Immediately after undergoing open-heart surgery, patients are brought to our intensive care unit (ICU) intubated and anesthetized, receiving propofol, with routine orders to wean and extubate under physician-specified parameters. It is primarily the responsibilit y of bedside registered nurses (RNs) to judge sedation level and turn off the propofol. When the patient meets parameters as measured by arterial blood gas values, the RN and the respiratory therapy staff determine whether the patient can be safely extubated.

In 2001, our nurses recovered 1300 open-heart surgery patients in our 22-bed cardiac ICU. Our unit’s mean extubation time was 12.5 hours after surgery, significantly higher than the national mean number of hours. The goal of our practice issue was to reduce the amount of mean extubation time in our unit. Prolonged intubation increases a patient’s risk of ventilator-associated complications and delays the recovery and rehabilitation process.

Nurses from our ICU who attended the...

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