title: Early tracheal extubation after on-pump coronary artery bypass grafting.
abstract: OBJECTIVE
  A fast-track recovery in cardiac surgery yields many benefits, and early tracheal extubation is important as the first step. The purpose of this study is to evaluate the status of early tracheal extubation after on-pump coronary artery bypass grafting (CABG) and to find key factors for successful early tracheal extubation.
  
  
  METHODS
  From September 1996 to February 2005, isolated on-pump CABG was performed on 485 patients, and an early tracheal extubation protocol was employed on all. It was defined as tracheal extubation within 6 hr of arrival in the intensive care unit (ICU).
  
  
  RESULTS
  An early tracheal extubation was successful on 450 patients (92.5%). Reintubation was necessary in 5 (1.1%) because of a resternotomy for bleeding in 3 and ventricular arrhythmia in 2. Mechanical ventilation exceeding 24 hours was required in 7 patients (1.4%) because of heart failure in 4 and respiratory failure in 3. Significant factors of successful early tracheal extubation were the European System for Cardiac Operative Risk Evaluation (P <0.05), the number of diseased arteries (P <0.01), ejection fraction (P <0.05), operation time (P <0.01), blood transfusion in ICU (P <0.05), and drainage in the first 12 hr (P <0.05).
  
  
  CONCLUSIONS
  Early tracheal extubation can be successfully performed in most patients receiving on-pump CABG. The management of higher-risk patients and efforts to reduce operation time and blood loss are keys to success for early tracheal extubation.
authors.affiliation: Nagasaki Kouseikai Hospital, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Sato
authors.forename: Etsuro
authors.initials: E
authors.lastname: Suenaga
authors.forename: Shugo
authors.initials: S
authors.lastname: Koga
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Matsuyama
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Fumie
authors.initials: F
authors.lastname: Maki
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D020127:Recovery of Function; D012086:Reoperation; D012121:Respiration, Artificial; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome