Early vs conventional extubation after cardiac surgery with cardiopulmonary bypass.
OBJECTIVE
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.


METHODS
Prospective, controlled, randomized clinical trial.


METHODS
We randomized 404 consecutive patients to early 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 within 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.
Reyes
A
A
Intensive Care Unit, Hospital de la Princesa, Universidad Autónoma, Madrid, Spain.
Vega
G
G
Blancas
R
R
Morató
B
B
Moreno
J L
JL
Torrecilla
C
C
Cereijo
E
E
D018806:APACHE; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D015300:Ventilator Weaning / Q000379:methods