Aggressive Weaning in Cardiac Surgical Patients

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Abstract
Nursing management of cardiac surgical patients has changed dramatically over the last several years. The need for cost-effective care with quality patient outcomes has forced critical care nurses to re-evaluate the standard of practice for postoperative cardiac patients. The authors describe the implementation of a fast-track weaning program giving critical care nurses more responsibility for weaning decisions and choice of sedative agent. Our experience in a six-bed Cardiothoracic Recovery Unit (CRU) in a midwestern community hospital evolved from receiving heavily anesthetized patients, continuing sedation postoperatively and prolonged intubation to minimal pharmacologic intervention with propofol and early extubation. In the fast-track weaning protocol, the nurses were given more authority to make critical decisions during the weaning process. This article describes the transition from the traditional time-based weaning system to the fast-track system where individual weaning progress is monitored by the critical care nurses.

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