Early Extubation Wean Protocol Development in Cardiac Surgery with Expert Content Validation

Abstract

Background: Cardiothoracic surgery patients remain intubated while transferred to the intensive care unit where ventilator weaning is initiated post-operatively. Prolonged intubation times can lead to patient complications and increased costs for the healthcare system. Wean protocols can be implemented to decrease ventilator times and meet quality measures set by The Society of Thoracic Surgeons while improving patient outcomes. Purpose: To: (a) evaluate current guidelines, standards, and trends in care for ventilator weaning and early extubation protocols in cardiothoracic surgery; (b) develop an evidence-based extubation protocol for cardiothoracic surgery patients; and (c) obtain expert content validation of the extubation protocol. Goal: Development of a content validated, evidence-based, early extubation protocol. Methods: Development of evidenced-based early ventilator wean protocol with expert content validation utilizing a two-step content validation technique. This single-center project was conducted in a community medical center with an internal and external multidisciplinary panel of ten experts. Selection of the expert panel was based on area of expertise, publications, and positions held. The protocol was distributed to the panel as an electronic survey with a four-point Likert Scale assigned to content relevance and clarity. The collected data was analyzed for level of expert consensus using both item and scale content validity indexes with percentage of agreement ≥78% determining achieved consensus. Findings: All twenty-six items obtained item content validity. The instrument reached excellent scale-content validity index, scoring 1 when calculating average and universal agreement. Three items were revised based on comments from the expert panel. Keywords: cardiothoracic surgery, extubation, ventilator hours, length of stay, ICU hours, cardiac surgical procedures, heart surgery, airway extubation, mechanical ventilators, wean protocol, quality, outcomes, content validation, protocol development, evidence-based practiceD.N.P., Nursing Practice -- Drexel University, 201