title: Rapid awakening protocol in complex head and neck reconstruction.
abstract: BACKGROUND
  Patients undergoing complex head and neck free flap reconstructions are commonly maintained on mechanical ventilation in an intensive care unit (ICU). This study reviews indications and outcomes of such patients undergoing a rapid awakening protocol (RAP).
  
  
  METHODS
  We retrospectively reviewed consecutive patients who underwent head and neck microvascular reconstructions by a single surgeon between 2001 and 2013.
  
  
  RESULTS
  Seventy-five patients underwent RAP and 605 received mechanical ventilation. Overall complications were significantly higher in mechanical ventilation patients than in the RAP cohort (61% vs 31%, respectively; p < .001). Univariate analysis demonstrates mechanical ventilation, age, and aerodigestive tract involvement are significant risk factors for a complication and longer hospital stay. Multivariate logistic regression model demonstrates RAP patients had significantly less risk of a complication (odds ratio [OR] = 0.32; 95% [CI] = 0.19-0.54; p < .001).
  
  
  CONCLUSIONS
  The recovery of select patients with early extubation/spontaneous breathing is superior to maintenance on mechanical ventilation.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
authors.forename: Summer E
authors.initials: SE
authors.lastname: Hanson
authors.forename: Samir
authors.initials: S
authors.lastname: Rao
authors.forename: Angela
authors.initials: A
authors.lastname: Truong
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002985:Clinical Protocols; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015300:Ventilator Weaning; D055815:Young Adult
keywords: free flaps; head and neck reconstruction; length of stay; mechanical ventilation; rapid awakening protocol