9 APRIL - JUNE 2023ELDERCARE REVIEWadmission and 12 hours later, which can be time-consuming. Another drawback is if a patient's status changes due to the accumulation of secretions or periodic sedation, they would need to be scored again to recognize a clinical change. To solve these issues, we collected data to identify predictors of extubation failure with the hope of automating an alert to help clinicians identify patients at risk. We found that APACHE II scores greater than 12 on extubation day, the presence of 3 or more of the high factors stated above, and an integrated pulmonary index (IPI) decreasing by 1 from baseline within one hour of extubation were predictive of extubation failure. IPI is a commercially available fuzzy logic monitoring software that uses end-tidal carbon dioxide, respiratory rate, heart rate, and oxygen saturation to provide a score of 1 to 10. While it has been reported that an IPI of 4 or less requires immediate intervention, we found that a decreasing change in IPI compared to baseline is a better predictor of extubation failure. Knowing this and IPI being automatically recorded into the electronic medical record, an alert was created to send a page to a respiratory therapist when IPI decreased by one. To test if this automated continuous monitoring to initiate the RAAT was as effective as the respiratory therapists scoring the RAAT tool on admission and 12-hour later, a randomized controlled trial was conducted. The groups had no significant differences in reintubation rate, length of stay, or intensive care costs. However, respiratory therapists' time spent with the patient was significantly less in the automated continuous monitoring group. Since the actual difference in reintubation rate between the groups was less than used to estimate the sample size, a larger randomized trial is needed to detect a significant difference.For IPI to work, patients must tolerate wearing a nasal cannula that has a scope in front of their lip. Post extubated patients with some sedation tolerate it while other intensive care patients or patients on the ward may not. We are currently assessing other predictors of extubation or respiratory failure that can be automated to send alerts to respiratory therapists. Once identified, randomized control trials will be needed to determine their efficacy in the clinical setting. IPI is a commercially available fuzzy logic monitoring software that uses end-tidal carbon dioxide, respiratory rate, heart rate, and oxygen saturation to provide a score of 1 to 10
< Page 8 | Page 10 >