Respiratory outcomes with early extubation after coronary artery bypass surgery.
OBJECTIVE
Aortocoronary bypass surgery has undergone recent changes, promoting the concept of "fast tracking," in which patients are extubated and discharged postoperatively at an accelerated pace compared with previous historic patterns. Postoperative respiratory function and complications have not been previously studied in patients selected for "fast tracking."


METHODS
Matched retrospective cohort study.


METHODS
Referral university teaching hospital.


METHODS
Thirty-one patients who were compared with a retrospective matched cohort of 112 patients. Matching was based on forced vital capacity, age, and gender.


METHODS
Respiratory physiological outcomes defined as pneumonia, postoperative pulmonary spirometry, chest x-ray atelectasis or lobar collapse, and gas exchange were compared.


RESULTS
The increase in atelectasis score compared with preoperative (0 = no atelectasis, 4 = lobar collapse) was higher (p < 0.01) on the day of extubation in the late extubation group (4.1 +/- 1.4) compared with the early extubation group (2.6 +/- 1.3). These chest radiographic findings were not related to pain (0 to 10 visual analog scalei, which were equivalent between groups (4.0 +/- 2.3 v 4.2 +/- 1.6). The decreases in spirometry on postoperative day 5 (FVC 1.15 +/- 0.42 v 0.86 +/- 0.54 liters; FEV1 0.92 +/- 0.38 v 0.59 +/- 0.50 liters) were greater (p < 0.001) in the late extubation group. A significantly (p < 0.001) greater decrease in FEV1/FVC ratio in the late extubation group (3.25 +/- 0.87 v -1.6 +/- 1.11%) was indicative of greater airway obstruction. Fluid balance until extubation was greater in the late extubation group (4.0 +/- 2.1 v 1.4 +/- 1.2 liters).


CONCLUSIONS
Differences in chest radiographs in the late extubation group at the time of extubation may be related to greater use of fluids or increased airway obstruction. The rationale of early extubation is based on cost minimization to decrease hospital duration. This article suggests that respiratory physiological outcomes are not worsened in patients who are extubated and discharged early after elective aortocoronary bypass surgery.
Johnson
D
D
College of Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Canada.
Thomson
D
D
Mycyk
T
T
Burbridge
B
B
Mayers
I
I
D000402:Airway Obstruction / Q000209:etiology; D016022:Case-Control Studies; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003363:Cost Control; D017558:Elective Surgical Procedures; D005260:Female; D005541:Forced Expiratory Volume; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000191:economics; D008297:Male; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000209:etiology; D010351:Patient Discharge; D011014:Pneumonia / Q000209:etiology; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology; D011659:Pulmonary Gas Exchange; D013902:Radiography, Thoracic; D012119:Respiration / Q000502:physiology*; D012189:Retrospective Studies; D013147:Spirometry; D014797:Vital Capacity; D014882:Water-Electrolyte Balance