Effects of advanced practice nurse-driven sedation weaning and early extubation after cardiac surgery amid health care disruption in South Korea

ABSTRACT Background: Cardiovascular disease has reached unprecedented levels, leading to a substantial increases in the number of cardiac surgeries. Despite the life-saving efforts of surgery, complications remain, including pulmonary complications, which can lead to death. To mitigate these complications, early extubation has emerged as an evidence-based practice for patients undergoing cardiac surgery. The physician shortages that occurred after the mass resignation of physician trainees in South Korea disrupted postoperative care provided in intensive care units (ICU) and impeded early extubation. Our institution accordingly expanded the advanced practice nurses' (APNs) scope of practice to include performing extubation when deemed clinically appropriate after cardiac surgery. This practice change led APNs to develop and implement a sedation weaning and early extubation protocol. Purpose: To evaluate the effects of an APN-driven protocol implemented in the cardiac ICU. Methodology: This retrospective study compared two group outcomes: preimplementation and postimplementation groups. Results: This study revealed differences in health outcomes between the two groups of patients. Beneficial health outcomes were achieved due to this protocol in the opioid use and ventilator time of patients with low grade of heart failure in the postprotocol group, which were 16.7% lesser and 17.0% shorter than those in the preprotocol group. Conclusion: This APN-driven protocol proves its effectiveness without causing compromised health outcomes during a health care crisis in South Korea. Implications: This protocol incorporating nursing staff autonomy for both sedation and extubation can be implemented and tested for its usefulness for instances where gaps of care occur such as during physician shortages.