title: Success and failure of fast track extubation in cardiac surgery patients of tertiary care hospital: one year audit.
abstract: OBJECTIVE
  To identify the causes of delayed extubation in patients planned for fast tract extubation during cardiac surgery.
  
  
  METHODS
  A prospective observational study was conducted at cardiothoracic unit of Aga Khan University Hospital for the period of one year. All elective coronary artery bypass graft (CABG) surgery patients, between the ages of 35-75 years with LVEF > or = 40 percent were included. Patients with Intra aortic balloon pump, chronic renal failure, respiratory compromise and requiring high ionotropic support were excluded from this audit. A performa was designed and later filled by the primary investigator. Patient demographics and various reasons for delayed extubation were noted in this proforma.
  
  
  RESULTS
  Total 614 patients underwent CABG surgery and 388 (63.19%) patients were planned for fast track extubation. A total of 196 (49.5%) patients could be extubated within six hours of arrival in the cardiac ICU. Common reasons for delayed extubation included deep sedation in 80 (46.5%), confusion 44 (25%), excessive bleeding in 20 (11.3%) and high inotropic support in 10 (5.68%).
  
  
  CONCLUSIONS
  Major contributing factors for delayed extubation were identified by this audit. These factors need to be targeted accordingly by modifications in intra operative management.
authors.affiliation: Cardio Thoracic Anaesthesia Department, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Mohammad Irfan
authors.initials: MI
authors.lastname: Akhtar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hamid
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010154:Pakistan; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000706:statistics & numerical data*