Criteria for early extubation after intracardiac surgery in adults.
Of 142 adult patients undergoing open-heart surgery, 123 were extubated either in the operating room or within 3 hours after admission to the recovery room, to avoid the discomfort and risks of prolonged mechanical ventilation. The remaining 19 patients, who had impaired cardiac function, were mechanically ventilated for 1 to 7 days postoperatively. The most important criteria for cardiopulmonary malfunction indicating the need for continued mechnical ventilation were a low mixed venous O2 saturation (SVO2) of less than 60% and a high left atrial pressure (greater than 20 torr). Of the 123 patients, 118, had an uneventful postoperative recovery and 5 needed reintubation, 2 because of low SVO2 and 3 because of complications unrelated to respiratory management. Most adult patients can spontaneously breathe adequately immediately after or within 3 hours of completed open-heart surgery, but a thorough physiologic and clinical evaluation should precede extubation, to identify those who need prolonged mechanical ventilation in the postoperative phase. Criteria for selection of patients for early extubation are presented.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D006348:Cardiac Surgical Procedures; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D007440:Intubation; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011182:Postoperative Care; D012121:Respiration, Artificial
D002245:Carbon Dioxide; D010100:Oxygen