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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2006 February;19(1):13-8
Factors affecting time of extubation in cardiac surgery patients
Bitzikas G. 1, Tsakiridis K. 1, Konstantinou F. 1, Vretzakis G. 1, 2, Tripsianis G. 2, 3, Bougioukas G. 1
1 Department of Cardio-Thoracic Surgery Democritus University of Thrace, Greece
2 Department of Anesthesiology Democritus University of Thrace, Greece
3 Department of Statistics Democritus University of Thrace, Greece
Aim. The aim of the study was to evaluate early extubation, <8h from Intensive Care Unit admission, in adult patients undergoing cardiac surgery, and to determine prognostic factors of prolonged mechanical ventilation.
Methods. From an initial group of 146 patients undergoing cardiac surgery under cardiopulmonary bypass and an appropriate anesthetic protocol for early extubation, 109 were successful in early extubation while 37 required prolonged mechanical ventilation. These 37 patients were retrospectively compared to a similar group from the early extubation pool, matched for the next ID number. Twenty-two preoperative and perioperative variables were evaluated using univariate and multivariate analysis, in order to determine prognostic factors of prolonged ventilation. Detection of need for C-PAP mask support, need for re-intubation, time of ICU stay and measurement of blood gasses were evaluated post extubation.
Results. Prognostic factors for failure of early extubation included: EF (p=0.027), CPB time (p=0.002), aortic cross clamp time (p=0.047), fluid balance during CPB (p=0.016), fluid balance during the first 8 hours of ICU stay (p=0.017), LCOS (p=0.012) and use of IABP (p=0.025). Multiple logistic regression analysis showed that independent prognostic factors for prolonged mechanical ventilation were EF (p=0.017), CPB time (p=0.018) and fluid balance during CPB (p=0.043). The two groups of patients had a similar post extubation recovery. Mean ICU stay was 1.30±0.66 and 3.46±1.77 days for patients with early and late extubation respectively.
Conclusions. Early extubation is safe and feasible in cardiac surgery patients. It significantly minimizes ICU stay time, and thus lowers hospitalization costs. Intraoperative and postoperative fluid balance is the most modifiable between the prognostic factors for prolonged mechanical ventilation, and its precise management is probably another important factor to consider in accomplishing early extubation in a greater number of patients.