Pro: early endotracheal extubation is preferable to late extubation in patients following coronary artery surgery.

Prolonged mechanical ventilation following CABG should not be uncritically considered "routine," and should only be used where indicated. A thorough physiologic and clinical evaluation with attention to hemodynamics, neurologic status, temperature and metabolism, hemostasis, and respiratory reserve should precede extubation. Continued post-operative ventilation is indicated in patients at high risk for complications, and it is possible to identify this subset preoperatively and upon arrival in the postoperative ICU. Early extubation (within 8 hours of arrival) should otherwise be the goal. The benefits of early extubation include improved cardiac function and patient comfort, reduction in respiratory complications, ease in management, and cost savings as the result of shortened length-of-stay in expensive postoperative units. More research is needed to clarify unanswered questions regarding ablating the stress response and avoiding myocardial ischemia.