Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation.
OBJECTIVE
To evaluate the effect of a short period of mechanical ventilation (3 hours) versus immediate extubation (within 1 hour of surgery) on pulmonary function, gas exchange, and pulmonary complications after coronary artery bypass graft (CABG) surgery.


METHODS
Prospective randomized study.


METHODS
University teaching hospital.


METHODS
Thirty-five patients undergoing CABG surgery.


METHODS
Patients were randomized into 2 groups. Patients in group I were extubated as soon as possible after surgery. Patients in group II were ventilated for a minimum of 3 hours after surgery. Patients in both groups were extubated only after achieving predetermined extubation criteria. Patients who did not meet the criteria for extubation within the predetermined set time limit (90 minutes in group I and 6 hours in group II) were withdrawn from the study. Pulmonary function tests (vital capacity, forced expiratory volume in 1 second, total lung capacity, functional residual capacity), arterial blood gases, and chest radiographs were done preoperatively and postoperatively. Pulmonary complications were recorded.


RESULTS
Demographic data were similar between groups. The mean time to extubation in group I was 45.7 plus minus 27.6 minutes and in group II was 201.4 plus minus 21 minutes (p < 0.01). Two patients in group I and 1 patient in group II did not meet the extubation criteria within the predetermined set time limit and were excluded from the study. In both groups, there was a significant decline in pulmonary function but no differences between groups at 24 or 72 hours after surgery. There were no differences between groups in blood gases, atelectasis scores, or pulmonary complications.


CONCLUSIONS
The data suggest that extending mechanical ventilation after CABG surgery does not affect pulmonary function. Provided that routine extubation criteria are met, patients can be safely extubated early (within 1 hour) after major cardiac surgery without concerns of further pulmonary derangement.
Nicholson
Donna J
DJ
Departments of Anesthesia, Cardiac Surgery, and Radiology, and Respiratory Investigation Unit, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada.
Kowalski
Stephen E
SE
Hamilton
G Andrew
GA
Meyers
Michael P
MP
Serrette
Carl
C
Duke
Peter C
PC
D000762:Anesthesia Recovery Period; D001026:Coronary Artery Bypass; D020878:Device Removal; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D015656:Respiratory Mechanics