title: Factors which predict safe extubation in the operating room following cardiac surgery.
abstract: BACKGROUND
  Extubation in the operating room (OR) after cardiac surgery is hampered by safety concerns, psychological reluctance, and uncertain economic benefit. We have studied the factors affecting the feasibility of extubation in the OR after cardiac surgery and its safety.
  
  
  METHODS
  The outcomes of 78 patients extubated in the OR after open heart surgery were retrospectively compared to a matched control group of 80 patients with similar demographics, co-morbidities, and operative procedures, that were performed over the same time period, but extubated in the intensive care unit (ICU) following a standard weaning protocol. Variables collected included the incidence of subsequent unplanned tracheal reintubation in the ICU, postoperative complications, need for mediastinal re-exploration, surgical and OR times, and ICU and hospital lengths of stay.
  
  
  RESULTS
  Out of a total of 372 cardiac procedures performed during the designated time frame, 78 (21%) resulted in extubation in the OR, mostly after off-pump coronary revascularization (41%) and aortic valve replacement (19.4%). Preoperative hypertension, EF ≥30%, off-bypass revascularization and shorter surgical times increased the likelihood of extubation in the OR. Extubation in the OR did not increase perioperative morbidity and mortality rates, but decreased the length of ICU and hospital stays. The incidence of unanticipated subsequent tracheal intubation in the ICU was comparable to noncardiac high-risk procedures (2.5%).
  
  
  CONCLUSIONS
  Extubation in the OR can be safely performed in a select group of cardiac surgery patients without any increase in postoperative morbidity or mortality. The proposed mathematical model performed reasonably well in predicting a successful extubation in the OR.
authors.affiliation: Department of Anesthesiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA.
authors.forename: Yiliam F
authors.initials: YF
authors.lastname: Rodriguez Blanco
authors.forename: Keith
authors.initials: K
authors.lastname: Candiotti
authors.forename: Angela
authors.initials: A
authors.lastname: Gologorsky
authors.forename: Fei
authors.initials: F
authors.lastname: Tang
authors.forename: Jadelis
authors.initials: J
authors.lastname: Giquel
authors.forename: Michael E
authors.initials: ME
authors.lastname: Barron
authors.forename: Tomas A
authors.initials: TA
authors.lastname: Salerno
authors.forename: Edward
authors.initials: E
authors.lastname: Gologorsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies