who were spared reintubatioo provided a direct cost savings of $19,740.24 in ventilator day per patient Concloskm: The clinical practice of eliminating the routine use of supplemental oxygen for the newly extubated trauma ICU patient reduces ICU costs. CPAP/BiPAP can be used effectively to prevent reintubation and promote a more aggressive strategy for the management of the hypoxic post-extubated patient which reduces unnecessary ventilator days and ancillary staff need allowing for further reduction in ICU costs.