Early vs conventional extubation after cardiac surgery with cardiopulmonary bypass

被引:78
作者
Reyes, A
Vega, G
Blancas, R
Morato, B
Moreno, JL
Torrecilla, C
Cereijo, E
机构
[1] Intensive Care Unit, Hospital de la Princesa, Universidad Autónoma, Madrid
[2] Unidad de Cuidados Intensivos, Hosp. Universitario de la Princeta, 28006 Madrid, Diego de León
关键词
cardiopulmonary bypass; early extubation; extracorporeal circulation; health resources; heart surgery; intensive care; intratracheal intubation; postoperative care; postoperative complications;
D O I
10.1378/chest.112.1.193
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: Sedation and ventilation overnight after cardiac surgery is common practice, However, early extubation may be feasible with no increase in postoperative complications. This study examines (1) if early extubation is possible in a significant number of patients, (2) if it reduces ICU stay, and (3) if this practice increases postoperative complications. Design: Prospective, controlled, randomized clinical trial. Patients and methods: We randomized 404 consecutive patients to earl, extubation (7 to 11 h postoperatively) (group A, 201 patients) or conventional extubation (between 8 and 12 AM the following day) (group B, 203 patients), Variables included type and severity of the disease, surgical risk, type of operation, operative incidences, postoperative complications, duration of mechanical ventilation, intubation and ICU stay, bleeding, reoperation, vasoactive drugs, and mortality. Results: Groups were comparable. Extubation within the preestablished time was successful in 60.2% of patients in group A and 74.4% in group B. Median ICU stay was 27 h in group A and 44 h in group B (p=0.008), Discharge from ICU within the first 24 h postoperatively was 44.3% in group A and 30.5% in group B (p=0.006). There was no significant difference in complications between groups. Successfully extubated patients in group A had more reintubation and prolonged ventilation than in group B. Conclusions: (1) Sixty percent of our patients were extubated nithin 11 h of operation, (2) As a result, the length of stay in ICU was reduced and the percentage of patients discharged within 24 h was increased, (3) There was no increase in clinically important postoperative complications.
引用
收藏
页码:193 / 201
页数:9
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