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Efficacy of a high‐observation protocol in major head and neck cancer surgery: A prospective study
Author(s) -
Barber Brittany,
Harris Jeffrey,
Shillington Cameron,
Rychlik Shan,
Dort Joseph,
Meier Michael,
Estey Angela,
Elwi Adam,
Wickson Patty,
Buss Michael,
Zygun David,
Ansari Kal,
Biron Vincent,
O'Connell Daniel,
Seikaly Hadi
Publication year - 2017
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24599
Subject(s) - medicine , head and neck cancer , limiting , intensive care unit , mechanical ventilation , sedation , prospective cohort study , cohort , head and neck , weaning , cohort study , emergency medicine , surgery , anesthesia , intensive care medicine , radiation therapy , mechanical engineering , engineering
Background The purpose of this study was to optimize an existing clinical care pathway (CCP) for head and neck cancer with a high‐observation protocol (HOP) and to determine the effect on length of intensive care unit (ICU) admission and length of stay in hospital (LOS). Methods The HOP mandated initiation of spontaneous breathing trials before the conclusion of the surgery, weaning of sedation, and limiting mechanical ventilation. All patients with head and neck cancer undergoing primary surgery on the HOP were compared to a historical cohort regarding length of ICU admission, ICU readmissions, and LOS. Results Ninety‐six and 52 patients were observed in “historical” and “HOP” cohorts. The length of ICU admission (1.9 vs 1.2 days; p = .021), LOS (20.3 vs 14.1 days; p = .020), and ICU readmissions (10.4% vs 1.9%; p = .013) were significantly decreased in the “HOP” cohort. Conclusion Rapid weaning of sedation and limiting mechanical ventilation may contribute to a shorter length of ICU admission and LOS, as well as decreased ICU readmissions. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1689–1695, 2016