Relationship Between ICU Nurses’ Working Shifts and the Time of Endotracheal Extubation After Cardiac Surgery

Document Type : Original Article

Authors

1 Nursing Care Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: The aim of this study was to determine the relationship between nurses’ work shifts in the intensive care unit (ICU) and the time of endotracheal extubation after cardiac surgery.
Methods: The present study enrolled 210 patients that underwent cardiac surgery in a university referral cardiovascular center in 2018. Samples were selected via the convenience sampling method from adult patients that underwent elective cardiac surgery. The study samples were divided into 3 groups based on their admission time in the ICU: before 2 pm (morning shift), between 2 and 7 pm (evening shift), and after 7 pm (night shift). The patients’ demographic characteristics, risk factors, and intraoperative and postoperative clinical variables were collected. Information regarding the time of admission into the ICU, the time of readiness for extubation, and the actual time of extubation was recorded. Finally, these times were compared between the patients admitted into ICU in the 3 abovementioned work shifts.
Results: The study population was comprised of 210 patients, 142 (67.6%) male and 68 (32.4%) female, at an average age of 55 years old (44–63). According to the findings, tracheal extubation was usually performed in the work shift after the patients’ admission time. There was a significant difference between the time of readiness for extubation and the actual time of tracheal tube removal on the different shifts, with the time being about 1 hour longer on the night shift than on the evening or morning shift (P < 0.05).
Conclusions: Our cardiac surgery patients who were admitted into the ICU on the morning and evening shifts were ready for extubation earlier than those admitted on the night shift. (Iranian Heart Journal 2020; 21(2): 34-40)

Keywords


1. Bansal S, Thai H, Hsu C, Sai-Sudhakar C, Goldman S, Rhenman B. Fast track extubation post coronary artery bypass graft: a retrospective review of predictors of clinical outcomes. World Journal of Cardiovascular Surgery. 2013;3(02):81-6.
2. Berger AM, Hobbs BB. Impact of shift work on the health and safety of nurses and patients. Clinical journal of oncology nursing. 2006;10(4):465-71.
3. College of Intensive Care Medicine of Australia and New Zealand. Minimum Standards for Intensive Care Unit: College of Intensive Care Medicine of Australia and New Zealand; 2011 [2018/11/018]. Available from: https://www.cicm.org.au/.../IC-1-Minimum-Standards-for-Intensive-Care-Units.pdf.
4. Durie M, Darvall J, Rechnitzer T, Tacey M. Impact of increasing overnight intensive care unit registrar staffing on duration of intubation of elective cardiac surgery patients. Anaesthesia & Intensive Care. 2015;43(5):600-7.
5. Ebrahimian A. [Accuracy in night work nurses]. Payesh. 2006;5(2):123-30.
6. Faghani H, Mosavinasab N, Gholipour Baradari A, Moosazadeh M, Kheradmand M, Esmaeili R. [Duration of Intubation after Coronary Artery Bypass Graft Surgery and Its Related Factors]. Journal of Mazandaran University of Medical Sciences. 2017;26(146):68-79.
7. Hansen BS, Fjaelberg WTM, Nilsen OB, Lossius HM, Søreide E. Mechanical ventilation in the ICU -is there a gap between the time available and time used for nurse-led weaning? Scandinavian journal of trauma, resuscitation and emergency medicine. 2008;16:1-8. PubMed PMID: 19055712.
8. Jaber S, Jung B. Non-invasive ventilation failure rates during day and night shifts: is the night shift the dark side of the moon? Minerva anestesiologica. 2010;76(4):237.
9. Jafroudi S, Mehdizadeh Attar M, Farmanbar R, Kazemnejadleili E, Paryad E. [Predictors' issues of intubation time after coronary artery bypass graft surgery]. Journal of Holistic Nursing and Midwifery. 2015;24(4):20-9.
10. Karmarkar S, Varshney S. Tracheal extubation. Continuing Education in Anaesthesia Critical Care & Pain. 2008;8(6):214-20.
11. Kwon E, Choi K. Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation. Asian Nursing Research. 2017;11(1):74-8.
12. Nicholson D, Kowalski S, Hamilton G, Meyers M, Serrette C, Duke P. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: A comparison between short-term mechanical ventilation and early extubation. J Cardiothorac Vasc Anesth. 2002;16(1):27-31.
13. Ohida T, Kamal A, Sone T, Ishii T, Uchiyama M, Minowa M, et al. Night-shift
work related problems in young female nurses in Japan. Journal of occupational health. 2001;43(3):150-6.
14. Rezaianzadeh A, Maghsoudi B, Tabatabaee H, Keshavarzi S, Bagheri Z, Sajedianfard J, et al. Factors associated with extubation time in coronary artery bypass grafting patients. PeerJ. 2015;3:e1414.
15. Rogers AE, Hwang W-T, Scott LD, Aiken LH, Dinges DF. The working hours of hospital staff nurses and patient safety. Health affairs. 2004;23(4):202-12.
16. Salminen S. Shift Work and Extended Working Hours as Risk Factors for Occupational Injury. The Ergonomics Open Journal. 2010;3.
17. Tanaka K, Takahashi M, Hiro H, Kakinuma M, Tanaka M, Kamata N, et al. Differences in medical error risk among nurses working two-and three-shift systems at teaching hospitals: a six-month prospective study. Industrial health. 2010;48(3):357-64.
18. Thille AW, Cortés-Puch I, Esteban A. Weaning from the ventilator and extubation in ICU. Current Opinion in Critical Care. 2013;19(1):57-64.
19. Zakerian SA, Mosaferchi S, Sepidarkish M, Nasiri Z, Momenyan S, Mortezapour Soufiani A, et al. [The Role of Individual Effective Factors on Nurses' Job Performance. A Case Study: Selected Hospitals in Tehran]. Occupational Medicine Quarterly Journal. 2018;10(1):54-61.